- Email: [email protected]
Arabic literacy
349
1 Correspondence
1
AIDS and leishmaniasis In the recent article bv Antunes er al. (1987: Transactions, 81, 595), reporting recrudescence of visceral leishmaniasis in a oatient with AIDS. the authors failed to mention thi dose, duration and the type of antimonial drug employed for the initial treatment of visceral leishmaniasis in that patient. More importantly, they have not mentioned whether parasitological cure after the first treatment was conlirmd~ e.g. by repeating marrow aspiration. It was only incidentally, after a suggestive liver biopsy done to exclude hepatotoxicity due to ketoconazole, that the suspected “recrudescence” of visceral leishmaniasis was confirmed by bone marrow aspiration. The second episode occurred four months after the initial attack. Bryceson et al. (1985: Transactions,79, 705714) have recommended prevention and early detection of relapse by adequate initial treatment and reassessmentof the patient at 2 and 6 months after treatment. These guidelines for uncomplicated cases of visceral leishmaniasis should be even more pertinent in immunocompromised patients with AIDS complicated by visceral leishmaniasis. Ahmed A. Abdel-Hameed Faculty of Medicine, University of Geziru, T$ Box 20, Wad Meduni, n 26 SeptemberI987 Arabic literacy Dr Greenwood and his colleagues (1987: Trunsuctions, 81, 534) may have developed a system which works for village health workers who, “though illiterate, have some famiharitv with Arabic scrint”. Unfortunately, the figure which they use to illusirate the system has obviously been drawn up by someone with no familiarity with Arabic, where numbers are written from Zefzto right, where zero is represented by a point and five by a near-circle, and where the hand-written (as opposed to printed) numeral for two has a flat top, and that for three a single arc (like the one that they draw for two). If no comprehension is required, why not stick to 1, 2, 3 etc.-which are, of course, Arabic not Roman numerals anyway! Medical Unit, Easteva General Hospital. Seujield Sweet, - . Edinburgh, EH6 7LN, UK
N. McD. Davidson
24 September1987
Arabic literacy: a reply Dr Davidson points out that there are inaccuracies in the Arabic numbering in the Figure used to illustrate our paper on a record system for illiterate village health workers (1987: TrutfFuctiofLs,81, 534). The numbering and script of the record card and register depicted were written by a senior Gambian field worker using the style with which he is familiar.
Subsequent checks with other Gambians, literate in local and standard Arabic, have confumed that the designations he used are in agreementwith the way in which Arabic is frequently written in The Gambia for example numbering from right to left rather than left to right. As in the case of other international languages, such as English, local variations in usage are to be expected. We suggestedthat, if a record system of the kind that we have described is to be adopted, symbols should be used with which the study population has somefamiharity. Although many village health workers in The Gambia are illiterate, most have some knowledge of Arabic script. We have, therefore, used Arabic numbers and letters for our record system written in a style with which the local population is familiar. This has achieved its purpose, even if grammatically incorrect. B. M. Greenwood Medical Reseurch Council Laboratories, Faa;im-eg Bmiyl, 4 NovemberI987 In vitro microtest for chloroquine
resistance of
Plasmodium fdciparum
As technical advisers to the microtest production unit in the Philippines which produces the microtest plates for the WHO standard in viwo microtest kit, we were most interested to read the short report by S. Sinha & A. Gaianana in the Trunsucrions(1987. vol. 81, p. 513) on the batch variations they found in the predosed chloroquine plates. Unfortunately, because of its brevity, the report did not include a sufficiently detailed account of their methods for us to make a thorough assessmentof their study but we believe that the following observations would be useful. The study was conducted in August and December 1985 on plates with production dates which ranged from 27-3.1984 (C/22) to 13.5.1985 (c/51). Consequently, the age of the plates ranged from a possible maximum of 20 months to a possible minimum of 4 months. Both these times fall well within the accepted minimum shelf-life of 24 months. The absence of any interplate or intraplate variation in minimum inhibitory concentration (MIC) was to be expected, since the mechanical system of dosing of the plates and the gravimetric and volumetric quality controls on the dosing apparatus and the dosed test plate make it practically impossible for any significant variation to occur from well to well on any specific plate or within a batch of plates. Over 3 years of external quality control testing by an independent laboratory in the USA, no batch of test plates has ever varied by more than + 10% from the desired drug doses (1 pmol to 32 pmol following a geometric progression with the factor 2). If we assume,therefore, that (a) the method used to evaluate the various batches of plates was completely uniform, (b) it closely followed the accepted incubation times of 24-30 h and (c) a standardized incuba-
1 Correspondence
1
AIDS and leishmaniasis In the recent article bv Antunes er al. (1987: Transactions, 81, 595), reporting recrudescence of visceral leishmaniasis in a oatient with AIDS. the authors failed to mention thi dose, duration and the type of antimonial drug employed for the initial treatment of visceral leishmaniasis in that patient. More importantly, they have not mentioned whether parasitological cure after the first treatment was conlirmd~ e.g. by repeating marrow aspiration. It was only incidentally, after a suggestive liver biopsy done to exclude hepatotoxicity due to ketoconazole, that the suspected “recrudescence” of visceral leishmaniasis was confirmed by bone marrow aspiration. The second episode occurred four months after the initial attack. Bryceson et al. (1985: Transactions,79, 705714) have recommended prevention and early detection of relapse by adequate initial treatment and reassessmentof the patient at 2 and 6 months after treatment. These guidelines for uncomplicated cases of visceral leishmaniasis should be even more pertinent in immunocompromised patients with AIDS complicated by visceral leishmaniasis. Ahmed A. Abdel-Hameed Faculty of Medicine, University of Geziru, T$ Box 20, Wad Meduni, n 26 SeptemberI987 Arabic literacy Dr Greenwood and his colleagues (1987: Trunsuctions, 81, 534) may have developed a system which works for village health workers who, “though illiterate, have some famiharitv with Arabic scrint”. Unfortunately, the figure which they use to illusirate the system has obviously been drawn up by someone with no familiarity with Arabic, where numbers are written from Zefzto right, where zero is represented by a point and five by a near-circle, and where the hand-written (as opposed to printed) numeral for two has a flat top, and that for three a single arc (like the one that they draw for two). If no comprehension is required, why not stick to 1, 2, 3 etc.-which are, of course, Arabic not Roman numerals anyway! Medical Unit, Easteva General Hospital. Seujield Sweet, - . Edinburgh, EH6 7LN, UK
N. McD. Davidson
24 September1987
Arabic literacy: a reply Dr Davidson points out that there are inaccuracies in the Arabic numbering in the Figure used to illustrate our paper on a record system for illiterate village health workers (1987: TrutfFuctiofLs,81, 534). The numbering and script of the record card and register depicted were written by a senior Gambian field worker using the style with which he is familiar.
Subsequent checks with other Gambians, literate in local and standard Arabic, have confumed that the designations he used are in agreementwith the way in which Arabic is frequently written in The Gambia for example numbering from right to left rather than left to right. As in the case of other international languages, such as English, local variations in usage are to be expected. We suggestedthat, if a record system of the kind that we have described is to be adopted, symbols should be used with which the study population has somefamiharity. Although many village health workers in The Gambia are illiterate, most have some knowledge of Arabic script. We have, therefore, used Arabic numbers and letters for our record system written in a style with which the local population is familiar. This has achieved its purpose, even if grammatically incorrect. B. M. Greenwood Medical Reseurch Council Laboratories, Faa;im-eg Bmiyl, 4 NovemberI987 In vitro microtest for chloroquine
resistance of
Plasmodium fdciparum
As technical advisers to the microtest production unit in the Philippines which produces the microtest plates for the WHO standard in viwo microtest kit, we were most interested to read the short report by S. Sinha & A. Gaianana in the Trunsucrions(1987. vol. 81, p. 513) on the batch variations they found in the predosed chloroquine plates. Unfortunately, because of its brevity, the report did not include a sufficiently detailed account of their methods for us to make a thorough assessmentof their study but we believe that the following observations would be useful. The study was conducted in August and December 1985 on plates with production dates which ranged from 27-3.1984 (C/22) to 13.5.1985 (c/51). Consequently, the age of the plates ranged from a possible maximum of 20 months to a possible minimum of 4 months. Both these times fall well within the accepted minimum shelf-life of 24 months. The absence of any interplate or intraplate variation in minimum inhibitory concentration (MIC) was to be expected, since the mechanical system of dosing of the plates and the gravimetric and volumetric quality controls on the dosing apparatus and the dosed test plate make it practically impossible for any significant variation to occur from well to well on any specific plate or within a batch of plates. Over 3 years of external quality control testing by an independent laboratory in the USA, no batch of test plates has ever varied by more than + 10% from the desired drug doses (1 pmol to 32 pmol following a geometric progression with the factor 2). If we assume,therefore, that (a) the method used to evaluate the various batches of plates was completely uniform, (b) it closely followed the accepted incubation times of 24-30 h and (c) a standardized incuba-