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Objectives: This study sought to evaluate patient-centered metrics in intermediate-surgical-risk aortic stenosis patients enrolled in the SURTAVI (Surgical Replacement and Transcatheter Aortic Valve Implantation) trial treated with self-expanding transcatheter aortic valve replacement (TAVR) or surgery. Background: Studies have shown TAVR to be an alternative to surgery in patients with severe symptomatic aortic stenosis but have focused on “hard endpoints,” including all-cause mortality and stroke, rather than on comparative patient-centered metrics, such as functional status and symptom burden. Methods: The study analyzed functional status (6-minute walk test [6MWT]) and symptom burden (Kansas City Cardiomyopathy Questionnaire) in 1,492 patients from the SURTAVI trial at baseline, 30 days, 1 year, and 2 years. Patients were categorized by baseline functional status into tertiles of slow, medium, and fast walkers. Results: Patients with lowest capacity baseline functional status were commonly women, had higher Society of Thoracic Surgeons scores, and had more New York Heart Association functional class III or IV symptoms; reduced baseline functional status was associated with higher aortic valve– and heart failure–related hospitalization at 2 years. There was greater improvement in 6MWT distance in TAVR compared with surgery patients at 30 days (P < 0.001) and 1 year (P = 0.012), but at 2 years, both groups had similar improvement (P = 0.091). The percentage of patients with large improvement in 6MWT was greatest in patients categorized as slow walkers and lowest in fast walkers. Symptom burden improved after TAVR at 30 days and after both procedures at 1 and 2 years. Conclusions: In this substudy of patients from the SURTAVI trial, patients receiving TAVR demonstrated a more rapid improvement in functional status and symptom burden compared with patients undergoing surgery; however, both groups had similar improvements in long-term follow-up.

The pathogenesis of Trypanosoma brucei rhodesiense was studied in 42 cattle experimentally infected with different isolates from Kenya, Ethiopia and Tanzania. Nineteen of the cattle died or were terminated in extremis 3-60 months post inoculation. Nine of 11 isolates tested produced central nervous system (CNS) disorder in the cattle. The CNS disorders developed early (3 months) in some animals and later (60 months) in others. Parasites were difficult to find on wet blood smears or by subinoculations of blood after the fourther month of infection. Parasites persisted in lymph nodes, however. It appears that the bovine is a suitable model for T.b. rhodesiense infection with syndromes similar to those in human infections. Berenil (R) treatment of hosts and subsequent transmission of T. congolense and T. vivax by tsetse flies were investigated. The complement fixation (CF) test and the micro-ELISA were compared in the diagnosis of visceral leishmaniasis, Originator-supplied keywords include: Glossina morsitans, kala-azar, Leishmania donovani, and Complement fixation test.

An outbreak of human sleeping sickness was investigated in the Lambwe Valley, Kenya. A total of 358 cattle and 500 people from the epidemic area were examined. Of 15 cattle showing central nervous system dysfunction, 13 were positive for Trypanosome brucei sp., and all of these 13 had typical Trypanosome rhodesiense - type brain lesions. Isolates collected from humans and cattle were cryopreserved for comparison with previous isolates from the area. Isolates from humans and cattle are being compared using neutralization techniques. (Author)

Investigators continued to monitor the antigenic stability of parasites from western Kenya. Current evidence indicates that there was a significant antigenic shift in the 1980-81 outbreak. Epidemiology and treatment record analysis studies continued. A treatment center was opened in western Kenya situated north of the Lambwe Valley endemic area and to the east of the Ugandan epidemic area. This center will serve as a routine treatment facility and research facility for the evaluation of standard drugs available and USMRDC developed drugs effective in screens against human African trypanosomiasis. An experimental compound WR 163577 is being evaluated in the goat model against T. brucei infection.