Summary:growth factor combinations with G-CSF might enhance these differences. Keywords: G-CSF; GM-CSF; stem cell mobilization Fifty patients with either lymphoid or selected solid tumor malignancies were apheresed an identical number of times for PBSC collection after being randomized to receive either G-CSF 10 g/kg/day alone (arm I), or PBSC collected using several different strategies to G-CSF at the same dose with GM-CSF 5 g/kg/day enhance the number of circulating progenitor and CD34 + (arm II). Growth factor(s) was/were given as the stem cells results in equally rapid neutrophil recovery after cell mobilizing agent for 5 days before the start of PBSC HDCT as autologous bone marrow transplant (ABMT) collection, and were continued throughout the 4 days of given in combination with recombinant myeloid growth apheresis. Aspiration and cryopreservation of autologfactors (GF). [1][2][3][4] However, platelet recovery is particularly ous bone marrow occurred on day 3 or 4 of growth enhanced after PBSC infusion compared with ABMT. 4-17 factor(s). Thirty-one of 50 patients received one cycleAlthough PBSC may be collected in the steady-state, only at time of evaluation, and 19 patients received two mobilization techniques increase the pool of circulating cycles of HDCT, each supported with PBSC with or progenitor cells and decrease the total number of required without autologous bone marrow. No patients received apheresis procedures. Approaches to PBSC mobilization growth factors post-autologous stem cell transplant, include chemotherapy and/or single or multi-agent GF unless the absolute neutrophils count (ANC) failed to administration; 18-28 however, the optimal method for PBSC recover to у100/l by day +18 post-transplant. The mobilization is unknown. Investigators have used G-CSF median number of days to recovery of ANC to 100/l, alone, 5,29-32 GM-CSF alone, 33,34 and combinations with 500/l and 1000/l, and of platelet counts to 20 000/l, interleukin-3 (IL-3) or stem cell factor (SCF) to mobilize 50 000/l and 100 000/l after either cycle 1 or cycle 2 progenitor cells into the circulation. [34][35][36][37][38][39] No reported ranof HDCT and the number of febrile days and platelet domized studies exist to evaluate the superiority of one GF and PRBC transfusion requirements was not signifiover another for stem cell mobilization. Small studies cantly different between the two arms of the study. The reported suggest that a sequential combination of IL-3 with duration of hospitalization was similar between study G-CSF may induce a PBSC product which enhances platearms for cycle 1 of HDCT, but was 3.5 days less with let recovery over G-CSF alone. 36,37 Studies evaluating the arm II compared to arm I (P = 0.0248) for cycle 2 of quality of PBSC products using surrogate markers of stem HDCT. The bone marrow buffy coat and PBSC product cells such as the quantity of CD34 + cells and colonymononuclear cell count (؋ 10 8 /kg) and CD34 ؉ cell count forming unit granulocyte-macrophage (CFU-GM), [38][39][40][41][42][43][44][45] (...

Objective This study describes clinical profiles including human immunodeficiency virus (HIV) disease history and seizure etiology among children living with HIV presenting with new‐onset seizure during the era of antiretroviral therapy (ART) in Zambia. 30‐day mortality and cause of death are also reported. Methods Children living with HIV (CLWHIV) with new‐onset seizures were prospectively evaluated at one large urban teaching hospital and two non‐urban healthcare facilities. Interviews with family members, review of medical records, and where needed, verbal autopsies were undertaken. Two clinicians who were not responsible for the patients' care independently reviewed all records and assigned seizure etiology and cause of death with adjudication as needed. Results From April 2016 to June 2019, 73 children (49 urban, 24 rural) were identified. Median age was 6 years (IQR 2.2‐10.0) and 39 (53%) were male children. Seizures were focal in 36 (49%) and were often severe, with 37% presenting with multiple recurrent seizures in the 24 hours before admission or in status epilepticus. Although 36 (49%) were on ART at enrollment, only 7 of 36 (19%) were virally suppressed. Seizure etiologies were infectious in over half (54%), with HIV encephalitis, bacterial meningitis, and tuberculous meningitis being the most common. Metabolic causes (19%) included renal failure and hypoglycemia. Structural lesions identified on imaging accounted for 10% of etiologies and included stroke and non‐accidental trauma. No etiology could be identified in 12 (16%) children, most of whom died before the completion of clinical investigations. Twenty‐two (30%) children died within 30 days of the index seizure. Significance Despite widespread ART roll out in Zambia, new‐onset seizure in CLWHIV occurs in the setting of advanced, active HIV disease. Seizure severity/burden is high as is early mortality. Enhanced programs to assure early ART initiation, improve adherence, and address ART failure are needed to reduce the burden of neurological injury and premature death in CLWHIV.

ObjectiveEpilepsy affects approximately 50 million people globally, with approximately 80% living in low/middle-income countries (LMIC), where access to specialist care is limited. In LMIC, primary health workers provide the majority of epilepsy care, despite limited training in this field. Recognising this knowledge gap among these providers is an essential component for closing the epilepsy treatment gap in these regions.SettingIn Zambia, the vast majority of healthcare is provided by clinical officers (COs), primary health providers with 3 years post-secondary general medical education, who predominantly work in first-level health centres around the country.ParticipantsWith cooperation from the Ministry of Health, a total of 10 COs from 4 surrounding first-level health centres around the capital city of Lusaka participated, with 9 completing the entire course.InterventionCOs were trained in a 3-week structured course on paediatric seizures and epilepsy, based on adapted evidence-based guidelines.ResultsPreassessment and postassessment were conducted to assess the intervention. Following the course, there was improved overall knowledge about epilepsy (69% vs 81%, p<0.05), specifically knowledge regarding medication management and recognition of focal seizures (p<0.05), improved seizure history taking and appropriate medication titration (p<0.05). However, knowledge regarding provoked seizures, use of diagnostic studies and general aetiologies of epilepsy remained limited.ConclusionsThis pilot project demonstrated that a focused paediatric epilepsy training programme for COs can improve knowledge and confidence in management, and as such is a promising step for improving the large epilepsy treatment gap in children in Zambia. With feasibility demonstrated, future projects are needed to expand to more rural regions for more diverse and larger sample of primary health provider participants and encompass more case-based training and repetition of key concepts as well as methods to improve and assess long-term knowledge retention.

Background: Neurocysticercosis (NCC) is the most common parasitic infection of the brain and a leading cause of epilepsy in resource-limited settings. While NCC and Human Immunodeficiency Virus (HIV) co-infections have commonly been reported, there is little data on how they interact. As part of an observational study of HIV and cognition in Lusaka, Zambia, we identified a cluster of subjects with NCC. We hypothesized that neighborhood of residence may be an important factor driving clustering of NCC.Methods: 34 subjects with HIV and 13 subjects without HIV (ages 8-17) were enrolled in a prospective cohort study. All subjects had Magnetic Resonance Imaging (MRI) of the brain performed and were evaluated for NCC. Standardized interviews were conducted to identify potential risk factors for NCC. Quantitative Geographic Information Systems (QGIS) was utilized to investigate the relationship between neighborhood of residence, HIV, and NCC.Results: Three of 34 subjects with HIV (8.82%) and one of 13 controls were found to have NCC. Geographic cluster analysis demonstrated that all subjects with NCC were clustered in two adjacent neighborhoods (Chawama and Kanyama) with lower rates of piped water (C-22.8%, K-26.7%) and flush toilets (C-14.0%, K-14.0%) than surrounding neighborhoods.

In much of sub-Saharan Africa, lumbar punctures (LPs) are performed less frequently than indicated. This is often attributed to patient/family refusal; however, other factors have not been systematically evaluated. We investigated predictors of LP performance for a prospective cohort of people with HIV and new-onset seizures at three hospitals in Zambia. We enrolled 257 participants, including 184 (72%) adults and 144 (56%) urban participants. LPs were performed for 65% of adults and 33% of children, and for 69% of urban and 38% of rural participants. In multivariate logistic regression analyses, LP completion was significantly less likely at one rural site and among children compared to adults. The Worst WHO HIV disease stage was associated with increased odds of undergoing LP. Low LP completion rates in Zambia are multifactorial and related to health system and provider factors and patient/family preferences. Further research is necessary to understand this complex problem and develop interventions to improve LP uptake.