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News Article | February 15, 2017
Site: www.eurekalert.org

University of Tübingen researchers in collaboration with the biotech company Sanaria Inc. have demonstrated in a clinical trial that a new vaccine for malaria called Sanaria® PfSPZ-CVac has been up to 100 percent effective when assessed at 10 weeks after last dose of vaccine. For the trial, Pro-fessor Peter Kremsner and Dr. Benjamin Mordmüller of the Institute of Tropical Medicine and the German Center for Infection Research (DZIF) used malaria parasites provided by Sanaria. The vac-cine incorporated fully viable - not weakened or otherwise inactivated - malaria pathogens together with the medication to combat them. Their research results have been published in the latest edition of Nature. DOI: 10.1038/nature21060 Malaria parasites are transmitted by the bite of female Anopheles mosquitoes. The Plasmodium falciparum parasite is responsible for most malaria infections and almost all deaths caused by the disease worldwide. Most of the previous vaccines which have been tried involved the use of individual molecules found in the pathogen. However, they were unable to provide sufficient immunity to the disease. The Tuebingen study involved 67 healthy adult test persons, none of whom had previously had malaria. The best immune response was shown in a group of nine test persons who received the highest dose of the vaccine three times at four-week intervals. At the end of the trial, all nine of these individuals had 100 percent protection from the disease. "That protection was probably caused by specific T-lymphocytes and antibody responses to the parasites in the liver," Professor Peter Kremsner explained. The researchers analyzed the bodies' immune reactions and identified protein patterns which will make it possible to further improve malaria vaccines, Kremsner added. The researchers injected live malaria parasites into the test subjects, at the same time preventing the development of the disease by adding chloroquine - which has been used to treat malaria for many years. This enabled the researchers to exploit the behavior of the parasites and the properties of chloroquine. Once the person is infected, the Plasmodium falciparum parasite migrates to the liver to reproduce. During its incubation period there, the human immune system could respond; but at this stage, the pathogen does not make the person sick. On top of that, chloroquine does not take effect in the liver - so it is unable to prevent the parasite from reproducing. Malaria only breaks out when the pathogen leaves the liver, entering the bloodstream and going into the red corpuscles, where it continues to reproduce and spread. As soon as the pathogen enters the bloodstream, however, it can be killed by chloroquine - and the disease cannot break out. "By vaccinating with a live, fully active pathogen, it seems clear that we were able to set of a very strong immune response," said study leader Benjamin Mordmueller, "Additionally, all the data we have so far indicate that what we have here is relatively stable, long-lasting protection." In the group of test persons who demonstrated 100 percent protection after receiving a high dose three times, Mordmueller said, the protection was reliably still in place after ten weeks - and remained measurable for even longer. He added that the new vaccine showed no adverse effects on the test persons. The next step is to further test the vaccine's effectiveness over several years in a clinical study in Gabon funded by DZIF. Malaria is one of the biggest health threats in the African nation. The University of Tuebingen has worked with the Albert Schweitzer Hospital in the Gabonese town of Lambaréné and with the neighboring research institute, the Centre de Recherches Médicales de Lambaréné, for many years. Malaria is one of the deadliest infectious diseases worldwide. The World Health Organization reports that some 214 million people became infected with malaria in the year 2015 alone. Approximately 438,000 died of the disease. Around 90 percent of those malaria deaths were in Africa. Nearly three-quarters of those who succumb to the disease are children under five. The search for a vaccine has been going on for more than a century. An effective vaccine would make it easier to control malaria; vaccination campaigns could be conducted in severely affected areas to eliminate the pathogen. Such a vaccine could also help to stop the spread of resistance to the treatment, and to better protect travelers.


News Article | November 4, 2016
Site: globenewswire.com

MILLWOOD, Md., Nov. 4, 2016 (GLOBE NEWSWIRE) -- Project HOPE announced an airlift of medicines and supplies to Haiti today as health needs persist one month after Hurricane Matthew blasted through the Caribbean nation. Project HOPE, a global health development organization, has been working closely with Haiti's Ministry of Health and other NGOs in response to the disaster. The medicines and medical supplies will be delivered to the Cholera Treatment Center located at GHESKIO, a Haitian health care and research facility in Port-au-Prince and to the Albert Schweitzer Hospital, a 100-bed hospital in Deschapelles, in the Artibonite Valley, where previous cholera outbreaks have occurred. "We're collaborating with the government and local partners to support Haiti's health system, which has been seriously compromised by the disaster," said Scott Crawford, Senior Director of Humanitarian Operations at Project HOPE. "We are delivering a range of much-needed medicines and supplies including antibiotics, water hydration tablets, gloves, saline solution, sponges, gauze, water purification units, and generators." Haiti's health facilities were severely damaged or destroyed by the hurricane and there are about 3,500 suspected cholera cases. The government will begin a cholera immunization campaign next week as cholera spreads quickly once the bacteria enters the water supply. Additional medicine and medical supply donations valued at over $8 million dollars are also being processed for health facilities in coordination with the Ministry of Health. Project HOPE has also been deploying medical volunteers to the southern region of Nippes. The HOPE medical team is providing direct patient care at the St. Therese Hospital in Miragoane and is also involved in the assessment of needs and health capacity building. Medical volunteer deployments will continue in the coming weeks as health needs evolve. The death toll from the Category 4 storm stands at 546, according to the government and the UN says 1.4 million Haitians need help, out of 2.1 million affected by the hurricane. HOPE is coordinating its operations based on the recommendations of the Ministry of Health which is closely monitoring all regions affected by the storm. Since the 2010 earthquake, Project HOPE has sent medical volunteers to train and assist local health care professionals in areas affected by cholera. The NGO provided health care to more than 1,000 Haitians in the aftermath of the disaster and distributed more than $60 million of donated medicines and supplies. About Project HOPE Founded in 1958, Project HOPE (Health Opportunities for People Everywhere) is dedicated to providing lasting solution to health problems with the mission of helping people to help themselves. Identifiable to many by the SS HOPE, the world's first peacetime hospital ship, Project HOPE now provides medical training and health education, and conducts humanitarian assistance programs in more than 30 countries. Visit our website projecthope.org and follow us on Twitter @projecthopeorg. Photos accompanying this release are available at: http://www.globenewswire.com/newsroom/prs/?pkgid=41829 http://www.globenewswire.com/newsroom/prs/?pkgid=41830


Damhuis R.A.M.,Comprehensive Cancer Center the Netherlands | Wijnhoven B.P.L.,Erasmus Medical Center | Plaisier P.W.,Albert Schweitzer Hospital | Kirkels W.J.,Erasmus Medical Center | And 2 more authors.
British Journal of Surgery | Year: 2012

Background: Various definitions are used to calculate postoperative mortality. As variation hampers comparability between reports, a study was performed to evaluate the impact of using different definitions for several types of cancer surgery. Methods: Population-based data for the period 1997-2008 were retrieved from the Rotterdam Cancer Registry for resectional surgery of oesophageal, gastric, colonic, rectal, breast, lung, renal and bladder cancer. Postoperative deaths were tabulated as 30-day, in-hospital or 90-day mortality. Postdischarge deaths were defined as those occurring after discharge from hospital but within 30 days. Results: This study included 40 474 patients. Thirty-day mortality rates were highest after gastric (8·8 per cent) and colonic (6·0 per cent) surgery, and lowest after breast (0·2 per cent) and renal (2·0 per cent) procedures. For most tumour types, the difference between 30-day and in-hospital rates was less than 1 per cent. For bladder and oesophageal cancer, however, the in-hospital mortality rate was considerably higher at 5·1 per cent (+1·3 per cent) and 7·3 per cent (+2·8 per cent) respectively. For gastric, colonic and lung cancer, 1·0 per cent of patients died after discharge. For gastric, lung and bladder cancer, more than 3 per cent of patients died between discharge and 90 days. Conclusion: The 30-day definition is recommended as an international standard because it includes the great majority of surgery-related deaths and is not subject to discharge procedures. The 90-day definition, however, captures mortality from multiple causes; although this may be of less interest to surgeons, the data may be valuable when providing information to patients before surgery. Copyright © 2012 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd.


Adegnika A.A.,Albert Schweitzer Hospital | Adegnika A.A.,University of Tübingen | Adegnika A.A.,Leiden University | Kremsner P.G.,Albert Schweitzer Hospital | Kremsner P.G.,University of Tübingen
Current Opinion in HIV and AIDS | Year: 2012

Purpose of Review: Malaria and helminthiasis are endemic in the same geographic areas, and may coinfect the same host. In the literature there is some controversy about the effect of helminth infection on malaria. Recent Findings: Large studies have been undertaken to clarify this interaction at the molecular and immunological level, we undertake a review of the epidemiology of the interaction between helminths and malaria in areas where both are endemic. A search of the literature from 2001 to 2011 showed that several studies have been conducted on the interaction of helminths and malaria. Most of the studies had a cross-sectional or longitudinal design, whereas few were interventional studies of school children and pregnant women. The main finding is that there is a trend toward a protective effect of Ascaris lumbricoides and Schistosoma hematobium, and worsening effect of hookworm and S. mansoni on the pathogenesis and incidence of malaria, respectively. It is important also to put emphasis on the general protective effect of helminth infection against severe malaria. Summary: Hookworm, A. lumbricoides and Schistosoma species were found to associate differently with malaria, which might explain the conflicting reports on interaction between helminths and malaria. It is therefore important to further investigate these three major helminths in relation to malaria, using universally accepted 'gold standard' study designs, which would be able to clearly define the nature of the interaction between malaria and helminth species. A better understanding of helminths and malaria coinfection may strengthen malaria control programmes in coendemic areas. © Lippincott Williams & Wilkins.


van de Ridder J.M.M.,Albert Schweitzer Hospital | Mcgaghie W.C.,Northwestern University | Stokking K.M.,University Utrecht | ten Cate O.T.J.,University Utrecht
Medical Education | Year: 2015

Context: Feedback is considered important in medical education. The literature is not clear about the mechanisms that contribute to its effects, which are often small to moderate and at times contradictory. A variety of variables seem to influence the impact of feedback on learning. The aim of this study was to determine which variables influence the process and outcomes of feedback in settings relevant to medical education. Methods: A myriad of studies on feedback have been conducted. To determine the most researched variables, we limited our review to meta-analyses and literature reviews published in the period from January 1986 to February 2012. According to our protocol, we first identified features of the feedback process that influence its effects and subsequently variables that influence these features. We used a chronological model of the feedback process to categorise all variables found. Results: A systematic search of ERIC, PsycINFO and MEDLINE yielded 1101 publications, which we reduced to 203, rejecting papers on six exclusion criteria. Of these, 46 met the inclusion criteria. In our four-phase model, we identified 33 variables linked to task performance (e.g. task complexity, task nature) and feedback reception (e.g. self-esteem, goal-setting behaviour) by trainees, and to observation (e.g. focus, intensity) and feedback provision (e.g. form, content) by supervisors that influence the subsequent effects of the feedback process. Variables from all phases influence the feedback process and effects, but variables that influence the quality of the observation and rating of the performance dominate the literature. There is a paucity of studies addressing other, seemingly relevant variables. Conclusions: The larger picture of variables that influence the process and outcome of feedback, relevant for medical education, shows many open spaces. We suggest that targeted studies be carried out to expand our knowledge of these important aspects of feedback in medical education. © 2015 John Wiley & Sons Ltd.


Van Den Bos E.J.,Albert Schweitzer Hospital | Constantinescu A.A.,Albert Schweitzer Hospital | Van Domburg R.T.,Erasmus Medical Center | Akin S.,Albert Schweitzer Hospital | And 2 more authors.
European Heart Journal | Year: 2011

Aims In patients with atrial fibrillation, minor troponin I elevation is regularly detected; however, the prognostic significance of this finding is unknown. We therefore sought to examine the prognostic value of elevated troponin I in patients with atrial fibrillation. Methods and results A prospective study was conducted analysing all consecutive patients admitted with atrial fibrillation in a 2-year period. Patients with an ST-elevation myocardial infarction (MI) were excluded. Minor troponin elevation was defined as a troponin I level between 0.15 and 0.65 ng/mL, which is still below the 99th percentile of the upper reference limit. A positive troponin I was defined as >0.65 ng/mL. Study outcomes were all-cause mortality (death), death and myocardial infarction (death/MI), or all major adverse cardiac events (MACE: death, MI, or revascularization). A total of 407 patients were eligible for inclusion. The median duration of follow-up was 688 days. A minor elevation occurred in 81 (20) patients and 77 (19) had a positive troponin I. In a multivariate model, minor troponin I elevation and a positive troponin I were independently associated with death [hazard ratio (HR): 2.36, 95 confidence interval (CI): 1.174.73 for minor elevation and HR: 3.77, 95 CI: 1.4210.02 for positive troponin I]. Also, there was an independent correlation between the combined endpoints of death/MI and MACE and both a minor elevation and a positive troponin I. Conclusion Minor elevations in troponin I on hospital admission are associated with mortality and cardiac events in patients with atrial fibrillation and might be useful for risk stratification. © 2010 The Author.


Korte M.R.,Albert Schweitzer Hospital | Habib S.M.,Erasmus Medical Center | Lingsma H.,Erasmus Medical Center | Weimar W.,Erasmus Medical Center | Betjes M.G.H.,Erasmus Medical Center
American Journal of Transplantation | Year: 2011

Encapsulating peritoneal sclerosis (EPS) is a severe complication of peritoneal dialysis (PD) and may present after kidney transplantation, a condition known as posttransplantation EPS. The prevalence and impact of posttransplantation EPS on survival after kidney transplantation is unknown. From January 1, 1996 until July 1, 2007, 1241 PD patients were transplanted. Thirty-eight cases of posttransplantation EPS (3%) were identified from the Dutch multicenter EPS study. In EPS patients the mean pretransplant dialysis duration was longer than in the controls (71.4 ± 37.5 months vs. 34.7 ± 25.5, p < 0.0001). The majority of EPS cases were observed within the first 2 years after transplantation, but some cases appeared many years after transplantation. Two hundred and one (16.2%) patients died after transplantation, of which 17 were EPS patients. After infection (23.9%), cardiovascular disease (21.9%) and malignancy (10.9%), EPS (8.5%) was the fourth known cause of death after transplantation. Kaplan - Meier analysis showed a significant decreased survival for transplanted patients with posttransplantation EPS compared to transplanted patients without EPS. In conclusion, posttransplantation EPS is rare but carries a high mortality. A prolonged clinical vigilance and a high index of suspicion for the diagnosis are warranted, specifically in PD patients with a relatively long cumulative pretransplant duration of PD. © 2011 The Authors Journal compilation © 2011 The American Society of Transplantation and the American Society of Transplant Surgeons.


Habib S.M.,Erasmus Medical Center | Korte M.R.,Albert Schweitzer Hospital | Betjes M.G.H.,Erasmus Medical Center
American Journal of Nephrology | Year: 2013

Background: Encapsulating peritoneal sclerosis (EPS) may occur after kidney transplantation (post-transplantation EPS) or may be diagnosed during or after peritoneal dialysis treatment (classical EPS). The aim of the present study was to investigate to what extent both EPS entities differ in clinical presentation, radiological findings, outcome, and the systemic inflammatory response, as measured by plasma C-reactive protein (CRP) levels both prior to and after EPS diagnosis. Methods: We performed a retrospective analysis of 15 post-transplantation EPS and 19 classical EPS patients who were diagnosed at seven hospitals in the Netherlands between January 1, 2000, and January 1, 2011. Results: There were no inter-group differences in age, duration of peritoneal dialysis, clinical presentation, or radiology findings at diagnosis. Post-transplantation patients had experienced a lower number of peritonitis episodes per patient-year (0.2 (0.0-0.4) vs. 0.7 (0.3-1.2), p = 0.01) with a longer interval between the last peritonitis and EPS diagnosis (18.1 (4.6-34.3) vs. 4.4 (0.89-13.78) months, p = 0.01). Post-transplantation EPS patients showed a remarkably lower mortality rate (40.0 vs. 84.2%, p < 0.05). In both groups a pattern of elevated CRP values was observed, increasing within the year before EPS diagnosis. In the post-transplantation group the median CRP level at diagnosis was lower (56.0 vs. 144.50 mg/l, p < 0.05) than in the classical EPS group. Conclusion: Post-transplantation EPS has a similar clinical presentation as classical EPS but with a lower systemic inflammatory response and better outcome. Copyright © 2013 S. Karger AG, Basel.


Van Bommel E.F.H.,Albert Schweitzer Hospital | Pelkmans L.G.,Albert Schweitzer Hospital | Van Damme H.,Albert Schweitzer Hospital | Hendriksz T.R.,Albert Schweitzer Hospital
European Journal of Internal Medicine | Year: 2013

Background Tamoxifen may be a viable treatment option for idiopathic retroperitoneal fibrosis (iRPF) but data are limited and its long-term safety and efficacy is unclear. We describe the long-term course and outcomes in a large group of patients with iRPF treated with tamoxifen monotherapy. Methods This is a single-center prospective, observational study of 55 patients with iRPF treated with tamoxifen for 2 years from April 1998 through April 2011. Measurements included clinical improvement, laboratory parameters and follow-up computed tomographic (CT) scanning. Treatment success was the composite endpoint of clinical improvement, mass regression and definite resolution of ureteral obstruction. Results Forty-seven (85%) patients reported substantial resolution of symptoms after median treatment duration of 3.0 weeks (IQR 1.4-4.8 weeks). Repeated CT scanning showed mass regression in 39 (71%) patients at 4 months and 47 (85%) patients at 8 months of follow-up, respectively. Nineteen (34.5%) patients did not meet the composite endpoint of treatment success, 56% of whom responded satisfactorily to second-line immunosuppressive treatment. Recurrence-free survival in patients with treatment success after post-treatment follow-up of 21 months (IQR 9.0-35.0 months) was 68%. Tamoxifen was well tolerated. Pulmonary embolism occurred in 2 patients receiving tamoxifen and in one patient receiving second-line treatment. Conclusion Tamoxifen is a safe and viable therapeutic option in the treatment of iRPF. © 2012 European Federation of Internal Medicine.


van Bommel E.F.,Albert Schweitzer hospital
Pathology international | Year: 2011

We present a case of atypical idiopathic retroperitoneal fibrosis (iRPF) presenting as a large pelvic tumor, for which it proved difficult to exclude T-cell malignant lymphoma. Histopathological examination of biopsy material showed collagenous tissue and fat with an exuberant and predominant T-cell infiltrate, largely consisting of CD4(+) cells expressing the IL-2 receptor-α chain (CD25). Focal plasma cells were negative for the immunoglobulin G4 (IgG4) isotype. T-cell receptor gene rearrangement (TRGR) pattern showed a Gaussian distribution, in keeping with a polyclonal T-cell population. Awareness of the sometimes exuberant and predominant T-cell infiltrate in iRPF should lead to earlier consideration of this disorder. This is particularly the case where there is an atypically localized and/or extensive mass, for which early exclusion of monoclonality with TRGR may provide helpful. Immunohistochemical findings suggest that CD4(+) CD25(+) cells, which are part of a naturally occurring population of regulatory T-cells, may be involved in the pathogenesis of iRPF. © 2011 The Authors. Pathology International © 2011 Japanese Society of Pathology and Blackwell Publishing Asia Pty Ltd.

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