Evaluation of TRIPSE

Name: RR

Provisional Hypotheses/Explanations (10): 7.5

Further Explorations/ Proposed Studies (10): 8

Re-Assessment/Synthesis (10): 7.8

Total (30): 23.3

Comments:

You proposed several explanations. Some were more plausible than others. Thus differences in genetics, diet and use of traditional medications were likely contributors. Other possibilities that were reasonable were variation in demographics, such as a higher percentage of elderly or younger patients at Choyo. Problems in the recording of actual events could contribute. However it is the same nurse who is recording the events so it is unlikely that she/he could have created so much confusion!

Other confounding variables could be the presence of another disease that is really responsible for the manifestations. The pharmaceutical problem that you alluded to (concentration of the drug) seems unlikely, however a variation on that theme could play a role. There could be differences in storage conditions in the different villages such that the drugs at the base are better kept. You also noted that the Canadians could be causing the problem by transmitting the disease. This is really far-fetched!

Your approach to obtaining further information was logical and thorough. It was nice of you to write with two different pens so that I could clearly separate out the information needed from the procedures to obtain them.

Oddly you did not comment on the higher incidence of adverse events amongst the Canadian team, based in the village that had the lowest microfilarial load.