Abstract The purpose of the present study was to compare the procalcitonin (PCT), neopterin, interleukin-8 (IL-8), interleukin-10 (IL-10) and interleukin-12 (IL-12) levels with those of erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) in cancer patients with (56) and without infection (36) and to evaluate their ability to differentiate infections from neoplastic fever (n = 10). The infection group had statistically higher levels of CRP (91 vs. 19 mg/l, p < 0.001), PCT (0.28 vs.0.12 ng/ml, p < 0.001), neopterin (12.8 pg/mL vs. 4.0 pg/mL, p < 0.001), IL-8 (27.7 vs. 16.9 pg/ml, p = 0.032), IL-10 (3.8 pg/mL vs. 1.8 pg/mL, p = 0.005) and ratios of neopterin to IL-12 (1.74 vs. 0.11, p < 0.001), and IL-10 to IL-12 (0.4 vs. 0.05, p < 0.001) than the non-infection group. After a subdivision of the study population into patients with local or advanced disease, the differences between the study groups remained statistically significant for CRP and neopterin both in local (p < 0.05 and p < 0.001) and advanced diasease (p < 0.01 and p < 0.001) and in advanced disease for PCT (p < 0.001), IL-10 (p < 0.05), IL-12 (p < 0.05), neopterin to IL-12 ratio (p < 0.01) and IL-10 to IL-12 ratio (p < 0.01). The ESR levels did not differ between the study group (50 vs. 42 p = 0.16), while the IL-12 values were lower in the infection group (10.6 pg/mL vs. 71.6 pg/mL, p = 0.007). The tumor load did not influence any of the studied infection markers within the study groups. For identifying bacteremia by area under the operating characteristics curves (AUC), the highest values were obtained for PCT (0.92) and neopterin (0.90), and slightly lower values were recorded for the ratios neopterin to IL-12 (0.79) and IL-10 to IL-12 (0.75). None of the markers or ratios were good for differentiating non-bacteremic infections from neoplastic fever, the AUC values rangin from 0.27 for ESR to 0.61 for IL-10 to IL-12 ratio. The simultaneous use of the ratio of neopterin to IL-12 with its high sensitivity (82%) and that of IL-10 to IL-12 with its high specificity (90%) should be further studied.

Coccidioidomycosis, or Valley Fever, is an infectious disease caused by inhalation of soil-dwelling fungus Coccidioides posadasii spores in the Lower Sonoran Life Zone (LSLZ) in Arizona. In the context of climate change, the habitat of environmentally-mediated infectious diseases, such as Valley Fever, are expected to change. Connections have been drawn between climate and Valley Fever infection. The operational scale of the organism is still unknown. Here, we use climatic variables, including precipitation, soil moisture, and temperature. We use PRISM precipitation and temperature data, and Moderate Resolution Imaging Spectroradiometer (MODIS) Normalized Difference Vegetation Index (NDVI) as a measure of soil moisture for the entire state of Arizona, divided into 126 primary care areas (PCA). These data are analyzed and regressed with Valley Fever incidence to determine the effects of climatic variability on disease distribution and timing. This study confirms that Valley Fever occurrence is clustered in the LSLZ. Seasonal Valley Fever outbreak was found to be variable year-to-year based on climatic variability. The inconclusive regression analyses indicate that the operational scale of Coccidioides is smaller than the PCA region. All variables are related to Valley Fever infection, but one variable was not found to hold more predictive power than others.

Background Hay fever is typically poorly managed, particularly in adolescents, in whom it is responsible for considerable morbidity and impairment in educational performance. Evidence-based training of professionals has the potential to improve outcomes, but it can be expensive and so warrants formal evaluation. This trial sought to evaluate the effectiveness of a training intervention for primary care-based health care professionals on adolescent disease-specific quality of life. Methods A cluster randomised controlled trial was conducted in UK general practices. Practices were centrally randomised to a short, intensive training course on the evidence-based management of hay fever (intervention arm) or distribution of guidelines (control arm). The primary outcome measure was the change in the validated Rhinoconjunctivitis Quality of Life Questionnaire with Standardized Activities (RQLQ(S)) score in adolescents with hay fever between baseline and six weeks post-intervention (minimal clinically important difference = 0.5). Secondary outcome measures included health care professionals’ knowledge and confidence in managing hay fever, number of hay fever-related consultations, relevant treatments prescribed and symptom scores. Multi-level modelling using a random effects model was used to take account of between and within cluster variation, adjusting for strata, individual covariates and year of study. Results Thirty-eight general practices were randomised (20 in the intervention arm) and 246/341 patients (50.2% male, mean age 15 years) were included in the primary outcome analysis. Health care professionals’ self-assessed knowledge and confidence improved (prescribing/recommending treatment mean score 95% CI 1.4, 2.8), and the training was perceived to be of value. This did not however result in clinically or statistically significant improvements in RQLQ(S): -0.15, 95% CI -0.52 to +0.21. There were no differences in consultation frequency (95% CI -0.02, +0.63), treatments issued for hay fever (95% CI -0.24, +0.08) or symptom scores (95% CI - 1.03, +0.54). Conclusions Although attendance on this short, intensive hay fever training course was associated with professionals’ increased self-assessed confidence and understanding of the clinical management of hay fever, this did not translate into improvements in disease-specific quality of life or reduction in rhinitis symptoms in adolescents with hay fever.

M.Tech. / Allergic rhinitis is on the increase around the world affecting between 15-20% of the global population and is the most common chronic condition of children in South Africa. Luffeel® is a propriety complex homeopathic product manufactured by Biologische Heilmittel Heel. It is available in nasal spray and tablet form. These two forms are designed to work in combination with each other in the treatment of allergic rhinitis. The aim of this study is to determine the effect of a combination of Luffeel® nasal spray and Luffeel® tablets on allergic rhinitis using Phadiatop® tests, RAST Inhalant screens and subjective evaluation on symptoms such as nasal itching, sneezing, congestion, discharge, ocular redness and itching as indicators. This study was a double-blind, placebo-controlled study conducted at the University of Johannesburg, Doornfontein campus over a period of eight weeks. Thirty participants were recruited by poster advertisement. It can be concluded that Luffeel® nasal spray and Luffeel® tablets decrease the symptoms of allergic rhinitis, when compared to the placebo, thus giving persons suffering from allergic rhinitis an alternative treatment with no rebound or lethargic effects. It can also be concluded that this study that Luffeel® nasal spray and Luffeel® tablets has no significant effect on Phadiatop® and RAST inhalant screens over an eight week period. The results are inconclusive due to the small sample size and short time frame of the study.

Milk fever (parturient paresis / hypocalcaemia) is a metabolic disorder that usually occurs near parturition and at the onset of lactation in high producing multiparous dairy cows. Milk fever can indirectly contribute to an increased incidence of several diseases in early lactation. This study was conducted to compare two different feeding strategies to prevent milk fever, namely (i) the established concept of feeding a diet with a negative DCAD and (ii) a feeding strategy combining a negative DCAD supplement with 25-hydroxyvitamin D3 (25-OH-D3). Thirty dairy cows were used in a randomized block design and were selected and blocked by parity (second parity and later), 305 day mature equivalent milk production in the previous lactation and expected calving date. Within each of the 15 blocks, the cows were allocated to two experimental groups named DCAD and DCAD + HyD. Fifteen animals in the DCAD + HyD group received a daily oral dosage of 3 mg of 25-OH-D3. Plasma samples were collected from day 21 prepartum to 10 days postpartum and were analysed for 25-OH-D3, 1,25-dihydroxyvitamin D3, total and ionized calcium, phosphorus and magnesium. Samples were collected on day 21, 14, 10 prepartum and every second day to calving, 4 and 6 h postpartum and every second day up to day 10 after calving. Urinary samples for determination of macro minerals (calcium and phosphorus) were collected via manual stimulation on day 21, 14, 8 and 4 prepartum and day 4 postpartum. These samples were used to ensure that mild metabolic acidosis was achieved in both treatment groups. The metabolic acidosis was demonstrated by decreased urinary pH. Milk samples were collected on day 1, 4 and 10 postpartum and used for macro mineral (calcium and phosphorus) determination. This study did not achieve all of the expected results observed in similar experiments. No treatment differences could be detected for plasma Ca2+ concentrations (P>0.05) and the mean plasma Ca2+ concentrations were [1.086a mmol/L ± 0.010 (DCAD treatment) and 1.083a mmol/L ± 0.010 (DCAD + HyD treatment)] respectively.   Furthermore 1,25-(OH)2D3 plasma concentrations did not indicate any treatment differences (P>0.05). These results could be due to the fact that the experimental animals were not sufficiently challenged and therefore the combination of a low DCAD diet and Rovimix HyD did not influence the calcium homeostatic mechanisms as expected. A clear correlation between plasma 25-OH-D3 concentration and treatment duration was however demonstrated (P<0.001), indicating effective absorption of orally supplemented 25-OH-D3. Several authors demonstrated that feeding massive doses of vitamin D2 (30 million units) for extended periods led to clinical evidence of vitamin D toxicity. When 10 million IU of vitamin D3 were however administered intramuscularly within 10 days of parturition, a reasonable measure of protection against toxicity could be provided. It can be concluded from this study that longer feeding periods (± 21 days) than the proposed 10 days prior to calving can safely be implemented when feeding 3 mg 25-OH-D3 per animal per day (=240 mg Rovimix HyD 1,25%). Copyright / Dissertation (MSc(Agric))--University of Pretoria, 2012. / Animal and Wildlife Sciences / unrestricted

A dissertation submitted in partial compliance with the requirements for the Master's Diploma in Technology: Homoeopathy at Technikon Natal, 1994. / The purpose of this study was to evaluate the efficacy of simillimum and allergen treatment to patients allergic to mixed grass pollens in terms of patients' responses to RAST and patients' percept ion of the effectiveness of treatment in order to identify key issues calling for the selection of the most effective method of treatment. / M

An epidemiological survey of Valley Fever (coccidioidomycosis) was conducted in dogs in Tucson and Phoenix. Dogs were tested for delayed type hypersensitivity (DTH) using coccidioidin, a reagent that is not commercially available and results of the skin tests were compared with corresponding serologic test results.

Dogs in the Tucson area with a known history of clinical Valley Fever were tested with two skin test reagents to determine their ability to detect delayed type hypersensitivity (DTH) to the Coccidioides spp. The reagents used were Spherusol, from Nielsen Biologicals, and coccidioidin, which is no longer commercially available. Skin tests were read 48 hours after placement and evaluated for erythema and/or induration.

Histopathology of a murine lymph node, 9 days post infection with Coccidioides. Magnification 10X

Rift Valley fever (RVF) is a peracute or acute disease of domestic ruminants and humans in sub-Saharan Africa, caused by a mosquito-borne virus. It is a high priority pathogen because of its potential to cause severe economic harm to the livestock industry and to cause life threatening haemorrhagic disease in humans. The disease was first recorded in southern Africa when a large epidemic occurred in the South Africa in 1950, and the first recorded outbreak in Namibia was in 1957. Since then, occasional large epidemics have occurred in southern Africa, with long interepidemic periods. The epidemiology of RVF is complex and many questions regarding the movements of the virus and its survival during the interepidemic period remain unanswered. The aim of this study was to compile a comprehensive description of the history of RVF in Namibia and to describe its epidemiological characteristics. This was accomplished using information available in the scientific literature, annual reports, disease reports and reports to the OIE. The geographical location and temporal occurrence of each outbreak was recorded as accurately as allowed by available records. Also recorded were suspected RVF outbreaks, defined as those outbreaks in which samples were not collected for laboratory analysis or RVF was not confirmed on submitted samples but where the clinical picture was suggestive of the disease. Serological surveys done in humans and animals were also included in the study. The collected data were analysed descriptively, by risk mapping and by cluster analysis. The relatively low number of recorded outbreaks and the poor spatial resolution of much of the data prevented more detailed multivariable analysis. Maps were produced to show the districts affected for the outbreaks with no coordinates and the exact location of the outbreaks which had coordinates. This was then followed by a detailed description of each outbreak showing the species affected and the mortalities caused. Risk mapping was done to identify areas of the country which are at high risk of having outbreaks. A quarter degree square grid was used to show the cumulative number of confirmed outbreaks occurring from 1957 to 2011. The accuracy of this was, however, limited due to the poor spatial resolution of data prior to 1986, which recorded only the district(s) affected. The risk map was visually compared with maps of sheep and cattle density and rainfall. A space-time permutation model, using case-only data, was used to detect space-time clusters with high rates, using SaTScan software on all the confirmed outbreaks with GPS coordinates. The objective was to detect areas of significantly high rates of RVF in Namibia, testing whether the outbreaks were randomly distributed over space and time. Space time permutation requires the use of precise geographic coordinates; therefore the only confirmed outbreaks that could be used for this analysis were those occurring during 2010 and the 2011. A total of six years had outbreaks of RVF in Namibia, the major outbreaks occurring in 1957, 1974, 1984, 2010 and 2011. Rift Valley fever was confirmed in the Karas, Hardap, Khomas, Erongo, Otjozondjupa, Omaheke and Oshikoto regions, with suspected outbreaks occurring in the Kavango and Caprivi regions. SaTScan analysis showed that there were two statistically significant outbreak clusters observed, one in the Hardap region in 2010 and the other in the Oshikoto region in 2011. The south-eastern part of the country was shown to be predisposed to RVF outbreaks; this correlated with sheep population density. The southern part of Namibia receives less rainfall and is hotter than the north, with colder winters, factors which may reduce vector and virus survival and therefore limit continuous viral circulation. This likely renders livestock highly susceptible to infection and if there is an introduction of the virus a severe epidemic may occur. In the Northern Communal Areas and adjacent Etosha National Park the positive serological results in humans and wildlife show that there is continuous or intermittent low level circulation of the virus. This could be leading to high levels of herd immunity and hence no confirmed outbreaks recorded in these areas to date. Nevertheless, all suspected cases should be tested for RVF to avoid misdiagnosis and under-reporting of cases. / Mini-dissertation (MSc)--University of Pretoria, 2015. / tm2016 / Veterinary Tropical Diseases / MSc / Unrestricted