Month: October 2012

Plasmonic ELISA for the ultrasensitive detection of disease biomarkers with the naked eye.

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In resource-constrained countries, affordable methodologies for the detection of disease biomarkers at ultralow concentrations can potentially improve the standard of living. However, current strategies for ultrasensitive detection often require sophisticated instruments that may not be available in laboratories with fewer resources. Here, we circumvent this problem by introducing a signal generation mechanism for biosensing that enables the detection of a few molecules of analyte with the naked eye. The enzyme label of an enzyme-linked immunosorbent assay (ELISA) controls the growth of gold nanoparticles and generates coloured solutions with distinct tonality when the analyte is present. Prostate specific antigen (PSA) and HIV-1 capsid antigen p24 were detected in whole serum at the ultralow concentration of 1 × 10−18 g ml−1. p24 was also detected with the naked eye in the sera of HIV-infected patients showing viral loads undetectable by a gold standard nucleic acid-based test.

Source:Nature.com

Consensus statement: CT colonography.

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Since its introduction (in 1994) , clinical implementation of computed tomography (CT) colonography has been governed by advances in CT technology, improvements in dedicated analysis software, development of patient preparation regimens and local diagnostic policies.

Objective   To update quality standards for CT colonography based on consensus among opinion leaders within the European Society of Gastrointestinal and Abdominal Radiology (ESGAR).
Material and methods   A multinational European panel of nine members of the ESGAR CT colonography Working Group (representing six EU countries) used a modified Delphi process to rate their level of agreement on a variety of statements pertaining to the acquisition, interpretation and implementation of CT colonography. Four Delphi rounds were conducted, each at 2 months interval.
Results   The panel elaborated 86 statements.
In the final round the panelists achieved complete consensus in 71 of 86 statements (82 %). Categories including the highest proportion of statements with excellent Cronbach’s internal reliability were colon distension, scan parameters, use of intravenous contrast agents, general guidelines on patient preparation, role of CAD and lesion measurement.
Lower internal reliability was achieved for the use of a rectal tube, spasmolytics, decubitus positioning and number of CT data acquisitions, faecal tagging, 2D vs. 3D reading, and reporting.
Conclusion   The recommendations of the consensus should be useful for both the radiologist who is starting a CTC service and for those who have already implemented the technique but whose practice may need updating.
Key Points   • Computed tomographic colonography is the optimal radiological method of assessing the colon • This article reviews ESGAR quality standards for CT colonography • This article is aimed to provide CT-colonography guidelines for practising radiologists • The recommendations should help radiologists who are starting/updating their CTC services

Emanuele Neri1, Steve Halligan2, Mikael Hellström3, Philippe Lefere4, Thomas Mang5, Daniele Regge6, Jaap Stoker7, Stuart Taylor8, Andrea Laghi9 and ESGAR CT Colonography Working Group10

1 Diagnostic and Interventional Radiology, University of Pisa, Pisa, Italy.
2 University College London, Centre for Medical Imaging, University College Hospital, London, UK.
3 Department of Radiology, Sahlgrenska University Hospital and Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden.
4 Virtual Colonoscopy Teaching Centre, Hooglede, Belgium.
5 Department of Radiology, Medical University of Vienna, Vienna, Austria.
6 Institute for Cancer Research and Treatment, Candiolo-Torino, Italy.
7 Department of Radiology, Academic Medical Center, University of Amsterdam, Amsterdam, NL, The Netherlands.
8 Department of Medical Imaging, University College London, London, UK.
9 Department of Radiological Sciences, Oncology and Pathology, Sapienza – Università di Roma, Rome, Italy.
10 Department of Translational Research, and Advanced Technologies in Medicine and Surgery, University of Pisa, Nuovo Ospedale S. Chiara, UO Radiodiagnostica 1, Via Paradisa 2, 56100 Pisa, Italy.

Source: http://www.getinsidehealth.com

Update on imaging role in diagnosing MS.

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(MS) is the most common disabling neurological disorder of young adults after trauma. Although the effect on mortality is limited, the association of a young demographic and significant morbidity combine to make MS a devastating disease. Since MS was given its first detailed description in 1868, diagnostic criteria continue to evolve. Recently, there has been an international commitment to combine both clinical and paraclinical tests to arrive at an earlier diagnosis. Widespread acceptance of the use of MRI in diagnosis, monitoring and research has made the role of the radiologist more critical than ever in this disease. The primary diagnostic criteria for MS are the International Panel criteria, commonly referred to as the McDonald criteria and it is essential that the radiology community is aware of the work preceding these criteria, so that they are understood in the correct context and the importance acknowledged.
Methods Literature review utilising key word search to obtain the historical and current context of magnetic resonance imaging in the diagnosis of MS.
Results A succinct description of the evolution of criteria for the diagnosis of MS.
Conclusions Radiologists must recognise that there are specific diagnostic criteria for MS that continue to evolve as a result of new research, improved technology and clinical experience and it is crucial that these criteria be applied in daily practice. It should be evident that diagnostic imaging criteria for MS will be most effective when combined with standardised MRI protocols such as those published by the international Consortium of Multiple Sclerosis Centres.

Lawrence Josey 1, Michael Curley 1, Foroogh Jafari Mousavi 1, Bruce V Taylor 3, Robyn Lucas 4, Alan Coulthard 1,2

1 Department of Medical Imaging Royal Brisbane and Womens Hospital Brisbane >Queensland> Australia
2 Academic Discipline of Medical Imaging University of Queensland Brisbane >Queensland> Australia
3 Menzies Research Institute Tasmania University of Tasmania Hobart >Tasmania> Australia
4 National Centre for Epidemiology and Population Health The Australian National University Canberra >Australian Capital Territory> Australia

Source: http://www.getinsidehealth.com

 

 

MRS versus DWI for diagnosing prostate cancer.

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Purpose To evaluate apparent diffusion coefficient (ADC) value, metabolic ratio ((Cho + Cr)/Cit) and the combination of the two in identifying prostate malignant regions.
Materials and Methods Fifty‐six consecutive patients with prostate biopsy results were retrospectively recruited in this study. Transrectal ultrasound‐guided (TRUS) systemic prostate biopsies were used as a standard of reference. Mean ADC value and mean metabolic ratio (MMR) were calculated within each benign sextant region or malignant region. The efficiency of these two indices in prostate cancer (PCa) diagnosis is estimated in Fisher linear discriminant analysis (FLDA). The area under the receiver operating characteristic (ROC) curve was used to evaluate the distinguishing capacity of mean ADC, MMR, and the combination of the two in differentiating between noncancerous and cancerous cases.
Results There were significant differences for mean ADC value and MMR between malignant and benign regions. Weights of mean ADC value obtained by FLDA were much higher than those of MMR. In differentiating malignant regions, both ADC alone and combined ADC and metabolic ratio performed significantly better than MMR alone. However, accuracy improvements were not significant by using combined ADC and MMR than ADC alone.
Conclusion DWI is more efficient than MR spectroscopic (MRS) in the detection of PCa in this study. Combined ADC and MMR performed significantly better than MMR alone in distinguishing malignant from benign region in prostate peripheral zone. J. Magn. Reson. Imaging 2012;. © 2012 Wiley Periodicals, Inc.

Bo Li MS 1, Wenchao Cai BS 2, Dongjiao Lv PhD 1, Xuemei Guo PhD 2, Xiaoying Wang PhD *,2,3, Jue Zhang PhD *,1,3, Jing Fang PhD 1,3

1 College of Engineering, Peking University, Beijing, China, People’s Republic of China
2 Department of Radiology, Peking University First Hospital, Beijing, China, People’s Republic of China
3 Academy for Advanced Interdisciplinary Studies, Peking University, Beijing, China, People’s Republic of China
*Correspondence: cjr.wangxiaoying@vip.163.com zhangjue@pku.edu.cn
College of Engineering, Peking University, Yiheyuan Road No. 5, Beijing, 100871, China
*Correspond

Source: http://www.getinsidehealth.com

 

 

 

Removing the Age Restrictions for Rotavirus Vaccination: A Benefit-Risk Modeling Analysis.

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To minimize potential risk of intussusception, the World Health Organization (WHO) recommended in 2009 that rotavirus immunization should be initiated by age 15 weeks and completed before 32 weeks. These restrictions could adversely impact vaccination coverage and thereby its health impact, particularly in developing countries where delays in vaccination often occur.

Methods and Findings

We conducted a modeling study to estimate the number of rotavirus deaths prevented and the number of intussusception deaths caused by vaccination when administered on the restricted schedule versus an unrestricted schedule whereby rotavirus vaccine would be administered with DTP vaccine up to age 3 years. Countries were grouped on the basis of child mortality rates, using WHO data. Inputs were estimates of WHO rotavirus mortality by week of age from a recent study, intussusception mortality based on a literature review, predicted vaccination rates by week of age from USAID Demographic and Health Surveys, the United Nations Children’s Fund (UNICEF) Multiple Indicator Cluster Surveys (MICS), and WHO-UNICEF 2010 country-specific coverage estimates, and published estimates of vaccine efficacy and vaccine-associated intussusception risk. On the basis of the error estimates and distributions for model inputs, we conducted 2,000 simulations to obtain median estimates of deaths averted and caused as well as the uncertainty ranges, defined as the 5th–95th percentile, to provide an indication of the uncertainty in the estimates.

We estimated that in low and low-middle income countries a restricted schedule would prevent 155,800 rotavirus deaths (5th–95th centiles, 83,300–217,700) while causing potentially 253 intussusception deaths (76–689). In contrast, vaccination without age restrictions would prevent 203,000 rotavirus deaths (102,000–281,500) while potentially causing 547 intussusception deaths (237–1,160). Thus, removing the age restrictions would avert an additional 47,200 rotavirus deaths (18,700–63,700) and cause an additional 294 (161–471) intussusception deaths, for an incremental benefit-risk ratio of 154 deaths averted for every death caused by vaccine. These extra deaths prevented under an unrestricted schedule reflect vaccination of an additional 21%–25% children, beyond the 63%–73% of the children who would be vaccinated under the restricted schedule. Importantly, these estimates err on the side of safety in that they assume high vaccine-associated risk of intussusception and do not account for potential herd immunity or non-fatal outcomes.

Conclusions

Our analysis suggests that in low- and middle-income countries the additional lives saved by removing age restrictions for rotavirus vaccination would far outnumber the potential excess vaccine-associated intussusception deaths.

Source: PLOS

Advances in breast cancer research

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To mark Breast Cancer Awareness Month, we review some of the many studies published in recent weeks, including research on the effects of screening and on the contributions of various imaging techniques to management of the disease.

Screening halves breast cancer mortality
Breast cancer screening is associated with an average 49% reduction in the risk of dying from the condition, according to the findings of a case-control study. Researchers in Melbourne, Australia, investigated the effects of taking part in the Western Australian population screening program, comparing 427 cases (women who died from breast cancer) with matched controls (up to 10 for each case).

The odds ratio for taking part in the program, in relation to breast cancer mortality, was 0.48 (95% confidence interval 0.38-0.59; p < 0.001), and the researchers said they were unable to find any biases that affected the significance of this finding. An accompanying meta-analysis of similar published case-control studies produced an odds ratio of 0.51.

Overall, said the researchers, the findings “suggest an average 49% reduction in breast cancer mortality for women who are screened”.1

Detecting lymph node metastases
What is the diagnostic value of FDG PET/CT, compared with the standard method using ultrasound, for investigating axillary lymph nodes in breast cancer patients? To find out, specialists in Dusseldorf, Germany, retrospectively studied the records of 90 patients with primary breast cancer who underwent both a whole-body FDG PET/CT scan and an axillary ultrasound scan. The reference standard for the presence of axillary lymph node metastases was the histopathology report.

The researchers found that FDG PET/CT was significantly more accurate than ultrasound for detecting axillary lymph node metastases (75%, compared with 62% for ultrasound; p = 0.019). There was no significant difference between the two methods in sensitivity (54% for FDG PET/CT, 38% for ultrasound; p = 0.0578). FDG PET/CT allowed the detection of extra-axillary loco-regional lymph node metastases that had not been revealed by other imaging methods, in seven patients (8% of the study population).

Concluding, the researchers noted the potential benefits of FDG PET/CT but pointed out that due to its low sensitivity it should not be used as a substitute for sentinel lymph node biopsy.2

Identifying disease relapse
Meanwhile, specialists in Padua, Italy, reported on their study comparing (18F-FDG) PET/CT with CT in patients with breast cancer who had already undergone surgery or other primary treatment. A total of 190 patients had both a PET/CT scan and a CT scan within 3 months, to evaluate disease status.

Overall, 43% of the patients showed evidence of disease relapse. The negative and positive predictive values for relapse were 90% and 72% respectively for PET/CT, compared with 75% and 55% for CT. Regression analyses (both univariate and multivariate) showed that a positive PET/CT scan was significantly associated with disease recurrence.

The researchers concluded that, in women at high-risk of recurrence, PECT/CT imaging could aid the early detection of breast cancer metastases.3

Cancer subtypes show different sonographic features
The different sonographic features of triple-negative breast cancer (negative for estrogen receptor, progesterone receptor, and human epidermal growth factor receptor 2 [Her2]) and non-triple-negative disease were highlighted in a new study by specialists in Bielefeld, Germany.

They retrospectively analysed the records of 315 consecutive breast cancer patients, and found that triple-negative breast cancer (seen in 33 of the patients) was significantly associated with a younger age, a higher tumor grade, and more lymph node involvement.

In terms of sonographic features, the margin of triple-negative breast cancer was significantly more likely to be described as lobulated or microlobulated (75.8% of cases, compared with 49.5% of non-triple-negative breast cancer cases), and less likely to have an echoic halo (39.4% versus 62.8%, respectively). Cooper ligaments were also displaced, instead of disrupted, in triple-negative breast cancer, the researchers said.

They noted that triple-negative breast cancer shares some sonographic features with benign masses, and said understanding the full distinct features of this cancer subtype could help examiners avoid false-negative classification.4

Overview of disease classification
Finally for this overview of recently published research, the current state of breast cancer classification was summarized in a paper published last month. The author, from Milan, Italy, concluded that the established histopathology-based system of classification is of limited value in terms of prognostic ability and predictive power.

Instead, more recent classification schemes based on the assessment of hormone receptor status, Her2 gene over-expression or amplification, and the proliferative fraction, or based on gene expression profiles, “correlate much better with the clinical outcome and may be used to inform the choice of the systemic therapy”.5

References:

  1. Nickson C, et al. Cancer Epidemiol Biomarkers Prev. 2012;21:1479-88.
  2. Riegger C, et al. Acta Radiol. 2012 Sep 22 [Epub ahead of print].
  3. Evangelista L, et al. Q J Nucl Med Mol Imaging. 2012;56:375-84.
  4. Wojcinski S, et al. J Ultrasound Med. 2012;31:1531-41.
  5. Viale G. Ann Oncol. 2012;23(suppl 10):x207-10.

Source: Get inside health.

 

 

Advances in breast cancer research.

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Decrease font size Reset font size Increase font size

To mark Breast Cancer Awareness Month, we review some of the many studies published in recent weeks, including research on the effects of screening and on the contributions of various imaging techniques to management of the disease.

Screening halves breast cancer mortality
Breast cancer screening is associated with an average 49% reduction in the risk of dying from the condition, according to the findings of a case-control study. Researchers in Melbourne, Australia, investigated the effects of taking part in the Western Australian population screening program, comparing 427 cases (women who died from breast cancer) with matched controls (up to 10 for each case).

The odds ratio for taking part in the program, in relation to breast cancer mortality, was 0.48 (95% confidence interval 0.38-0.59; p < 0.001), and the researchers said they were unable to find any biases that affected the significance of this finding. An accompanying meta-analysis of similar published case-control studies produced an odds ratio of 0.51.

Overall, said the researchers, the findings “suggest an average 49% reduction in breast cancer mortality for women who are screened”.1

Detecting lymph node metastases
What is the diagnostic value of FDG PET/CT, compared with the standard method using ultrasound, for investigating axillary lymph nodes in breast cancer patients? To find out, specialists in Dusseldorf, Germany, retrospectively studied the records of 90 patients with primary breast cancer who underwent both a whole-body FDG PET/CT scan and an axillary ultrasound scan. The reference standard for the presence of axillary lymph node metastases was the histopathology report.

The researchers found that FDG PET/CT was significantly more accurate than ultrasound for detecting axillary lymph node metastases (75%, compared with 62% for ultrasound; p = 0.019). There was no significant difference between the two methods in sensitivity (54% for FDG PET/CT, 38% for ultrasound; p = 0.0578). FDG PET/CT allowed the detection of extra-axillary loco-regional lymph node metastases that had not been revealed by other imaging methods, in seven patients (8% of the study population).

Concluding, the researchers noted the potential benefits of FDG PET/CT but pointed out that due to its low sensitivity it should not be used as a substitute for sentinel lymph node biopsy.2

Identifying disease relapse
Meanwhile, specialists in Padua, Italy, reported on their study comparing (18F-FDG) PET/CT with CT in patients with breast cancer who had already undergone surgery or other primary treatment. A total of 190 patients had both a PET/CT scan and a CT scan within 3 months, to evaluate disease status.

Overall, 43% of the patients showed evidence of disease relapse. The negative and positive predictive values for relapse were 90% and 72% respectively for PET/CT, compared with 75% and 55% for CT. Regression analyses (both univariate and multivariate) showed that a positive PET/CT scan was significantly associated with disease recurrence.

The researchers concluded that, in women at high-risk of recurrence, PECT/CT imaging could aid the early detection of breast cancer metastases.3

Cancer subtypes show different sonographic features
The different sonographic features of triple-negative breast cancer (negative for estrogen receptor, progesterone receptor, and human epidermal growth factor receptor 2 [Her2]) and non-triple-negative disease were highlighted in a new study by specialists in Bielefeld, Germany.

They retrospectively analysed the records of 315 consecutive breast cancer patients, and found that triple-negative breast cancer (seen in 33 of the patients) was significantly associated with a younger age, a higher tumor grade, and more lymph node involvement.

In terms of sonographic features, the margin of triple-negative breast cancer was significantly more likely to be described as lobulated or microlobulated (75.8% of cases, compared with 49.5% of non-triple-negative breast cancer cases), and less likely to have an echoic halo (39.4% versus 62.8%, respectively). Cooper ligaments were also displaced, instead of disrupted, in triple-negative breast cancer, the researchers said.

They noted that triple-negative breast cancer shares some sonographic features with benign masses, and said understanding the full distinct features of this cancer subtype could help examiners avoid false-negative classification.4

Overview of disease classification
Finally for this overview of recently published research, the current state of breast cancer classification was summarized in a paper published last month. The author, from Milan, Italy, concluded that the established histopathology-based system of classification is of limited value in terms of prognostic ability and predictive power.

Instead, more recent classification schemes based on the assessment of hormone receptor status, Her2 gene over-expression or amplification, and the proliferative fraction, or based on gene expression profiles, “correlate much better with the clinical outcome and may be used to inform the choice of the systemic therapy”.5

References:

  1. Nickson C, et al. Cancer Epidemiol Biomarkers Prev. 2012;21:1479-88.
  2. Riegger C, et al. Acta Radiol. 2012 Sep 22 [Epub ahead of print].
  3. Evangelista L, et al. Q J Nucl Med Mol Imaging. 2012;56:375-84.
  4. Wojcinski S, et al. J Ultrasound Med. 2012;31:1531-41.
  5. Viale G. Ann Oncol. 2012;23(suppl 10):x207-10.

Source: Get inside health.

 

 

Israeli Athlete’s Donated Organs Save Six Lives.

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Sixteen year old Gilad Veturi collapsed during running practice and died two days later. He had just completed a 60-meter sprint. Gilad was an excellent athlete in perfect health. Doctors are unsure if he died from a brain aneurysm or an irregular heartbeat.

Gilad’s parents decided to donate his organs to save the lives of others. His heart was given to a 56-year-old man, his lungs were transplanted into two men ages 63 and 67, his liver was given to a 64-year-old woman, one kidney and his pancreas were given to a 36-year-old woman, and the other kidney went to a 24-year-old woman. The surgeries took place at the Rabin Medical Center in Petach Tikva and Tel Aviv’s Sourasky Medical Center.

Israel Transplant director Dr. Tamar Ashkenazi said: “Gilad’s parents represent the beautiful Israel. They are people who give, who are ready to help others and who, at a time of

Source: http://unitedwithisrael.org

Israel Develops Test for Early ID of Lung Cancer.

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A new non-invasive test to aid in early detection of lung cancer may soon be available thanks to Israeli scientists.  The test uses scanning-microscope imaging equipment developed by

, an Israeli company, and fluorescent DNA markers called FISH probes to analyze a patient’s sputum (phlegm).   BioView licensed these markers from MD Anderson Cancer Center in Houston,Texas.  If a certain percentage of the cells show abnormal fluorescent patterns, that indicates lung cancer.

BioView CEO Alan Schwebel explains: “The average life expectancy of lung cancer patients is only about 18 months, mainly because usually it’s found at a later stage. Early detection and subsequent treatment can increase life expectancy to five years or more.”

Smokers and others deemed at risk for lung cancer usually get a CT scan to look for nodules that could be malignant. Small ones are too hard to biopsy, so people must return for another CT scan every few months. This is problematic because it exposes the patient to more radiation and also allows the potential cancer to grow.

More than 250,000 new cases of lung cancer are diagnosed in the United States each year and more than 160,000 lung-cancer patients die from the disease. The form of cancer detected by this new test, Non-small-cell lung carcinoma, accounts for 85 percent of all lung cancers.

Schwebel related that initial results from the trials are expected this year, but it’s already been shown that the test performs better than any existing non-invasive methods for aiding the early diagnosis of lung cancer. BioView was founded in 2000 by Dr. Opher Shapira and Yuval Harrari and has become the leader in the laboratory equipment market for cancer screening and monitoring.

Source: http://unitedwithisrael.org

 

 

Israelis Create Cardboard Bicycle.

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Izhar Gafni, 50, has invented bicycle made almost entirely of cardboard. He told the Jerusalem Post that his invention can transform transportation throughout the world. The bicycle will include no metal parts, even the brake mechanism and the wheel and pedal bearings will be made of recycled substances. Once the shape has been formed and cut, the cardboard is treated with a secret concoction made of organic materials to give it its waterproof and fireproof qualities. In the final stage, it is coated with lacquer paint for appearance.

The bicycles are not only very cheap to make, they are very light and do not need to be adjusted or repaired, the solid tires that are made of reconstituted rubber from old car tires will never get a puncture. A full-size cardboard bicycle will weigh around 9 kg (about 20 lbs) compared to an average metal bicycle, which weight around 14 kg.

In testing the durability of his invention, Gafni said he immersed a cross-section in a water tank for several months and it remained completely hard throughout. Top of the line bikes cost thousands of dollars each, but this cardboard bike should cost no more than about $20.

Gafni said, “When we started, a year and a half or two years ago, people laughed at us, but now we are getting at least a dozen e-mails every day asking where they can buy such a bicycle…”

Nimrod Elmish, Gafni’s partner, said that initial production was set to begin in Israel in a few months on three bicycle models and a wheelchair and they will be available to purchase within a year.

“In six months we will have completed planning the first production lines for an urban bike which will be assisted by an electric motor, a youth bike which will be a 2/3 size model for children in Africa, a balance bike for youngsters learning to ride, and a wheelchair that a non-profit organization wants to build with our technology for Africa,” he said.

Aside from all the other benefits, countries that cannot afford regular bikes will now have access to this form of transportation.

Source: http://unitedwithisrael.org

Novel Program Shows Strong Promise in Malaria Prevention.

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BAMAKO, MALI/N’DJAMENA, CHAD/PARIS/NEW YORK

A large-scale malaria prevention program, consisting of intermittent distributions of anti-malaria medicines, appears to be drastically reducing the number of new cases of the disease among young children during peak transmission season, according to preliminary results from projects run by the international medical humanitarian organization Doctors Without Borders/Médecins Sans Frontières (MSF) in two African countries.

Antimalaria medicines have been administered prophylactically to approximately 175,000 children between three months and five years of age in Koutiala District in southern Mali and in two areas of Moïssala District in Chad, through an intervention known as seasonal malaria chemoprevention (SMC). Children in that age group are among the most vulnerable to death from malaria due to weaker immunity. Preliminary results show more than a two-thirds drop in the number of simple malaria cases in the intervention area in Mali and up to an 86 percent drop in Chad. A significant decrease of cases of severe malaria is also being recorded.

“While we need to continue evaluating the broader impact of SMC, in terms of its overall effect on a population’s health, the initial results of our intervention show a spectacular decrease in the number of malaria cases,” said Dr. Estrella Lasry, a malaria specialist at MSF. “The bottom line is that we are seeing a correlation with our intervention: more than half the beds in the pediatric ward of the hospital in which we work in Mali are empty, something we have never seen in prior years during peak malaria season, when bed occupancy was typically over 100 percent.”

The World Health Organization (WHO) recommended SMC in March, 2012, based upon research carried out in multiple countries in the Sahel region of Africa that experience high seasonal malaria. The intervention consists of the intermittent provision of a full course of treatment of an anti-malaria medication during peak malaria season, with the aim of preventing new cases of malaria. Different drugs are used to treat people in the area who test positive for malaria.

The MSF projects were launched in July and will last until October, the period of high malaria transmission, and mark the first time MSF has carried out a large-scale SMC program. Some 165,000 children in Mali and 10,000 in Chad take a total of three tablets of amodiaquine and one of sulphadoxine/pyrimethamine over a three-day period once a month. Children who are ill at the time of a distribution, and who test positive for malaria, receive artemisinin-based treatment and are excluded from that month’s distribution.

The areas in Mali and Chad were tested for resistance to the SMC drugs prior to the initiation of the intervention. No resistance was discovered among the representative sample tested. Further resistance surveys will be conducted periodically in Koutiala and Moïssala .

In Mali, MSF teams observed a 65 percent drop in the number of simple malaria cases in the weeks following the distribution of treatment. Additionally, the number of malaria-associated hospitalizations plummeted from an average 247 per week to 84. In southern Chad, results were equally encouraging; in two health zones in Moïssala, the decrease in the number of simple malaria cases was between 72 percent and 86 percent, compared to cases recorded in the weeks prior to the first SMC distribution.

“This prevention strategy could be an extraordinary public health tool, particularly for protecting children, who account for the vast majority of malaria deaths,” said Dr. Lasry. “We can draw on our projects in Chad and Mali to assess the feasibility of employing this strategy in other contexts.”

Additional malaria prevention methods, such as bed net distributions, insecticide spraying, and adequate diagnosis and management of malaria must continue to be supported and implemented in endemic countries, MSF said.

According to the WHO, an estimated 650,000 people die from malaria every year. Ninety percent of cases occur in Sub-Saharan Africa, mainly among young children.

MSF is running projects for the treatment and prevention of the most deadly diseases in young children in Mali and Chad. Since the beginning of 2012, more than 12,000 people have been treated for malaria as outpatients and 3,500 sick and/or severely malnourished children have been hospitalized in Koutiala district in southern Mali. In the Moïssala district in Chad, more than 18,000 people have received malaria treatment in MSF-supported facilities or from non-medical health workers in villages who have been trained by MSF.  

Related:

Source: MSF Newsletter.