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H Feldmeier

Publications and source records attributed to H Feldmeier.

At least 55 records · Page 3Linked to original sources
PubMed1996

Diagnosis of female genital schistosomiasis by indirect disease markers: determination of eosinophil cationic protein, neopterin and IgA in vaginal fluid and swab eluates.

Based on assumptions about the pathophysiology of egg-related lesions in the lower reproductive tract, putative indirect disease markers were investigated in vaginal fluids from 54 Malawi adolescent girls and women infected with S. haematobium. These women received a careful gynecological examination during which biopsies were taken from the cervix, and, if present, also from suspicious lesions in the vagina and the vulva. If the biopsies, either in wet crushed preparations or in histological sections, contained eggs the patients were considered to have female genital schistosomiasis (FGS; n = 33). The remainder (n = 21) were classified as having urinary schistosomiasis only. Eosinophil cationic protein (ECP), a cytotoxic granule protein of eosinophils, neopterin, a second messenger molecule generated during the activation of macrophages, and IgA as an indicator of local B-cell activation were quantitatively determined in vaginal fluid. To clarify the origin of ECP, this protein was also looked for in histological sections by an immunohistochemical method. In order to explore whether such disease markers can be detected after absorption to a tampon-like material, ECP and IgA were also assessed after elution from a non-porous, polypropylene fibre web impregnated with vaginal fluid. The concentration of ECP in vaginal fluid and the degree of immunohistochemical staining in histological sections were significantly higher in patients with FGS than in women with urinary schistosomiasis only. The amount of ECP detected in histological sections correlated to the number of eggs/mm2 of compressed genital tissue (rho = 0.36, P = 0.02), and the concentration of ECP in vaginal fluid correlated to the concentration of neopterin as well as to that of IgA (rho = 0.52, P = 0.004 and rho = 0.37, P = 0.02, respectively). Median neopterin concentration in vaginal fluid was also higher in the FGS group, but the difference was not statistically significant. ECP could also be detected in eluates from impregnated fibre webs, but the concentration was approximately one power of 10 less than in the original vaginal fluid. These results demonstrate that indicators of immunological mechanisms related to the egg-granuloma might be useful as indirect disease markers for women with FGS if assessed in vaginal washings or swab eluates.

Adolescent↗
PubMed1996

Urine reagent strips for diagnosis of schistosomiasis haematobium in women of fertile age.

Hematuria, proteinuria and leukocyturia were semiquantitatively assessed by reagent strips in single morning urine of women of fertile age visiting the outpatient department of the Mangochi district hospital, Malawi. This was part of a diagnostic approach to female genital schistosomiasis (FGS). In 51 women ova of Schistosoma haematobium were detected in urine by a filtration technique. In 33 of these women ova were also present in genital tissue as demonstrated by microscopic examination of biopsies. In 209 women no ova were found in the single urine filtered. There were significantly higher scores for hematuria, proteinuria and leukocyturia as well as of the combined reagent strip index (RSI) in egg-excreting than in egg-negative women. The sensitivity of a single hematuria, proteinuria and leukocyturia reading was 98, 84 and 73%, respectively. However, the respective specificity was only 24, 22 and 23%. The best prediction of urinary schistosomiasis was achieved by a +2 score for hematuria, of which the sensitivity was 94% and the specificity was 61%. The high false-positive rates can probably be explained by contamination of urine by vaginal secretion. Moreover, cases of schistosomiasis have probably been overlooked because only a single morning urine sample was examined. The total absence of hematuria, proteinuria and leukocyturia, however, may be used to rule out heavy infections in community surveys. There was no difference in reagent strip scores between women with genital and urinary schistosomiasis as compared with those with urinary tract lesions alone. Thus urine analysis reagent strip readings do not help to discriminate between S. haematobium infected women with and without FGS.

Adolescent↗
PubMed1996

Reversibility of lower reproductive tract abnormalities in women with Schistosoma haematobium infection after treatment with praziquantel--an interim report.

Little is known whether and to what extent antiparasitic treatment cures female genital schistosomiasis (FGS). Using a standard protocol, of twenty-one women with FGS nine were re-examined at two to nine weeks after they had been treated with praziquantel at a single dose of 40 mg/kg. Symptoms related to pathology of the urinary tract and to a lesser extent of genital pathology subsided in most patients. Schistosoma haematobium ova were no longer detectable in urine of any of the patients post-treatment. Efficiency of chemotherapy against adult worms was confirmed by the disappearance of circulating anodic antigen (CAA) in serum. Sandy patches showed resolution in two of four cases after chemotherapy. Papillomata due to schistosomiasis alone improved, but persisted in mixed infection with human papilloma virus (HPV) or when HPV was the only underlying cause. In one patient ulcera could not be related with certainty to schistosomiasis at admission, but resolved after treatment with parziquantel. Leukoplakia (two cases) was not influenced by chemotherapy, or even increased during follow-up, regardless of whether ova had been detected or not. Although the follow-up period was rather short, time intervals were not standardized, and a relatively small number of patients was investigated, it could be shown that genital pathology due to sequestered S. haematobium ova is, at least partially, reversible already two to nine weeks after killing the adult worms by praziquantel. This is paralleled by a normalization of inflammatory immune responses detectable in histological sections and vaginal lavage.

Adolescent↗
PubMed1996

[Growth hormone substitution in adulthood. Use of recombinant human GH--strict diagnostic criteria].

Human growth hormone (GH) is produced in the anterior lobe of the pituitary gland not only in childhood but also in the adult. It has an influence on the physical performance, composition and metabolism of the adult organism. A complex system of endocrine and paracrine factors mediate the influence of growth hormone, and its deficiency in the adult leads to such typical clinical symptoms as fatigue, a lack of drive, poor physical performance and truncal obesity. Since recombinant human growth hormone can now be produced by gene technology in unlimited amounts, it has become possible to investigate new indications for growth hormone therapy in adults. GH replacement has recently become an accepted form of treatment of patients with proven GH deficiency after controlled clinical trials had shown it to have beneficial results.

Adult↗
PubMed1996

Insulin-like growth factor I is an independent coregulatory modulator of natural killer (NK) cell activity.

We aimed to investigate the natural killer (NK) cell activity in hGH-deficient adults and to analyze the effect of insulin-like growth factor (IGF)-I in vivo and in vitro on NK cell activity. NK cell activity was measured in a 4-h nonisotopic assay with europium-labeled and cryopreserved K-562 cells. NK-cell numbers were measured after incubation with murine monoclonal CD3 and CD16 antibodies by flow cytometry analysis. In a cross-sectional study, the basal and interferon-beta (IFN-beta) stimulated (1000 IU/ml) NK cell activity of 15 hGH-deficient patients and 15 age- and sex-matched controls was measured. The percentages and absolute numbers of CD3-/16+ NK-cells were not significantly different in the patient vs. control group. The basal and IFN-beta stimulated NK cell activity however was significantly decreased in the patient vs. control group at all effector/target (E/T) cell ratios from 12.5-100 (e.g. 17 +/- 3 vs. 28 +/- 3% lysis without IFN-beta, P < 0.05, and 42 +/- 4 vs. 57 +/- 4% lysis with IFN-beta, P < 0.05; both at E/T 50). IGF-I levels of patients and controls showed a significant positive correlation with NK cell activity (r = 0.37; P < 0.05). In an IGF-I in vitro study (IGF-I in vitro 250-1250 microg/L), the basal and IFN-beta stimulated NK cell activity of 13 hGH-deficient patients and of 18 normal subjects was significantly enhanced by IGF-I in vitro (e.g. GH-deficient patients: 9 +/- 2 vs. 10 +/- 2% lysis without IFN-beta, P < 0.05 and 25 +/- 4 vs. 30 +/- 4% lysis with IFN-beta, P < 0.005; and normal subjects: 15 +/- 3 vs. 23 +/- 3% lysis without IFN-beta, P < 0.001 and 35 +/- 4 vs. 44 +/- 5% lysis with IFN-beta, P < 0.001; both at IGF-I 500 microg/L). In summary, in our cross-sectional study, adult GH-deficient patients showed a significantly lower basal and IFN-beta stimulated NK cell activity than matched controls, despite equal NK cell numbers. IGF-I levels of patients and controls showed a weak positive correlation with NK cell activity. In an in vitro study, IGF-I significantly enhanced basal and IFN-beta stimulated NK cell activity of hGH-deficient patients and also of normal subjects. The decreased NK cell activity in GH-deficient patients may be caused at least in part by low serum IGF-I levels. IGF-I appears to be an independent coregulatory modulator of NK cell activity.

Adult↗
PubMed1996

Sonographic screening for urinary tract abnormalities in patients with Schistosoma haematobium infection: pitfalls in examining pregnant women.

In areas where Schistosoma haematobium is endemic, urinary schistosomiasis and pregnancy are frequently concomitant; however, both these conditions may produce similar urinary tract changes in ultrasound scans and hence their differential diagnosis may be difficult. In patients with urinary schistosomiasis, focal and/or diffuse urinary bladder wall changes are frequently detected ultrasonically. Dilatation of one or both ureters and progressive hydronephrosis may be observed in more severe cases. Satisfactory ultrasound examination of the urinary bladders of pregnant women is generally not feasible because mechanical compression by the fetus or transitory lower urinary tract infection hampers adequate filling of the bladder. Pregnancy itself is frequently associated with dilatation of one or both ureters and/or hydronephrosis; this is due to hormonal factors, infection, or compression of one or both ureters by the enlarged uterus and growing fetus. Hence, when sonography of the urinary bladder is not feasible such pregnancy-associated changes are virtually indistinguishable from those caused by S. haematobium, and may be incorrectly attributed to the latter. Pregnant women, therefore, should be excluded from ultrasonic surveys of urinary schistosomiasis. In contrast, ultrasound scans of adolescents and of women with positive parasitological findings and/or pathological alterations in the urinary tract should include examination of the uterus in order to assess whether the woman is pregnant; thereby, misinterpretation of sonographic findings can be avoided. Pregnant women with significant hydronephrosis must be closely followed up by an obstetrician since this condition may indicate a complication of the pregnancy; in some cases only a postpartum examination will permit definitive diagnosis.

Adolescent↗
PubMed1996

Synthesis of tumour necrosis factor-alpha in tissue culture of rat caecum: lack of suppression by phosphodiesterase inhibitors and prostanoids.

Tumour necrosis factor-alpha (TNF) plays a pivotal role in acute and chronic inflammatory processes. It has been demonstrated that TNF is a mediator in inflammatory bowel disease. In the past different pharmacological approaches have been identified to suppress TNF synthesis in lipopolysaccharide-stimulated human mononuclear cells by cAMP-elevating agents. In the present study we examine whether TNF synthesis in the colon underlies similar regulatory mechanisms as in mononuclear cells. We therefore established a short-time organ culture of rat caecum. In this model we obtained maximal TNF formation of 159 pg/ml after a 7-h incubation period, as determined by L929 bioassay. The formation of bioactive TNF was confirmed by the application of neutralizing TNF antibody in the L929 bioassay and by immunodot blot. Lipopolysaccharide and pokeweed mitogen did not further enhance TNF synthesis. In contrast, TNF production was suppressed to 25% of control by 5 micrograms/ml hydrocortisone. Unexpectedly, the specific type IV phosphodiesterase inhibitor rolipram and cicaprost, a stable prostacyclin analogue, did not achieve significant suppression of TNF synthesis in this model. The present study defines an experimental model to investigate ex vivo TNF synthesis in rat colonic tissue. Applying this model, cAMP-elevating agents are identified as poor candidates for TNF-suppressing strategies in inflamed colon.

Animals↗
PubMed1995

Clinical and immunologic follow-up study of patients with neurocysticercosis after treatment with praziquantel.

In a prospective study, 17 Brazilian patients with parenchymatous neurocysticercosis were monitored for a period of 12 months after treatment with praziquantel. Taenia solium-specific IgG antibodies, interleukin-1 beta (IL-1 beta), tumor necrosis factor alpha, neopterin, and soluble interleukin-2 receptor (sIL-2R) were measured in serum and CSF before starting the therapy, on the last day of treatment, 5 weeks after treatment, and 3, 6, and 12 months after treatment. The most common symptoms and signs found in patients before treatment were headache, neck stiffness, and seizures. Six months after commencement of therapy, 13 of the 17 patients were free of complaints. Clinical normalization was paralleled by a significant decrease (p < 0.05) in the amount of intrathecally produced anti-T solium IgG 1 year after treatment. IL-1 beta was undetectable in serum at all times, whereas in the CSF it was within the normal range during the whole study period. The mean concentration of sIL-2R in the CSF was 65 kU/l (normal, < 50 kU/l) 5 weeks after treatment, whereas in all subsequent investigations sIL-2R was undetectable. The median CSF neopterin level was slightly elevated before treatment (6.8 nmol/l). One year after treatment, it had dropped by 69% (p < 0.001) to a median value of 2.1 nmol/l. The size of planimetrically measured focal cystic brain lesions on CT correlated with the amount of intrathecally synthesized anti-T solium IgG at the end of the study (r = 0.89, p < 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1995

Female genital schistosomiasis. New challenges from a gender perspective.

Female genital schistosomiasis has been neglected as a disease entity during a period when considerable progress has been achieved for schistosomiasis as such. The pathophysiology and immunology are imperfectly understood, appropriate diagnostic tools are not at hand, therapeutic rationales do not exist, the natural history is not well known and women's perception of their illness has never been studied. Based on the findings of a systematic analysis, made by an inventory of research needs on women and tropical diseases, it has been possible to highlight individual and public health hazards of female genital schistosomiasis, such as the disease being a possible cofactor for te spread of the human immunodeficiency virus. This paper gives an example of how a gender perspective on a well-known parasitic disease can bring new challenges to the research community and the public health sector.

Female↗
PubMed1994

Circulating anodic and cathodic antigen in serum and urine from Schistosoma haematobium-infected Cameroonian children receiving praziquantel: a longitudinal study.

A cohort of 148 Cameroonian children infected with Schistosoma haematobium was followed before praziquantel therapy and 1, 2, 3, 5, and 12 months thereafter. Egg output, the reagent strip index (RSI, a pathological marker), and circulating anodic antigen (CAA) and circulating cathodic antigen (CCA) in serum and urine were quantified. At enrollment, the median level of egg output was 365/10 mL of urine; 97% of children had a positive RSI; CAA was detected in serum from 76% of children and in urine from 64%; and CCA was detected in serum from 55% of children and in urine from 87%. Two months after chemotherapy, egg output and RSI had decreased significantly; reinfection later developed in parallel with increases in the serum and urine concentrations of CAA and the urine concentrations of CCA. The measurement of CAA and CCA is useful for diagnosis, evaluation of disease severity, and follow-up of chemotherapy in individuals infected with S. haematobium.

Adolescent↗
PubMed1993

The cecum is the site with the highest calcium absorption in rat intestine.

In the absence of electrochemical gradients, mucosa-to-serosa Ca transport across the rat cecum is about six times higher than the serosa-to-mucosa flux, resulting in a marked Ca absorption, which is considerably higher when compared with Ca absorption reported for other intestinal segments. The voltage-clamp experiments reveal that 45% of the total mucosa-to-serosa Ca transport measured across the short-circuited tissue is cellular whereas 55% is paracellular. The serosa-to-mucosa Ca flux, however, is purely paracellular. Dexamethasone or 1,25(OH)2D3 has no effect on the Ca transport across the cecum. Diphosphonate, known to inhibit 1,25(OH)2D3 synthesis, abolishes cellular mucosa-to-serosa Ca transport but this effect can be restored by simultaneous exogenous 1,25(OH)2D3 application. It is concluded that the cecum is the site with the highest calcium absorption in the rat intestine. The cellular mucosa-to-serosa Ca transport is dependent on 1,25(OH)2D3 but cannot be increased by exogenous 1,25(OH)2D3 application, suggesting that the Ca carrier in this segment already under normal nutritional conditions works at the maximal level. Ca absorption across the proximal colon therefore seems to be of physiological importance in the regulation of intestinal Ca homeostasis.

Animals↗
PubMed1993

Diagnostic techniques in schistosomiasis control. A review.

Diagnosis is central to all aspects of schistosomiasis. Decisions on individual and community treatment, estimations on prognosis and assessment of morbidity, evaluation of chemotherapy and control measures all require the results from diagnostic tests. Unfortunately, all presently available techniques are characterised by diagnostic imperfections. Selection and application of methods should therefore correspond to the type of information sought by the public health officer or the epidemiologist and interpretation of test results must take into consideration the drawbacks and constraints inherent to each of the various diagnostic approaches.

Humans↗
PubMed1993

A synoptic inventory of needs for research on women and tropical parasitic diseases. I. Application to urinary and intestinal schistosomiasis.

The determinants of major parasitic infections in women have never been studied systematically. Much work remains to be done before vital gaps in our knowledge will be filled. The protocol presented here categorizes the determinants of parasitic diseases, and functions as an inventory for research needs and priorities. In this paper, the synoptic inventory is tested by matching it against the scientific knowledge of schistosomiasis that is at hand. Available data and existing lacunae are discussed. We conclude that the environmental, economic, socio-cultural, nutritional, genetic, biological and immunological factors which determine schistosomiasis in women are largely unknown. There is an urgent need for systematic and interdisciplinary investigations before appropriate and sustainable interventions can be initiated.

Adult↗