Impact of a quality improvement programme on family planning services in Egypt

The Egyptian government's national Gold Star programme to improve the quality and usage of family planning was conducted from 1995 to 2000. Data from the 2004 Egypt Service Provision Assessment survey were used to assess whether the certified Gold Star facilities had sustained higher quality services than non-Gold Star facilities 4 years after conclusion of the programme. A nationally representative sample of 637 facilities providing family planning services were compared using several quality indicators. Gold Star facilities had significantly better availability of family planning methods, counselling and examination services than non-Gold Starfacilities, independent of type, size and geographical location. Providers in Gold Star facilities were also more likely to adhere to higher quality practices in counselling and examination than in non-Gold Star facilities. The Gold Star programme was effective and could be implemented elsewhere in the region and globally.

Correlation analysis of noise and ultrafine particle counts in a street canyon

Ultrafine particles (UFP, diameter<100 nm) are very likely to negatively affect human health, as underlined by some epidemiological studies. Unfortunately, further investigation and monitoring are hindered by the high cost involved in measuring these UFP. Therefore we investigated the possibility to correlate UFP counts with data coming from low-cost sensors, most notably noise sensors. Analyses are based on an experiment where UFP counts, noise levels, traffic counts, nitrogen oxide (NO, NO(2) and their combination NO(x)) concentrations, and meteorological data were collected simultaneously in a street canyon with a traffic intensity of 3200 vehicles/day, over a 3-week period during summer. Previous reports that NO(x) concentrations could be used as a proxy to UFP monitoring were verified in our setup. Traffic intensity or noise level data were found to correlate with UFP to a lesser degree than NO(x) did. This can be explained by the important influence of meteorological conditions (mainly wind and humidity), influencing UFP dynamics. Although correlations remain moderate, sound levels are more correlated to UFP in the 20-30 nm range. The particles in this size range have indeed rather short atmospheric residence times, and are thus more closely short-term traffic-related. Finally, the UFP estimates were significantly improved by grouping data with similar relative humidity and wind conditions. By doing this, we were able to devise noise indicators that correlate moderately with total particle counts, reaching a Spearman correlation of R=0.62. Prediction with noise indicators is even comparable to the more-expensive-to-measure NO(x) for the smallest UFP, showing the potential of using microphones to estimate UFP counts.

Influence of different generations of poly(propylene imine) dendrimers on human erythrocytes

The unique characteristics of dendrimers make them attractive candidates as drug carriers. However, the toxicity associated with dendrimers is a basic hurdle in their biomedical application. To ensure development of dendrimer based safe and effective delivery systems, the effect of dendrimers on human erythrocytes (RBCs) must be studied. The present study explores the toxicological behavior of different generations of poly(propylene imine) dendrimers on human RBCs. Plain fifth generation PPI dendrimers (1 mg/mL) showed approximately 6.39% hemolysis which was an indication of their suitability in drug delivery. The study was conducted on all generations from 0.5 to 5.0 G of PPI dendrimers.

Gedunin and photogedunin of Xylocarpus granatum show significant anti-secretory effects and protect the gastric mucosa of peptic ulcer in rats

In the present study, the gastroprotective mechanism of Xylocarpus granatum fruit and its active constituents gedunin and photogedunin was investigated. Chloroform fraction (Fr-CHCl(3)) of X. granatum fruit was evaluated against cold restraint (CRU), aspirin (AS), alcohol (AL) and pyloric ligation (PL) induced gastric ulcer models in rats and histamine (HA) induced duodenal ulcer model in guinea pigs. Potential anti-ulcer activity of Fr-CHCl(3) was observed against CRU (58.28%), AS (67.81%), AL (84.38%), PL (65.66%) and HA (61.93%) induced ulcer models. The standard drug omeprazole (10mg/kg, p.o.) showed 68.25% protection against CRU, 57.08% against AS and 69.42% against PL model and 70.79% against HA induced duodenal ulcer. Sucralfate, another standard drug (500 mg/kg, p.o.) showed 62.72% protection in AL induced ulcer model. Fr-CHCl(3) significantly reduced free acidity (51.42%), total acidity (30.76%) and upregulated mucin secretion by 58.37% respectively. Phytochemical investigations of Fr-CHCl(3) yielded gedunin (36%), photogedunin (2%). Further, Fr-CHCl(3) and its compounds gedunin and photogedunin significantly inhibited H(+) K(+)-ATPase activity in vitro with IC(50) of 89.37, 56.86 and 66.54 microg/ml respectively as compared to the IC(50) value of omeprazole (30.24 microg/ml) confirming their anti-secretory activity. Conclusively, Fr-CHCl(3) of Xylocarpus granatum was found to possess anti-ulcerogenic activity which might be due to its anti-secretory activity and subsequent strengthening of the defensive mechanism. This study is the first of its kind to show significant anti-secretory effect of gedunin and photogedunin. Therefore it could act as a potent therapeutic agent against peptic ulcer disease.

Biowaiver: an alternative to in vivo pharmacokinetic bioequivalence studies

Bioequivalence is a vital concern in drug development even more significant in the case of Narrow Therapeutic Index (NTI) drugs. In clinical development of New Chemical Entities (NCE), bioequivalence studies necessitate to be performed when the formulation of the pharmaceutical dosage form has been changed. In vivo pharmacokinetic data can be used as surrogate parameters for in vivo solubility and permeability data. The Biopharmaceutics Classification System (BCS) has emerged as a helpful tool in product development by alluding to the in vivo performance of the active substance. The bio-relevance of the BCS properties and the in vitro release are best expressed through a correlation between in vitro and in vivo data. Recently BCS has been implemented for waiving bioequivalence studies on the basis of the solubility and gastrointestinal permeability of drug substance and can be strategically deployed to save time and resources during generic drug development. The BCS has been adopted as a very useful tool for in vivo drug design and development worldwide, particularly in terms of regulatory standards. A BCS-based biowaiver has become an important and cost-saving tool in approval of generic drugs.

Adhesive properties of food and faecal potential probiotic lactobacilli

In the present investigation, total four isolates of Lactobacillus species i.e. L. casei, L. helveticus, L. brevis and L. fermentum were examined for the cell surface hydrophobicity by bacterial adherence to hydrocarbons assay in LAPTg broth and hydrophobicity was calculated as percentage decrease in Optical Density at 600 nm. The general range of hydrophobicity in Lactobacilli was found in between 6-73%. Remarkably, L. helveticus and L . fermentum showed 73% hydrophobicity in xylene. Higher value of hydrophobicity could point toward a better ability of lactobacilli to adhere to epithelium cells. The outcome of present study concludes that L. helveticus and L. fermentum have good adhesive properties which may help them to adhere to surface epithelium of host cell and further screening with other probiotic attributes could be designated as probiotics.

Investigating the role of protein folding and assembly in cell-type dependent expression of alpha7 nicotinic receptors using a green fluorescent protein chimera

To test the hypothesis that cell-dependent expression of alpha7 receptors is due to differences in protein folding or assembly, we constructed a chimeric rat alpha7 subunit with green fluorescent protein (GFP) at the receptor C-terminal. Expression of alpha7-GFP in Xenopus oocytes resulted in currents that were indistinguishable from wild type receptors but were only 33% of control. (125)I-alpha-bungarotoxin (alphaBGT) binding at the oocyte surface was reduced to 23% of wild type. Transfection of alpha7-GFP into GH4C1 cells produced fluorescence that was less intense than GFP alone, but showed significant alpha-BGT binding compared to transfection with GFP. In contrast, alpha7-GFP transfection in SH-EP1, HEK293 and CHO-CAR cells produced fluorescence without alphaBGT binding. Flow cytometry of cells transfected with alpha7-GFP indicated fluorescence in both SH-EP1 and GH4C1 cells, but surface toxin binding sites and sites immunoprecipitated using anti-GFP antibodies were undetectable in SH-EP1 cells, suggesting a problem in folding/assembly rather than trafficking. Surprisingly, integrated fluorescence intensities in GH4C1 cells transfected with alpha7-GFP did not correlate with amounts of cell surface or immunoprecipitable alphaBGT binding. Therefore, GFP folding at the C-terminal of the alpha7-GFP chimera is cell-line independent, but toxin binding is highly cell-line dependent, suggesting that if altered protein folding is involved in the cell-type dependence of alpha7 receptor expression, the phenomenon is restricted to specific protein domains. Further, C-terminal GFP-labeled alpha7 receptors decreased the efficiency of folding/assembly not only of chimeric subunits, but also wild-type subunits, suggesting that the C-terminal is an important domain for alpha7 receptor assembly.

A randomised, controlled trial of two mobile-bearing total ankle replacements

We describe the results of a randomised, prospective study of 200 ankle replacements carried out between March 2000 and July 2003 at a single centre to compare the Buechel-Pappas (BP) and the Scandinavian Total Ankle Replacement (STAR) implant with a minimum follow-up of 36 months. The two prostheses were similar in design consisting of three components with a meniscal polyethylene bearing which was highly congruent on its planar tibial surface and on its curved talar surface. However, the designs were markedly different with respect to the geometry of the articular surface of the talus and its overall shape.

A total of 16 ankles (18%) was revised, of which 12 were from the BP group and four of the STAR group. The six-year survivorship of the BP design was 79% (95% confidence interval (CI) 63.4 to 88.5 and of the STAR 95% (95% CI 87.2 to 98.1). The difference did not reach statistical significance (p = 0.09). However, varus or valgus deformity before surgery did have a significant effect) (p = 0.02) on survivorship in both groups, with the likelihood of revision being directly proportional to the size of the angular deformity. Our findings support previous studies which suggested that total ankle replacement should be undertaken with extreme caution in the presence of marked varus or valgus deformity.

Comparison of HIV prevalence estimates from antenatal care surveillance and population-based surveys in sub-Saharan Africa

Objective:

To compare HIV seroprevalence estimates obtained from antenatal care (ANC) sentinel surveillance surveys in Ethiopia, Kenya, Malawi, Tanzania and Uganda with those from population-based demographic and health surveys (DHS) and AIDS indicator surveys (AIS).

Methods:

Geographical information system methods were used to map ANC surveillance sites and DHS/AIS survey clusters within a 15-km radius of the ANC sites. National DHS/AIS HIV prevalence estimates for women and men were compared with national prevalence estimates from ANC surveillance. DHS/AIS HIV prevalence estimates for women and men residing within 15 km of ANC sites were compared with those from ANC surveillance. For women, these comparisons were also stratified by current pregnancy status, experience of recent childbirth and receiving ANC for the last birth.

Results:

In four of the five countries, national DHS/AIS estimates of HIV prevalence were lower than the ANC surveillance estimates. Comparing women and men in the catchment areas of the ANC sites, the DHS/AIS estimates were similar to ANC surveillance estimates. DHS/AIS estimates for men residing in the catchment areas of ANC sites were much lower than ANC surveillance estimates for women in all cases. ANC estimates were higher for younger women than DHS/AIS estimates for women in ANC catchment areas, but lower at older ages. In all cases, urban prevalence was higher than rural prevalence but there were no consistent patterns by education.

Conclusions:

ANC surveillance surveys tend to overestimate HIV prevalence compared to prevalence among women in the general population in DHS/AIS surveys. However, the ANC and DHS/AIS estimates are similar when restricted to women and men, or to women only, residing in catchment areas of ANC sites. Patterns by age and urban/rural residence suggest possible bias in the ANC estimates.

Evaluation of bias in HIV seroprevalence estimates from national household surveys

OBJECTIVES

To evaluate HIV seroprevalence estimates from demographic and health surveys (DHS) and AIDS indicator surveys (AIS) for potential bias because of non-response and exclusion of non-household population groups.

METHODS

Data are from 14 DHS/AIS surveys with HIV testing, conducted during 2003-6. Blood samples were collected and analysed for HIV using standard laboratory and quality control procedures. HIV prevalence among non-tested adults was predicted based on multivariate statistical models of HIV for those who were interviewed and tested, using a common set of predictor variables. Estimates of the size of non-household populations in national censuses were used to assess potential bias because of their exclusion in the household surveys under different assumptions about proportion of adults and HIV prevalence in non-household populations.

RESULTS

Non-tested men had significantly higher predicted HIV prevalence than those tested in eight of the 14 countries, while non-tested women had significantly higher predicted prevalence than those tested in seven of the 14 countries. Effects of non-response were somewhat stronger in lower-prevalence countries. The overall effect of non-response on observed national HIV estimates was small and insignificant in all countries. Estimated effects of exclusion of non-household population groups were generally small, even in concentrated epidemics in India and Cambodia under the scenario that 75% of the non-household population was adults having 20 times greater HIV prevalence than adults in household surveys.

CONCLUSIONS

Non-response and the exclusion of non-household population groups tend to have small, insignificant effects on national HIV seroprevalence estimates obtained from household surveys.

Comparison of adult HIV prevalence from national population-based surveys and antenatal clinic surveillance in countries with generalised epidemics: implications for calibrating surveillance data

Background:

Estimates of the impact of HIV in countries with generalised epidemics are generally based on antenatal clinic surveillance data collected over time. In an attempt to obtain geographically more representative estimates of HIV prevalence, many countries are now also conducting national population-based surveys in which HIV testing is included. We compare adult HIV prevalence estimates from antenatal clinic surveillance to those from national population-based surveys to assess the implications for calibrating surveillance data.

Methods:

HIV prevalence estimates derived from fitting prevalence curves to antenatal clinic surveillance data are statistically compared to prevalence from national population-based surveys using data from 26 countries with generalised epidemics for the year in which the survey was conducted. Appropriate transformations are applied to inform the correction factors needed to adjust prevalence in countries where population-based surveys have not been conducted.

Results:

HIV prevalence derived from antenatal clinic surveillance data generally overestimate population-based survey prevalence by about 20% (95% confidence interval: 10% to 30%) in both urban and rural areas.

Conclusions:

In countries where national population-based HIV surveys have been conducted, survey estimates of HIV prevalence (adjusted for potential survey biases as appropriate) can be used directly to calibrate antenatal clinic surveillance data. In countries where national HIV surveys have not been conducted, HIV prevalence derived from antenatal clinic surveillance data should be multiplied by about 0.8 to adjust for overestimation.

Economic disparity and child survival in Cambodia

Despite improvements in child survival in recent decades, levels of infant and child mortality remain unacceptably high, particularly among the poor in developing countries recovering from recent wars and civil unrests. Using information on 8498 childbirths in five years preceding the 2000 Cambodia Demographic and Health Survey, this study measured the association between economic disparity and infant mortality using multivariate Weibull regression. Results indicate that children born in the poorest 40% households were more than twice as likely to die during infancy as those born in the richest 20% households, even after controlling for pregnancy care, birth weight, household living conditions, and other factors. Children born in the middle-income households also had significantly higher mortality risks. Not receiving antenatal care and low birth weight were associated with an increased risk. Also, boys had a higher risk than girls. The study concludes that poverty is strongly negatively associated with infant survival in Cambodia.

Prevalence of duodenal ulcer-promoting gene (dupA) of Helicobacter pylori in patients with duodenal ulcer in North Indian population

BACKGROUND

The duodenal ulcer (DU)-promoting gene (dupA) of Helicobacter pylori has been identified as a novel virulent marker associated with an increased risk for DU. The presence or absence of dupA gene of H. pylori present in patients with DU and functional dyspepsia in North Indian population was studied by polymerase chain reaction (PCR) and hybridization analysis.

MATERIALS AND METHODS

One hundred and sixty-six patients (96 DU and 70 functional dyspepsia) were included in this study. In addition, sequence diversity of dupA gene of H. pylori found in these patients was analyzed by sequencing the PCR products jhp0917 and jhp0918 on both strands with appropriate primers.

RESULTS

PCR and hybridization analyses indicated that dupA gene was present in 37.5% (36/96) of H. pylori strains isolated from DU patients and 22.86% (16/70) of functional dyspepsia patients (p < or = .05). Of these, 35 patients with DU (97.2%) and 14 patients with functional dyspepsia (81.25%) were infected by H. pylori positive for cagA genotype. Furthermore, the presence of dupA was significantly associated with the cagA-positive genotype (p < or = .02).

CONCLUSION

Results of our study have shown that significant association of dupA gene with DU in this population. The dupA gene can be considered as a novel virulent marker for DU in this population.

Effect of ambient temperature on in vitro fertilization of Bubaline oocyte

The present study was used to examine the effect of ambient temperature on the day of slaughter of buffaloes on oocyte cleavage and subsequent embryo development following in vitro fertilization (IVF)/chemical activation (parthenogenesis). A total of 601 oocytes were collected from buffaloes, which were sacrificed when the ambient temperature was >40 or < or =40 degrees C and the collected oocytes were matured in vitro. During each experiment about half of the matured oocytes were used for IVF whereas the remaining oocytes were subjected to one of the three chemical activation protocols viz. (i) 7% ethanol (ET) and 6-di methyl amino purine (6-DMAP), (ii) ET and cycloheximide (CHX) and (iii) ET followed by a combined treatment of 6-DMAP and CHX. Cleaved oocytes were cultured in mSOF supplemented with BSA, essential amino acids, non-essential amino acids, ITS (insulin transferrin and selenium) and L-glutamine. Low cleavage and subsequent embryo development was observed in those oocytes which were collected from buffaloes slaughtered at ambient temperature >40 degrees C than at < or =40 degrees C. There was no significant difference in cleavage rate following different chemical activations in oocytes collected from buffaloes slaughtered on the day when the maximum ambient temperature was >40 degrees C or < or =40 degrees C. These results suggest that high ambient temperature influences competence of oocytes to cleave and develop to blastocyst stage following natural activation with sperm and/or process of fertilization and subsequent embryo development.

A comparative study of parthenogenic activation and in vitro fertilization of bubaline oocytes

The effect of chemical activation protocols on in vitro-matured oocytes were compared to results with IVF (natural activation). Buffalo ovaries were collected in normal saline and transported to the laboratory within 2 h of slaughter. Good quality oocytes, collected by aspiration from 3 to 10 mm follicles, were matured for 22-24 h. Matured oocytes were subjected to either IVF (control) or chemical activation (treatment). For IVF, in vitro-matured oocytes were co-incubated with in vitro-capacitated approximately 1x10(6) frozen/thawed sperm of a Murrah bull and fertilized in modified synthetic oviductal fluid (mSOF) medium. Chemicals for oocytes activation comprised (a) 7% ethanol (ET) for 7 min+2.5 mM 6-dimethyl amino purine (6-DMAP) for 4h, (b) 7% ET for 7 min+10 microg/ml cycloheximide (CHX) for 6h and (c) 7% ET for 7 min+2.5 mM 6-DMAP+10 microg/ml CHX for 6 h. To study embryo development, fertilized and chemically activated oocytes were cultured in mSOF medium for up to 8 days. In this study, a mean of 1.9+/-0.02 maturable oocytes/ovary were recovered and 90.4% matured. Cleavage rate was significantly higher following ET+DMAP, ET+CHX and ET+CHX+DMAP activation (52.5%, 52.5% and 44.4%, respectively) compared to IVF (36.5%, 23.4% and 26.8%, respectively). Blastocyst development (30.9% versus 15.2%) was also significantly higher following ET+CHX+DMAP activation than IVF. The results of parthenogenesis reveal that buffalo oocytes had better inherent developmental competence and that the poor cleavage and embryo development following IVF may be due partly to the poor quality of frozen/thawed sperm, improper sperm capacitation and/or fertilization.