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ALI, T. M. O., K. E. E. IBRAHIM, E. H. A. ELTOM, M. E. HAMID 2001 ; : Animal diseases diagnosed at the University of Khartoum Veterinary Teaching Hospital 1995-1998 ; . Sud. J. Vet. Sci. Anim. Husb. 40, 38-44. ANONYM 1986 ; : Manual of Veterinary Parasitological Techniques, Ministry of Agriculture, Fisheries and Food. Reference Book 418, 3rd ed. ; . HMSO, London, 160. CAMPBELL, W. C., W. H. D. LEANING, R. L. SEWARD 1989 ; : Use of Ivermectin in horses. In: Ivermectin and Abmectin. W. C. Campbell, Ed. ; , Springer Verlag. New York Inc. 234-244. COSTA, A. J., O. F. BARBOSA, F. R. MORAES, A. H. ACUNA, U. F. ROCHA, V. E. SOARES, A. C. PAULLILO, A. SANCHES 1998 ; : Comparative efficacy evaluation of moxidectin gel and Ivermectin paste against internal parasites of equines in Brazil. Vet Parasitol. 80, 29-36. 58. Macotela-Ruiz E, Pena-Gonzalez G. The treatment of scabies with oral ivermectin. Gaceta medica de Mexico, 1993, 129: 201205. Glazion P et al. Comparison of ivermectin and benzyl benzoate for treatment of scabies. Tropical medicine and parasitology, 1993, 44: 331332. Taplin D et al. Comparison of Crotamin 10% cream Eurax ; and permethrin 5% cream Elimite ; for the treatment of scabies in children. Pediatric dermatology, 1990, 7: 6773. Paller AS. Scabies in infants and small children. Seminars in dermatology, 1993, 12: 3 Haustein UF. Pyrethrin and pyrethroid permethrin ; in the treatment of scabies and pediculosis. Hautarzt, 1991, 42: 915. Bischoff E, Fischer A, Liebenberg B. Assessment and control of house dust mite infestation. Clinical therapeutics, 1990, 12: 216220. Van Bronswijk JEMH, Schober G, Kniest FM. The management of house dust mite allergies. Clinical therapeutics, 1990, 12: 221226. Research higher community microfilarial loads, i.e. 3080 microfilariae per skin snip. The importance of coverage levels for the successful outcome of a treatment strategy has been recognized previously under field conditions. Several inexpensive, rapid and easy methods for its measurement have been developed, and one of them is currently in use 22, 23 ; . We found that intervals of six months would require slightly less than half the time to reach elimination than yearly intervals. A treatment strategy based on six-monthly rather than annual intervals thus has two clear implications: the whole programme can achieve elimination at higher levels of community microfilarial load, and, where annual treatments would also accomplish elimination, six-monthly intervals would do so in less than half the time, i.e. with fewer treatment rounds. However, this strategy would fail if the population contained only two types of individuals, viz. perfect compliers, who would not contribute to transmission, and consistent noncompliers. Our conclusions therefore depend on the assumption that there are many individuals who sometimes comply and sometimes do not comply, e.g. because they are absent or pregnant at the time of the intervention. If this group were smaller than we assumed in our model the benefits of sixmonthly treatments would be smaller than predicted. Also, the prospect of elimination by six-monthly treatments may be exaggerated as a result of our assumption that each treatment would result in a 35% reduction in microfilaria production, also when applied six-monthly. This assumption has not yet been validated for such intense treatment schemes. If it were not true, as in our pessimistic macrofilaricidal assumption of a constant 20% reduction in microfilaria production, our optimistic conclusions about the advantages of a six-monthly treatment scheme would be largely invalidated. Although elimination, when possible, would still be achieved in fewer years, the required number of treatments would exceed that under the annual scheme. This indicates that the macrofilaricidal effect is an important aspect of ivermectin treatment, supplementing its better-publicized microfilaricidal properties. Furthermore, shortening the treatment interval might have practical disadvantages, such as increased demands on drug supply, community participation, and so on. Strategies aimed at maintaining or increasing compliance and motivation at all levels, e.g. by using appropriate incentive schemes, may therefore be vital for the success of such high-frequency programmes. Both the annual biting rate in a community and variation in exposure to biting among individuals strongly influence the duration of a treatment programme. In areas with mediumhigh to high levels of community microfilarial load, i.e. 30 80 microfilariae per skin snip, and an intermediate level of individual variation in the biting rate, annual treatments at a coverage level of 65% would have to be continued for at least 27 years in order to eliminate infection. Model predictions suggest that, in such areas, much longer durations, exceeding 38 years, would be required if there were a high level of individual variation in the biting rate and consequently in counts of microfilariae. It should be borne in mind that the values of many parameters in the ONCHOSIM model, including the effects of ivermectin treatment, are based on field data from one focus of endemicity, viz. Asubende, Ghana, in the West African savanna, and that the transmission of onchocerciasis is simulated in villages of fewer than 400 inhabitants without migration of infected individuals and without reinvasion by infected flies 24 ; . Our results are therefore only predictive for this type of setting. For an extensive account of the impact of these assumptions on our conclusions, reference should be made to an earlier study 15 ; . For other areas in Africa, or other parts of the world, where different epidemiological, entomological and demographic conditions exist, the model should be requantified in accordance with local field data so that ONCHOSIM modelling studies can produce meaningful results. The effects of 10 years of ivermectin treatment in the Onchocerciasis Control Programme are now being analysed. It is intended to update model quantifications on the basis of the results of this analysis. Our analyses suggest that the elimination of onchocerciasis by means of mass treatment programmes is feasible only where high treatment coverage can be maintained for the entire period of programme implementation, which is often very long. This requires, inter alia, an absence of prolonged civil unrest and a stable drug supply. Such foci should also be free from reinvasion by infective blackflies and should remain so. Comparatively low precontrol community microfilarial loads and a low individual variability in exposure to vectors are also necessary. These requirements indicate that, under field conditions, ivermectin mass treatment programmes by themselves would not always be able to eliminate onchocerciasis completely. In this connection it is of interest to note that Abiose et al. 7 ; concluded that a definite solution would be difficult with ivermectin alone. This suggests that six-monthly treatments could be considered for the elimination of the parasite from isolated foci where biting rates and other epidemiological factors were favourable. We therefore suggest that for most affected parts of Africa, in the absence of vector control, ivermectin treatment should primarily be considered as a measure for controlling morbidity by reducing transmission and microfilarial loads, for which purpose annual treatments would probably suffice 25, 26 ; . Consequently, there seems to be no clear rationale for switching to more frequent treatments at present. Furthermore, more frequent treatments would require resources that might be better used for achieving high coverage rates. However, the impact of more frequent ivermectin administration on the development of drug resistance, and the response of the population to different treatment schedules, appear to be important subjects for research. Global eradication of the parasite by means of ivermectin alone does not appear to be feasible. This, together with the undesirability of permanent reliance on a single drug, suggests that priority should continue to be given to research into alternative drugs and safe, effective and affordable alternative elimination strategies, for example ones based on macrofilaricides 5, 27 ; . n Acknowledgement This study was supported by a Technical Service Agreement between the Erasmus University and the Onchocerciasis Control Programme in West Africa WHO ; . Conflicts of interest: none declared.

References of interest: 1 ; paul aj et al clinical observations in collies given ivermectin orally and kaletra!

BYLAWS CHANGES REFLECT RISING STATURE OF ACG INSTITUTE In 2005, important changes to the ACG Bylaws formalizing the structure and functions of the ACG Institute are the result of the first comprehensive review of the Institute and its mission since its inception in 1994. A major initiative by ACG Institute Director Edgar Achkar, MD, FACG, this year was to convene a leadership group for a strategic planning session. Charged with defining a blueprint for future action for the Institute and making recommendations about its leadership structure and functions, this group met at the ACG Headquarters in June 2005. Historically, the ACG Institute has been an autonomous body reporting to the Board of Trustees and directly connected to the College's leadership. Its mission was developed and approved by the Board itself. With these Bylaws changes, the Institute now has a defined role in the life of the College, specific authority in key areas, terms for its leaders, and enumerated roles and responsibilities for its governing Board of Directors and a new Management Subcommittee. The Bylaws changes formalized the composition and role of the ACG Institute Board of Directors that has overseen the work of the Institute throughout its history. This group includes the Institute Director, Officers of the College, Chairs of the Educational Affairs and Research Committees as well as the ACG Executive Director. Another key element of the Bylaws change was the appointment of an ACG Institute Management Subcommittee. Their role is to provide scientific and educational leadership for programs of the Institute; advise the Institute Director on new initiatives; review proposed Institute programs and initiatives; and oversee status of ongoing Institute programs. Members of the Institute's Management Subcommittee will serve staggered terms of three years with an option to renew for one additional term. The following ACG leaders have been tapped by Dr. Achkar and approved by the ACG Board of Trustees: ACG Past Presidents Seymour Katz, MD, MACG, David Y. Graham, MD, MACG, and Christina M. Surawicz, MD, FACG; former Trustee Linda Rabeneck, MD, FACG, and current Trustees Mitchell Shiffman, MD, FACG, and Lawrence R. Schiller, MD, FACG and kaon.

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