Laboratory Division

Chake Chake, Tanzania

Laboratory Division

Chake Chake, Tanzania

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Speich B.,Swiss Tropical and Public Health Institute | Ame S.M.,Laboratory Division | Ali S.M.,Laboratory Division | Hattendorf J.,Swiss Tropical and Public Health Institute | And 3 more authors.
New England Journal of Medicine | Year: 2014

BACKGROUND: Infections with soil-transmitted helminths (Ascaris lumbricoides, hookworm, and Trichuris trichiura) are widespread and often occur concomitantly. These parasitic-worm infections are typically treated with albendazole or mebendazole, but both drugs show low efficacy against T. trichiura. Albendazole is the drug of choice against hookworm. METHODS In this double-blind trial conducted on Pemba Island, Tanzania, we randomly assigned children, 6 to 14 years of age, to receive one of four treatments: oxantel pamoate at a dose of 20 mg per kilogram of body weight, plus 400 mg of albendazole, administered on consecutive days; oxantel pamoate at a single dose of 20 mg per kilogram; albendazole at a single dose of 400 mg; or mebendazole at a single dose of 500 mg. We assessed the efficacy and safety profile of oxantel pamoate-albendazole when used in the treatment of T. trichiura infection (primary outcome) and concomitant soil-transmitted helminth infection (secondary outcome). Efficacy was determined by means of assessment of the cure rate and egg-reduction rate. Adverse events were assessed four times after treatment. RESULTS: Complete data were available for 458 children, of whom 450 were infected with T. trichiura, 443 with hookworm, and 293 with A. lumbricoides. The cure rate of T. trichiura infection was significantly higher with oxantel pamoate-albendazole than with mebendazole (31.2% vs. 11.8%, P = 0.001), as was the egg-reduction rate (96.0% [95% confidence interval {CI}, 93.5 to 97.6] vs. 75.0% [95% CI, 64.2 to 82.0]). The cure rate with albendazole (2.6%) and the egg-reduction rate with albendazole (45.0%; 95% CI, 32.0 to 56.4) were significantly lower than the rates with mebendazole (P = 0.02 for the comparison of cure rates). Oxantel pamoate had low efficacy against hookworm and A. lumbricoides. Adverse events (mainly mild) were reported by 30.9% of all children. CONCLUSIONS: Treatment with oxantel pamoate-albendazole resulted in higher cure and egg-reduction rates for T. trichiura infection than the rates with standard therapy. Copyright © 2014 Massachusetts Medical Society.


Speich B.,Swiss Tropical and Public Health Institute | Ali S.M.,Laboratory Division | Ame S.M.,Laboratory Division | Bogoch I.I.,Toronto General Hospital | And 6 more authors.
The Lancet Infectious Diseases | Year: 2015

Background: Existing anthelmintic drugs (eg, albendazole and mebendazole) have low efficacy against the intestinal nematode species Trichuris trichiura and the drug pipeline is exhausted. We aimed to investigate the strategy of combination chemotherapy with existing drugs to establish whether their efficacy could be enhanced and broadened. Methods: In this randomised controlled trial, we compared three drug combinations and one standard drug alone in children aged 6-14 years in two schools on Pemba Island, Tanzania infected with T trichiura and concomitant intestinal nematodes. We assigned children, via a randomisation list with block sizes of either four or eight, to orally receive albendazole (400 mg) plus ivermectin (200 μg/kg); albendazole (400 mg) plus mebendazole (500 mg); albendazole (400 mg) plus oxantel pamoate (20 mg/kg); or mebendazole (500 mg) alone. The primary endpoints were the proportion of children cured of T trichiura infection and the reduction of T trichiura eggs in stool based on geometric means, both analysed by available case. This study is registered with ISRCTN, number ISRCTN80245406. Findings: We randomly assigned 440 eligible children infected with T trichiura between Sept 2, and Oct 18, 2013, to one of the four treatment groups (110 children per group). Data for 431 children were included in the analysis for the primary endpoints. Albendazole plus oxantel pamoate (74 of 108 children cured [68·5%, 95% CI 59·6-77·4]; egg reduction 99·2%, 98·7-99·6) and albendazole plus ivermectin (30 of 109 cured [27·5%, 19·0-36·0]; egg reduction 94·5%, 91·7-96·3) were significantly more effective against T trichiura than mebendazole alone (nine of 107 cured [8·4%, 3·1-13·8]; egg reduction 58·5%, 45·2-70·9). Albendazole plus mebendazole had similar low efficacy (nine of 107 cured [8·4%, 3·1-13·8; egg reduction 51·6%, 35·0-65·3) to mebendazole alone. About a fifth of the children reported adverse events, which were mainly mild. Abdominal cramps and headache were the most common adverse events after treatment; abdominal cramps were reported by 13 (12·0%) children for albendazole plus ivermectin, 10 (9·3%) for albendazole plus mebendazole, 20 (18·2%) for albendazole plus oxantel pamoate, and 16 (14·5%) for mebendazole; headaches were reported by 5 (4·6%) children for albendazole plus ivermectin, 6 (5·6%) for albendazole plus mebendazole, 12 (10·9%) for albendazole plus oxantel pamoate, and 7 (6·4%) for mebendazole. Interpretation: Our head-to-head comparison of three combination chemotherapies showed the highest efficacy for albendazole plus oxantel pamoate for the treatment of infection with T trichiura. Further studies should investigate the combination of albendazole plus oxantel pamoate so that it can be considered for soil-transmitted helminthiasis control programmes. Funding: Medicor Foundation and Swiss National Science Foundation. © 2015 Elsevier Ltd.


Christensen A.M.,Laboratory Division | Myers S.W.,Hoover
Journal of Forensic Sciences | Year: 2011

Little is known about the decomposition of remains in aquatic environments of varying pH, and even less is known about the specific effects of these environments on bone. Bovine bones were placed in solutions of pH 1, 4, 7, 10, and 14 and observed over a period of 1year. All solutions eventually removed or dissolved the soft tissues from the external surface of the bone. The pH 7 and pH 10 solutions had little effect on the bone, but the other solutions affected the bone to varying degrees. Extreme pH levels were the most destructive, while more moderate pH levels had lesser but significant and interesting effects. Empirical data on postmortem aquatic changes may be extremely useful in forensic contexts for both improving time since death estimates and also for providing better information to underwater recovery experts thereby potentially increasing the quantity and quality of remains recovery. 2010 American Academy of Forensic Sciences. Published 2010. This article is a U.S. Government work and is in the public domain in the U.S.A.


LeBeau M.A.,Laboratory Division | Montgomery M.A.,Laboratory Division | Brewer J.D.,Laboratory Division
Forensic Science International | Year: 2011

Segmental analysis of hair for drugs, metabolites, and poisons has been widely reported in the scientific literature over the past two decades. Two fundamental assumptions in interpreting results of such analyses are (1) an average linear growth rate of head hair of 1. cm/month and (2) that sample collections occur with the hair being cut directly next to the scalp. The purpose of this study was to evaluate the variability associated with growth rate of human head hair, as well as the ability to uniformly collect hair next to the scalp. The results were used to determine how these factors affect the interpretation of results generated in segmental analysis of hair. A thorough literature review was conducted to assess the range of linear growth of human head hair from the vertex posterior and occipital regions. The results were compiled to establish the average (1.06. cm/month), as well as the range of possible growth rates of head hair. The range was remarkable and suggests that conclusions based on the 1-cm/month growth rate could be significantly skewed. A separate study was undertaken to evaluate collection of hair next to the scalp. Fourteen individuals were provided oral instructions, as well as a written standard collection procedure for head hair. The experience levels among the collectors varied from novice to expert. Each individual collected hair from dolls with short- and long-hair. Immediately following each collection, the sampling area was evaluated to determine how close to the scalp the cuts were made, as well as the variability in the lengths of hair remaining at the sampled area. From our collection study, we determined that 0.8 ± 0.1. cm of hair was left on the scalp after cutting. When taking into account the amount of hair left on the scalp after collecting, the use of a growth rate of 1.06. cm/month, and the assumption that it takes two weeks for newly formed hair in the follicle to reach the scalp, we find that the first 1-cm segment of hair typically corresponds to hair formed 1.3 ± 0.2 to 2.2 ± 0.4 months (95% confidence) earlier. The impact of these findings as it relates to the corresponding time for each additional segment is demonstrated. As a result, we recommend that hair collection be delayed 8 weeks after a suspected ingestion to ensure that the sample fully represents the exposure period. The results of this study suggest that the variability in the growth rate of human head hair, as well as the inconsistent collection of hair, significantly affect the interpretation of results from segmental analysis of hair. © 2011.


Christensen A.M.,Laboratory Division | Smith V.A.,Oak Ridge Associated Universities
Journal of Forensic Sciences | Year: 2013

Forensic anthropologists have become increasingly involved in the interpretation of skeletal trauma caused by exploding ordnance. This study examines the cause and significance of butterfly fractures observed in a recent study investigating skeletal blast trauma by Christensen et al. Fractured ribs resulting from blast events carried out in the original study were re-examined revealing that rib butterfly fractures with the tensile indicator on the visceral surface were present in 100% of viable pig specimens. Additionally, manual fracture testing was performed on 46 pig ribs to simulate the bending force believed to have been sustained in the original blast events. Fracture testing resulted in 93% of specimens presenting butterfly fractures with the tensile indicator on the visceral surface. This fracture pattern differs significantly from that normally observed in association with other types of trauma events and may aid forensic anthropologists and other investigators in the identification and interpretation of blast events. © 2012 American Academy of Forensic Sciences.


Williams D.K.,Laboratory Division | Brown C.J.,Oak Ridge Institute for Science and Education | Bruker J.,Oak Ridge Institute for Science and Education
Forensic Science International | Year: 2011

The chemistry of children's latent fingerprint residues was investigated as a function of time and temperature by non-destructive spectrochemical analysis. Latent fingerprints from children, ranging in age from 2 to 11 years, were deposited onto aluminum-coated glass slides and were analyzed by Fourier-Transform Infrared Microspectroscopy. The results revealed that there are three major classes of compounds present in children's latent fingerprints: carboxylic acid salts, proteins, and esters. By studying the changes in the fingerprint residues as a function of time and at elevated temperatures, we discovered that the salts in the fingerprint residues are stable relative to the esters. These findings have relevant forensic implications; by targeting the acid salts instead of the esters or proteins, children's latent fingerprints may be recovered after extended periods of time have elapsed. © 2011.


Christensen A.M.,Laboratory Division | Smith M.A.,Chemistry Unit | Thomas R.M.,Laboratory Division
Journal of Forensic Sciences | Year: 2012

Forensic anthropological examinations typically involve the analysis of human skeletal remains, but in cases where samples are very small and/or physically compromised, it may first be necessary to determine whether the material is even osseous or dental in origin. X-ray fluorescence spectrometry (XRF) is a technique that reveals the elemental composition of materials and is hypothesized to have utility in such cases. XRF analysis was conducted on a variety of tissues and materials in unaltered and altered (damaged) states. With few exceptions, osseous and dental tissues in unaltered and altered conditions contained characteristic levels of calcium and phosphorus, while other materials did not. Materials could be accurately identified as osseous or dental in origin based on the calcium and phosphorus levels identified by XRF, and we therefore conclude that XRF analysis is a valid and effective means of determining osseous or dental origin of unknown material. © 2011 American Academy of Forensic Sciences.


Mehltretter A.H.,Laboratory Division | Bradley M.J.,Laboratory Division | Wright D.M.,Laboratory Division
Journal of Forensic Sciences | Year: 2011

The backings of 90 black electrical tapes were analyzed to evaluate the chemical components of these films, the ability of individual techniques to discriminate samples, and the ability of the techniques combined to distinguish samples. The techniques utilized and their respective discrimination results were stereomicroscopy and physical measurements, to include observation of surface features of the backing, width, and thickness measurements (c.64%); Fourier transform infrared spectroscopy (FTIR) using a microscope accessory (c.83%); pyrolysis-gas chromatography/mass spectrometry (Py-GC/MS; c.81%); and scanning electron microscopy/energy-dispersive spectroscopy (SEM/EDS; c.87%). Ninety-four percent of the backings were discriminated through this combination of analytical methods. Finally, evaluating these results in conjunction with previously published data on the analysis of the adhesives from the same set of electrical tapes provided an overall discrimination of nearly 96%. 2011 American Academy of Forensic Sciences. Published 2011. This article is a U.S. Government work and is in the public domain in the U.S.A..


Mehltretter A.H.,Laboratory Division | Bradley M.J.,Laboratory Division | Wright D.M.,Laboratory Division
Journal of Forensic Sciences | Year: 2011

This study involved the comparative analysis and discrimination of 90 electrical tape adhesives. The objectives included the evaluation of the ability of individual techniques to discriminate samples and the assessment of the ability of the techniques combined to distinguish samples. The techniques utilized were stereomicroscopy, Fourier transform infrared spectroscopy (FTIR), pyrolysis-gas chromatography/mass spectrometry (Py-GC/MS), and scanning electron microscopy/energy dispersive spectroscopy (SEM/EDS). Stereomicroscopy, to assess adhesive colors of black, clear/colorless, and clear adhesives with brown tint, resulted in a discrimination of 53%. FTIR analysis yielded eight distinct groups with a discrimination of 67%. Py-GC/MS analysis resulted in 16 groups with a discrimination of 83%. These analyses confirmed and further subdivided the FTIR groups. SEM/EDS resulted in five separate groups at 17% discrimination, increasing the overall discrimination to above 85%. © 2010 American Academy of Forensic Sciences. Published 2010. This article is a U.S. Government work and is in the public domain in the U.S.A.


Smith V.A.,Oak Ridge Associated Universities | Christensen A.M.,Laboratory Division | Myers S.W.,Emory University
Journal of Forensic Sciences | Year: 2010

Several studies have investigated frontal sinus comparison for personal identification. One study addressed the statistical reliability of correct identification using automated digital methods and resulted in a 96% accuracy rate. Missed matches with the digital methods generally involved small, less featured sinuses. This study investigates the hypothesis that human examiners may be able to more accurately identify correct matches than digital methods, even when the comparisons involve small frontal sinuses. Participants were provided two sets of 28 radiographs and were instructed to identify matching radiographs and list the radiographs that did not have a corresponding match. Overall, error rates were low, with correct associations identified at a rate of 0.983. No incorrect associations ("false positives") were made. Correct association rates were highest among participants "experienced" examining radiographs. Results support previous assertions that frontal sinus radiographs are a reliable means of personal identification even when the frontal sinuses are small. 2010 American Academy of Forensic Sciences. Published 2010. This article is a U.S. Government work and is in the public domain in the U.S.A.

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