In the setting of pulmonary hypertension cheap kamagra gold 100mg line erectile dysfunction viagra not working, pulmonary reactivity to vasodilators should be documented and a net left-to-right shunt demonstrated during catheterization before consideration for closure discount 100 mg kamagra gold with amex impotence young adults. Alternatively, the defect can be temporarily balloon occluded at the time of catheterization, and the hemodynamic effects are directly measured. Generally, surgical closure is the treatment of choice for ostium primum, sinus venosus, and coronary sinus defects. Ostium primum defects require patch closure as well as repair of the likely cleft mitral valve. Repair of sinus venosus defects is technically more challenging, as the pulmonary veins often have anomalous drainage and require rerouting. Important preoperative risk factors include older age at operation, presence of atrial fibrillation, and elevated pulmonary pressure and resistance. Postoperatively, patients are at risk for heart block, which is a significant complication in these cases. They are also at risk for postpericardiotomy syndrome, more so than after other surgery for congenital defects. In some centers, prophylactic β-adrenergic blockade is advocated empirically for 3 to 6 months after surgery. Catheter closure decreases hospital length of stay, avoids surgical wounds and their possible complications, and significantly speeds up postprocedure recovery. With the devices available today, defects with a resting diameter of <35 mm may be considered. In general, the gently stretched diameter of the defect is approximately 6 to 8 mm greater than the resting diameter. The Amplatzer device consists of two disks made of Nitinol wire mesh filled with polyester fabric and separated by a narrower waist, which is appropriately fitted by balloon sizing. It is inserted percutaneously through a 6F to 12F sheath, depending on the device size required. The Helex device is also disk-like and consists of expanded polytetrafluoroethylene patch material supported by a single Nitinol wire frame. Major complications, such as cardiac perforation or device embolization, occur very rarely (generally fewer than 1% of cases), and successful closure of the defect is achieved in up to 95% of all patients. After closure, antiplatelet therapy, frequently aspirin and clopidogrel, is prescribed for a minimum of 6 months, after which time the device is generally believed to be endothelialized. Long-term outcomes can be improved by closing these defects, especially if performed early in life. Atrial arrhythmias are common, especially in older patients, and are the result of long-standing atrial stretch. Arrhythmias, particularly atrial flutter and fibrillation, contribute to a significant portion of the morbidity and mortality of older patients, particularly the risk of systemic embolization and the resultant stroke. It has been demonstrated that age at the time of surgical repair is inversely related to the risk of subsequent atrial fibrillation or flutter after repair and argues for earlier closure. Some have advocated for consideration of a concomitant ablation procedure in high-risk patients, but the available data do not generally support this. Generally these defects are asymptomatic, most often coming to attention in patients with cryptogenic (unexplained) stroke. A simple way to determine if a shunt is present is the “bubble study,” which is the injection of agitated saline via an upper extremity vein. If shunting is not present at rest, the patient can perform a Valsalva maneuver, which augments right-to-left shunt. Generally, administration of agitated saline in patients with suspected right-to-left shunts is considered safe, but there have been rare case reports of cerebral ischemic events from passage of bubbles into the systemic circulation. In general, atrial septal abnormalities are not treated for primary prevention of stroke. Regarding secondary prevention, most patients with neurologic events are treated with antiplatelet agents (either aspirin or a thienopyridine, or both), anticoagulants (warfarin), and percutaneous or surgical closure, although no clear consensus exists. Several randomized controlled studies have failed to demonstrate a benefit of closure over medical therapy by intention-to-treat analysis. There were several significant limitations to these trials (short duration of follow-up, low event rates, attrition bias) that preclude definitive conclusions regarding the merits of closure. Patient selection for device closure is critical as is excluding other potential sources of stroke. Device closure is mainly performed in patients with recurrent cryptogenic stroke despite aggressive medical therapy. After 6 months, there was no statistically significant difference in the primary end point of complete cessation of migraine headache or in a host of secondary end points including change in severity, quality, and frequency of headache as well as quality of life. As such, device closure should only be performed in migraine patients who are part of a randomized clinical study. Comparison between transcatheter and surgical closure of secundum atrial septal defect in children and adults: results of a multicenter nonrandomized trial. Prevalence and repair of intra-operatively diagnosed patent foramen ovale and association with perioperative outcomes and long-term survival in patients undergoing cardiothoracic surgery. Recurrent cerebrovascular events associated with patent foramen ovale, atrial septal aneurysm, or both. Long-term outcomes of patent foramen ovale closure or medical therapy after stroke. Survival patterns without cardiac surgery or interventional catheterization: a narrowing base. The prevalence in neonates has been reported to be as high as 5% when screened with color Doppler echocardiography, although most of these are miniscule defects that close spontaneously within the first year. Thus the true prevalence is difficult to ascertain, given that many defects close spontaneously and patients are frequently asymptomatic with smaller lesions. Unlike many other congenital abnormalities, males and females appear to be affected equally. This reflects the natural tendency for spontaneous closure during infancy and an improved ability to confirm the diagnosis in childhood, which leads to surgical closure. These higher rates of spontaneous closure in more recent series are a reflection of the ability to diagnose much smaller defects with contemporary echocardiographic modalities. Large and nonrestrictive defects have significantly lower spontaneous closure rates (approximately 10% to 15%); malalignment defects rarely close spontaneously. Defects close by two mechanisms: (1) by muscular septum growth and (2) by “aneurysmal tissue” from a septal leaflet of the tricuspid valve as in the case of perimembranous defects. Endocarditis is a risk because of the presence of a high-velocity, turbulent jet into the right ventricle. Endocarditis most frequently involves the septal leaflet of the tricuspid valve apparatus at the point of jet impact. The incidence of endocarditis varies widely in the literature, but ranges from 1% to 15%. Children with very large defects usually present during infancy or early childhood with signs and symptoms of heart failure and pulmonary hypertension.
A physician/investigator who participates in research by administering the new drug to consenting patients should ensure that the patients understand and remember that the drug is experimental and that its benefits for the condition under study are yet unproven order kamagra gold mastercard erectile dysfunction doctors naples fl. Use of a placebo in drug trials and sham surgery has come under severe scrutiny at the present age and requires careful consideration before approval cheap kamagra gold uk erectile dysfunction treatment honey. Denial of the available treatment to control (placebo) group of patients is unethical. After the clinical trial is over, if need be, it should be made mandatory that the sponsoring agency should provide the drug to the patient till it is marketed in the country. This is important when on interim analysis the test drug is found to be clearly more effective or less effective than the standard drug. The trial can be discontinued thereafter and better drug should be given to patient receiving less effective drug. No individual center should publish any data till appropriate authorities accept the combined report. Monitoring and Reporting adverse Reactions or Events Any serious adverse events occurring during the course of the trial should be immediately brought to the attention of ethics committee, sponsors and Drug Controller General of India. At the end of the trial, all adverse events whether related to trial or not are to be listed, evaluated and discussed in detail in the final report. The phases of these trials differ from drug trials as given below: Phase I: This refers to the first introduction of a vaccine into a human population for determination of its safety and biological effects including immunogenicity. This phase includes study of dose and route of administration and should involve low risk subjects. For example, immunogenicity to hepatitis B vaccine should not be determined in high-risk subjects. While prophylactic vaccines are given to normal subjects, therapeutic or curative vaccines may be given to patients suffering from particular disease. Special Concerns • Some vaccines that contain active or live-attenuated micro-organisms can possibly possess a small risk of producing that particular infection. However, for all the recombinant vaccines/products the guidelines issued by the Department of Biotechnology should be strictly followed. Clinical Trials with Surgical Procedures/Medical Devices Of late, biomedical technology has made considerable progress in the conceptualization and designing of bio-equipments. Several medical devices and critical care equipments have been developed and many more are in various stages of development. This is evidenced by the very low number of patents or propriety medical equipments manufactured and produced 236 Research Methodology for Health Professionals in the country. As the capacity of the country in this area is improving day by day, the need for a regulatory mechanism/authority is increasingly obvious. The concept of regulations governing investigations involving biomedical devices is, therefore, relatively new in India. At present, except for needles and syringes, these are not covered by the Drugs and Cosmetics Act, 1940. Until the guidelines are formulated and implemented by this Regulatory Authority clinical trials with biomedical devices should be approved on case to case basis by committees constituted for the specific purpose. Defnitions Medical devices: A medical device is defined as an inert diagnostic or therapeutic article that does not achieve any of its principal intended purposes through chemical action, within or on the body unlike the medicated devices which contain pharmacologically active substances which are treated as drugs. Such devices include diagnostic test kits, crutches, electrodes, pacemakers, arterial grafts, intra-ocular lenses, orthopedic pins and other orthopedic accessories. Non-critical devices–An investigational device that does not present significant risk to the patients, e. Critical devices–An investigational medical device that presents a potential serious risk to the health, safety or welfare of the subject for example, pacemarkers, implants, internal catheters. All the general principles of clinical trials described for drug trials should also be considered for trials of medical devices. As for the drugs, safety evaluation and premarket efficacy of devices for 1–3 years with data on adverse reactions should be obtained before pre-market certification. The duration of the trial and extent of use may be decided in case to case basis by the appropriate authorities. However, the following important factors that are unique to medical devices should be taken into consideration while evaluating the related research projects: • Safety data of the medical device in animals should be obtained and likely risks posed by the device should be considered. Ethical Issues in Health Research 237 • Medical devices not used regularly have less risk potential than those used regularly, for example, contact lens vs intraocular lenses. The patient information sheet should contain information on following procedures to be adopted if the patient decides to withdraw from the trial. Diagnostic agents–use of Radioactive Materials and X-rays In human beings, for investigation and treatment, different radiations— X-rays, gamma rays and beta rays, radiopaque contrast agents and radioactive materials are used. The relative risks and benefits of research proposal utilizing radioactive materials or X-rays should be evaluated. Special Concerns • Informed consent should be obtained before any diagnostic procedures. Clinical Evaluation of herbal Remedies and Medicinal Plants For the herbal remedies and medicinal plants that are to be clinically evaluated for use in the Allopathic System and which may later be used in allopathic hospitals, the procedures laid down by the office of the Drugs Controller General of India for allopathic drugs should be followed. This does not pertain to guidelines issued for clinical evaluation of Ayurveda, Siddha or Unani drugs by experts in those systems of medicine which may be used later in their own hospitals and clinics. All the general principles of clinical trials described earlier pertain also to herbal remedies. Special Concerns The herbal products can belong to either of the three categories given below: 1. A lot is known about the use of a plant or its extract in the ancient Ayurveda, Siddha or Unani literature or the plant may actually be regularly used by physicians of the traditional systems of medicine for a number of years. The substance is being clinically evaluated for same indication for which it is being used or as has been described in the texts. An extract or a compound isolated from a plant which has never been in use before and has not ever been mentioned in ancient literature, should be treated as a new drug, and, therefore, should undergo all regulatory requirements before being evaluated clinically. However, it needs to be emphasized that since the substance to be tested is already in use in Indian Systems of Medicine or has been described in their texts, the need for testing its toxicity in animals has been considerably reduced. Clinical trials with herbal preparations should be carried out only after these have been standardized and markers identified to ensure that the substances being evaluated are always the same. The recommendations made earlier regarding informed consent, inducements for participation, information to be provided to the subject, withdrawal from study and research involving children or persons with diminished autonomy. Epidemiological studies are of primary importance in a large developing country like ours where the natural history, incidence, prevalence and impact on morbidity and mortality of a variety of diseases are not known. It has usually been considered that epidemiology of infectious diseases is of prime importance in our country. However, the evolving pattern of change in the society with upward economic mobility and increasing number of middle classes would mean that a significant number of life-style related diseases such as Ischemic Heart Disease are increasing. There is very little information about this and it would be useful to undertake long-term cohort studies in different population groups. Observational and Experimental Designs of these studies are based on cross-sectional, case-control or cohort approaches. Scope of ethical guidelines for epidemiological studies is concerned with epidemiological research. Ethics in epidemiological studies is multidimensional covering clinical medicine, public health and the social milieu.
Generally respiratory symptoms subside increased leukotrienes produced by reduced within 48 hours of discontinuation of the drug but Prostaglandin synthesis order kamagra gold paypal erectile dysfunction inventory of treatment satisfaction edits. Hypersensitivity is intolerance like stomatitis discount kamagra gold 100 mg with amex erectile dysfunction foundation, dysphagia and nephrotic a common pathological event in interstitial pneu- syndrome. Hypersensitivity is an immunological peripheral eosinophilia and pulmonary function tests reaction from various antibodies like IgG, IgE showing obstuction rather than restrictive causing tissue injury. It is caused by free oxygen radical Radiologically bilateral reticulonodular shadows damage to alveolar epithelial and capillary endo- with bilateral pleural effusions are seen. Other than the temporal relation to the darone induced pneumonitis is diagnosed more causative drugs, there are no clinical or radiological easily by Gallium scintigraphy which helps to Drug-induced Respiratory Diseases 361 exclude primary cardiac arrythmias as a cause for thromboembolism is to discontinue heparin and radiological opacities and clinical symptoms like institution of anti-vitamin K treatment. The onset of toxicity is within few damage occurs is as follows: hours to few days. Hypersensitivity reaction: It is an immunological noncardiogenic pulmonary edema with predominant mediated lung disease presenting as pneumonitis neutrophil infiltration. Serum IgE and syndrome or alveolar hemorrhage is common positive skin tests to the offending drug confirms complication with D-penicillamine and has high the diagnosis. Oxidants: Lung damage occurs through free lazine, Procainamide, Chlorpromazine, D-penicilla- oxygen radicals and presents as pneumonitis. Altered collagen production: Collagen induced lung skin, kidney, blood involvement with antihistone damage either due to increased production or antibodies detected in the serum. The above drugs reduced degradation of collagen, clinically also cause mediastinal lymphadenopathy. Lipidosis: Crystalloid phospholipases intra-cellular iatrogenic pulmonary edema is also known. In or cytoplasmic inclusion bodies cause cell certain drugs like Mitomycin, Busulphan , Procar- damage. Clinically reversible interstitial lung bazine, Bromocryptine and Methysergide unilateral involvement also associated with multiorgan or bilateral pleural effusions either acute or chronic involvement. Lupoid reaction: Autoantibody induced lung is usually exudative with lymphocytic predominance damage occurs in cases with personal predis-. Drugs like oral steroid cause iatrogenic Clinical suspicion can be made depending on the Cushings which leads to mediastinal lipomatosis, presence of certain symptoms like fever , breathless- Methysergide causes mediastinal fibrosis which may ness, bronchospasm, lupus like presentation as lead to superior vena caval obstruction. High index of clinical Pulmonary vascular involvement: Pulmonary suspicion is very important for early diagnosis of hypertension leading to right heart failure caused drug induced respiratory disorders, but sometimes by appetite suppressant Aminorex occurs usually in it is very difficult to find out the exact site of lung 6 to 12 percent of cases. Proper correlation of clinicoradiological manifes- Pulmonary thromboembolism is known during tations with history of drug ingestion, e. Radiological correlation is very easy and non- • Acebutolol invasive but not all cases show positive cor- • Amiodarone relation, i. Pneumonitis and fibrosis: Appears like usual • Sulphasalazine interstitial pneumonia with predominant basal subpleural distribution. Role of High Resolution Computerized Tomo- this results in diffuse airspace consolidation graphy Scan of lung: that may have a dependent distribution. Ground glass pattern suggestive of pneumonitis logical drug and symptomatic treatment if neces- b. Usually, drug induced respiratory disorders reverse but sometimes corticosteroids are required to prevent further progression as well as to cure, D. Drug induced lung monoxide diffusion capacity (D ) in Bleomycin disease; 1990 review. High For example, granulomatous pneumonitis seen in Resolution Computerized Tomography of Drug induced methotrexate lung hazards. Shailly Saxena, Bavin M Shah, Jyotsna M Joshi Pulmonary Hydatidosis andPulmonary Hydatidosis andPulmonary Hydatidosis andPulmonary Hydatidosis andPulmonary Hydatidosis and 20 Pleuropulmonary AmoebiasisPleuropulmonary AmoebiasisPleuropulmonary AmoebiasisPleuropulmonary AmoebiasisPleuropulmonary Amoebiasis 20. Unilateral multiple foci are reported in 20 percent patients as most patients harbor only Cystic hydatid disease is a zoonotic infection of one solitary cyst with single organ involvement tapeworms of genus Echinococcus and species (80%). The frequency of cyst in the Various radiological signs are seen in case of hydatid literature is as follows: liver 60 to 75 percent, lung cyst of the lung depending whether the cyst is 15 to 25 percent and remaining parts of the body ruptured or not (Table 20. Central unruptured 10 to 15 percent including mediastinum, brain and cysts may present, as round homogenous nodular bone. Ruptured cyst produces several radiological appearances, as the The progressive growth of the cysts, their tendency cyst enlarges and comes in communication with the to erode the organs and tissues with which they bronchus, air may enter between the pericyst and come in contact, their infectivity and the existence the ectocyst which appears as a thin lucent crescent of intrathoracic pressure could explain the unusual in the upper circumference referred to as Crescent evolution of the cyst in the hepatic dome. Sometimes double crescent cyst of the lung can be located in any pulmonary shaped lucencies may be seen between the pericyst lobe and can consist of multiple foci in one or both and ectocyst, ectocyst and endocyst called as Double lungs. If the cyst itself ruptures and attacked area of the lung due to abundance of blood air enters the cyst outlined by double arch known flow to this area compared to other lobes of lung. Collapsed • Double arch of Ivanissevich membrane of parasite may give rise to radiological • Cumbo sign • Onion peel sign appearances described as serpent or snake sign (Fig. Polycyclic calcification when both mother and daughter cyst are calcified within the chest wall. A crushed eggshell sunburst appearance of calcification may result from prior rupture and Fig. Rarely daughter cyst may give appearance Treatment of “Rising sun” in the lower part of cavity. Response to medical therapy abscesses and fistulous tract can be picked up and is related to the thickness of the cyst wall, which hydatid cyst with detached membrane is seen with the drug must penetrate to reach the germinal layer, great precision. Surgery includes complete excision of the disease process with maximum preservation of the lung tissue, most authors advocate conser- vation of the lung parenchyma, reserving resection for ruptured cysts that result from destruction or infection of the adjacent tissue. Every patient who has hydatid cyst in the lung should be investigated for associated cyst in the liver. This procedure is usually reserved in patients where other methods have failed or in inoperable patients. Transdia-phragmatic Thoracic Involvement in Hepatic Hydatid Disease Presenting as Pneumonitis Right Base: A Case Report and Brief Review of the Literature. It is the third most common into the bronchus with little infiltration of the manifestation of amoebiasis in the body and is parenchyma or sometimes a lung abscess may probably a morbid entity. The disease predominantly rupture into a bronchus thus establishing a occurs in 3rd or 4th decade and in males with the hepatobronchial fistula. Rarely a homogeneous mass lesions with ill-defined margins, bronchobiliary fistula may occur due to turbid fluid with low echoes and hepatomegaly. Due to also differentiates empyema, air pockets in pleura complicated symptomatology, the most important and subphrenic region. Transverse and saggital prerequisite in the diagnosis of such cases is a high windows help to locate the site and dimensions of index of suspicion, especially true in countries like the abscess. Hemoptysis often precedes show the primary abscess in liver with subphrenic expectoration of dark reddish-brown sputum that collection and the rent in the diaphragm if present. Past history of dysentery, localized pain and tenderness over the liver area, right shoulder pain or persistent hiccough all indicate concomitant hepatic and subphrenic involvement. Diagnosis Apart from hematology and serum biochemistry, radiological and microbiological investigations are mandatory for diagnosis and therapeutics. Serological tests like indirect hemmaglutination test and Enzyme linked immunosorbent assay for antigen detection may support an amoebic etiology.
Another study found that giardiasis may be a risk factor for zinc defciency in schoolchildren in northwestern Mexico  purchase 100 mg kamagra gold with mastercard whey protein causes erectile dysfunction. They found that Entamoeba histolytica was negatively associated with growth in the 3-year observational period purchase kamagra gold online erectile dysfunction treatment non prescription. They suggested that malnutrition may in fact have predisposed the children to amoebiasis by suppressing the normally protective cell-mediated response. In addition to its humoral and cell-mediated arms, it relies on a number of additional factors such as complement, lymphokines, cytokines, phagocytic cells, and hormones. These pathways require additional energy and a constant supply of building blocks that would be provided by an optimum nutritional status. It would be safe to say that the nutritional status of the host determines outcomes of infection. The immune impairment in the face of macronutrient and micronutrient defciency is shown in Tables 9. However, malnourished children are defcient for protective IgE antibodies against A. While the concentrations of total IgE in malnourished children with helminth infec- tions are high, the antibodies are neither worm specifc nor protective. Diarrheal diseases in malnourished indi- viduals, especially children, further exacerbate the problem by decreasing nutrient uptake. Severe protein malnutrition in children has been shown to be associated with atrophy of the thymus and poorly developed peripheral lymphoid organs (lymph nodes and spleen). As the structure and function of this organ are diminished, so is the memory T-cell response to antigens . In a study to assess the infuence of nutrition on the outcome of Leishmania infection, a decrease in body mass index and mid-upper arm circum- ference by age z-scores for children with the disease was observed . Zinc Defciency and Parasitic Infections Studies conducted in a zinc-defcient, nematode-infected mouse model revealed that parasites are better able to survive in zinc-defcient hosts than in well-nourished hosts. Prolonged parasite infection results in suppressed local gut mucosa and systemic immune systems due to a combination of zinc defciency and energy restriction . Both Th1 and Th2 responses were impaired in zinc-defcient mice infected with nematodes . Other studies have shown that Trypanosoma cruzi and zinc defciency Impact of Malaria/Parasitic Infections on Human Nutrition 237 interact synergistically to increase mortality (80% vs. Selenium Defciency and Parasitic Infections Signifcant amounts of selenium are found in the liver, spleen, and lymph nodes, and its defciency can lead to the impairment of both cellular and humoral immune responses . Moreover, selenium has immune-stimulant properties that include enhanced clonal expansion and natural killer cell activity to antigen stimulation . Benefcial effects of selenium supplementation have been reported in murine models, and increasing severity of T. This might explain the decreased risk of mortality and morbidity from some forms of diarrhea in vitamin A-supplemented preschool children . Another study examining the rela- tion of intestinal parasite treatment and oral supplementation for iodine defciency revealed that intestinal parasites interfered with absorption, thereby reducing the effcacy of oral iodine supplementation . The most recent Cochrane database review examining the effects of deworm- ing drugs for soil-transmitted intestinal worms on nutritional indicators, hemoglo- bin, and school performance in children showed marked variability in results . While treating only infected children with a single dose of deworming medication may have increased weight and hemoglobin, cognitive function appeared unchanged. The Cochrane review concluded that there was a lack of good-quality data to deter- mine the effect of deworming on cognitive function. A double-blind placebo-controlled trial to evaluate the effect of vitamin A and zinc supplementation on gastrointestinal infections and growth among 584 infants aged 5–15 months was conducted in Mexico City. Vitamin A- and zinc-supplemented children infected with any parasite and zinc-supplemented children infected with either A. It was concluded that gastrointestinal parasite infections may modify the effect that zinc or vitamin A supplementation has on childhood growth . Parasitic infections impair growth and cognitive function, and deworming programs improve growth and possibly cognitive function. Interventions to prevent parasitic infections, such as deworming, are feasible, have a favorable cost–beneft ratio, and are paramount in improving the health of the community as a whole. Coupled with targeted nutritional supplemental programs, a great deal can be achieved in terms of productivity and health of the population in endemic areas. Nutrition plays a seminal role in modulating the morbidity and mortal- ity resulting from malarial and parasitic infections. Despite the complex interrelation between nutrition and parasitic infestations, overall the evidence emphasizes that mal- nutrition and specifc micronutrient defciencies exacerbate malaria and other parasitic infections and vice versa. The limited clinical trials done on micronutrient supplementa- tion, especially vitamin A and zinc, suggest that improving specifc nutrition defciencies by nutrition intervention programs is highly warranted. Nutritional programs should be coupled with general preventative strategies, such as provision of clean drinking water, sanitary facilities, better housing, mosquito nets, and measures to eliminate poverty to combat these debilitating diseases. It is paramount that the impact of these interventions is assessed periodically and systematically. Brooker, The health impact of polyparasitism in humans: Are we under-estimating the burden of parasitic diseases? Habicht, Epidemiologic evidence for a potentiating effect of malnutrition on child mortality. An investigation of fve hundred seriously ill children in whom a “clinical” diagnosis of malaria was made on admission to the children’s emergency room at University College Hospital, Ibadan. Beatty, Effect of joint iron and zinc supplementation on malarial infection and anaemia. Hayes, Attributable fraction estimates and case defnitions for malaria in endemic areas. Bazaz-Malik, Brain histomorphology in protein deprived rhesus mon- keys with fatal malarial infection. Targett, Resistance to superinfection with Plasmodium berghei in rats fed a protein-free diet. Sauerwein, How malaria modulates memory: Activation and dys- regulation of B cells in Plasmodium infection. Prasad, Zinc and immune function: The biological basis of altered resistance to infection. Nesheim, Iron defciency protects inbred mice against infection with Plasmodium chabaudi. International Nutritional Anemia Consultative Group, Safety of iron supplementation programs in malaria-endemic regions. Nesheim, Nutritional impact of intestinal helminthiasis dur- ing the human life cycle. Mathur, Effect of deworming and vitamin A administration on serum vitamin A levels in preschool children. Ajjampur, Giardiasis: A review on assemblage distribu- tion and epidemiology in India. Kierszenbaum, Alteration of the immune and nutritional status of mice by synergy between zinc defciency and infection with Trypanosoma cruzi.
Z. Zuben. Cazenovia College.