Estimation of Serum Fibrinogen in Males with Type 2 Diabetes

The patient with diabetes mellitus (DM) and its complication is increasing in our country and all over the world. Fibrinogen is a renowned factor of progressive atherosclerotic lesions and a predictor of cardiovascular events. Level of fibrinogen is increases in patients with diabetes mellitus (DM) may accelerate thromboembolic risk for cardiovascular disease (CVD). This study was carried out to assess plasma fibrinogen level in subjects with type 2 diabetes mellitus. It was a cross sectional analytic study and conducted in the Department of Physiology, Dhaka Medical College, Dhaka, Bangladesh from July 2013 to June 2014. A total number of 200 adult male subjects were selected with age ranging from 40-60 years. Among them, 100 subjects with type 2 diabetes mellitus were included in the study group (Group B) and 100 healthy subjects with same age range were considered as controls (Group A) for comparison. The subjects were selected from BIRDEM hospital Dhaka and personal contact from different areas of Dhaka city on the basis of exclusion and inclusion criteria. The study parameter was plasma fibrinogen level, and was measured in the Department of Microbiology and Immunology of BIRDEM hospital, Dhaka, Bangladesh. The data were collected and recorded in pre-designed structured questionnaire by the researcher herself. For statistical analyses unpaired Student's 't' test and Pearson's correlation coefficient (r) test were performed as applicable using SPSS for windows version 19.0. In this study plasma fibrinogen level was significantly (p<0.001) higher in the study group than that of control group. From this study, it may be concluded that estimation of plasma fibrinogen level might be beneficial for prediction of future cardiovascular risk in adult diabetic male.

OUP accepted manuscript

Current methods for tuberculosis treatment monitoring are suboptimal. We evaluated plasma matrix metalloproteinase (MMP) and procollagen III N-terminal propeptide concentrations before and during tuberculosis treatment as biomarkers. Plasma MMP-1, MMP-8, and MMP-10 concentrations significantly decreased during treatment. Plasma MMP-8 was increased in sputum Mycobacterium tuberculosis culture–positive relative to culture-negative participants, before (median, 4993 pg/mL [interquartile range, 2542–9188] vs 698 [218–4060] pg/mL, respectively; P = .004) and after (3650 [1214–3888] vs 720 [551–1321] pg/mL; P = .008) 6 months of tuberculosis treatment. Consequently, plasma MMP-8 is a potential biomarker to enhance tuberculosis treatment monitoring and screen for possible culture positivity.

Mean Platelet Volume in Type 2 Diabetes Male

The patient with diabetes mellitus and its complication is increasing in our country and all over the world. Altered platelet morphology and function have been reported in patient with DM. Mean platelet volume has been suggested as a newly emerging and independent risk marker for atherothrombosis and cardiovascular disease. The present study was carried out to assess the mean platelet volume in subjects with type 2 diabetes mellitus. The present study was a cross sectional analytic study and conducted in the Department of Physiology, Dhaka Medical College, Dhaka, Bangladesh from July 2013 to June 2014. A total number of 200 adult male subjects were selected with age ranging from 40 to 60 years. Among them, 100 subjects with type 2 diabetes mellitus were included in the case (Group B) and 100 healthy subjects with same age range were considered as control (Group A) for comparison. The subjects were selected from BIRDEM hospital Dhaka and personal contact from different areas of Dhaka city on the basis of exclusion and inclusion criteria. The study parameter was mean platelet volume and was measured in the Department of Hematology of BIRDEM hospital, Dhaka. The data were collected and recorded in pre-designed structured questionnaire by the researcher herself. For statistical analyses unpaired Student's 't' test was performed as applicable using SPSS for windows version 19. In this study, mean platelet volume was significantly (p<0.001) higher in the case group than that of control group. Therefore, estimation of mean platelet volume might be beneficial for prediction of future cardiovascular risk in adult diabetic male.

Older age at first tuberculosis diagnosis is associated with tuberculosis recurrence in HIV-negative persons

SETTING

Tuberculosis (TB) clinic in Durban, South Africa.

OBJECTIVE

To assess the factors associated with TB recurrence among human immunodeficiency virus (HIV) negative adults and children.

DESIGN

We conducted a retrospective longitudinal study from January 2000 to December 2012. We defined recurrence as a TB episode occurring within the study period after treatment completion or cure of a previous episode. We used a multivariable Poisson regression model to assess the factors associated with the number of recurrences among HIV-negative patients.

RESULTS

Among 17 941 patients with known HIV status, 3653 (20%) were HIV-negative; of these, 235 (6%) had one recurrence, 21 (1%) had two recurrences and 4 (0.1%) had three recurrences. The median follow-up time from the end of treatment for the first episode was 3.0 years (interquartile range 1.9-4.2). Age at the first TB episode was significantly associated with the number of TB recurrences: younger patients had the lowest rate of recurrence, with a steady increase in rates until age 40 years, after which rates stabilized.

CONCLUSIONS

TB recurrence rates among HIV-negative patients were higher at increased age at the first TB episode. Further translational studies are needed to clarify the factors that drive multiple TB recurrences in older age, including impaired immunity, the results of which have implications for TB vaccine development.

Isoniazid-monoresistant tuberculosis is associated with poor treatment outcomes in Durban, South Africa

SETTING

A large tuberculosis (TB) clinic in Durban, South Africa.

OBJECTIVE

To determine the association between isoniazid (INH) monoresistant TB and treatment outcomes.

DESIGN

We performed a retrospective longitudinal study of patients seen from 2000 to 2012 to compare episodes of INH-monoresistant TB with those of drug-susceptible TB using logistic regression with robust standard errors. INH-monoresistant TB was treated with modified regimens.

RESULTS

Among 18 058 TB patients, there were 19 979 TB episodes for which drug susceptibility testing was performed. Of these, 557 were INH-monoresistant and 16 311 were drug-susceptible. Loss to follow-up, transfer, and human immunodeficiency virus (HIV) co-infection (41% had known HIV status) were similar between groups. INH-monoresistant episodes were more likely to result in treatment failure (4.1% vs. 0.6%, P < 0.001) and death (3.2% vs. 1.8%, P = 0.01) than drug-susceptible episodes. After adjustment for age, sex, race, retreatment status, and disease site, INH-monoresistant episodes were more likely to have resulted in treatment failure (OR 6.84, 95%CI 4.29-10.89, P < 0.001) and death (OR 1.81, 95%CI 1.11-2.95, P = 0.02).

CONCLUSION

INH monoresistance was associated with worse clinical outcomes than drug-susceptible TB. Our findings support the need for rapid diagnostic tests for INH resistance and improved treatment regimens for INH-monoresistant TB.

Erythrocyte Glucose-6-Phosphate Dehydrogenase Level in Type 2 Diabetes Male

The patient with diabetes mellitus (DM) and its complication is increasing in our country and all over the world. There is also significant increase in the prevalence of erythrocyte glucose-6-phosphate dehydrogenase (eG6PD) deficiency in the men with longer duration of diabetes mellitus. To assess the eG6PD in type 2 diabetes male subjects to observe their enzyme status. This cross-sectional study was conducted in the Department of Physiology, Dhaka Medical College, Dhaka, Bangladesh from January 2011 to December 2011. Sixty male subjects with type 2 diabetes mellitus were selected with the age ranging from 40 to 60 years. Out of diabetic subjects, 30 (thirty) were with controlled (B1) and other 30 (thirty) with uncontrolled (B2) type 2 diabetes mellitus were selected from Outpatient Department of BIRDEM Hospital by random basis. And 30 age-matched, healthy non-diabetic male subjects were considered as control group for comparison. Erythrocyte G6PD level was measured by spectrophotometric method. Fasting Blood Glucose (FBG), HbA1c were measured by standard laboratory techniques in the laboratory of BIRDEM and Armed Forces Institute of Pathology (AFIP), Dhaka Cantonment, Dhaka. For statistical analysis unpaired Student's 't' test was performed. The result was expressed as Mean±SD among the groups. In this study, eG6PD level was significantly lower in both the study groups. This study concludes that eG6PD level decreases in male with diabetes mellitus.

Liver failure determines the outcome in patients of acute-on-chronic liver failure (ACLF): comparison of APASL ACLF research consortium (AARC) and CLIF-SOFA models

BACKGROUND AND AIMS

Acute-on-chronic liver failure (ACLF) is a progressive disease associated with rapid clinical worsening and high mortality. Early prediction of mortality and intervention can improve patient outcomes. We aimed to develop a dynamic prognostic model and compare it with the existing models.

METHODS

A total of 1402 ACLF patients, enrolled in the APASL-ACLF Research Consortium (AARC) with 90-day follow-up, were analyzed. An ACLF score was developed in a derivation cohort (n = 480) and was validated (n = 922).

RESULTS

The overall survival of ACLF patients at 28 days was 51.7%, with a median of 26.3 days. Five baseline variables, total bilirubin, creatinine, serum lactate, INR and hepatic encephalopathy, were found to be independent predictors of mortality, with AUROC in derivation and validation cohorts being 0.80 and 0.78, respectively. AARC-ACLF score (range 5-15) was found to be superior to MELD and CLIF SOFA scores in predicting mortality with an AUROC of 0.80. The point scores were categorized into grades of liver failure (Gr I: 5-7; II: 8-10; and III: 11-15 points) with 28-day cumulative mortalities of 12.7, 44.5 and 85.9%, respectively. The mortality risk could be dynamically calculated as, with each unit increase in AARC-ACLF score above 10, the risk increased by 20%. A score of ≥11 at baseline or persisting in the first week was often seen among nonsurvivors (p = 0.001).

CONCLUSIONS

The AARC-ACLF score is easy to use, dynamic and reliable, and superior to the existing prediction models. It can reliably predict the need for interventions, such as liver transplant, within the first week.

Augmented endothelial-specific L-arginine transport prevents obesity-induced hypertension

AIM

Hypertension is a major clinical complication of obesity. Our previous studies show that abnormal uptake of the nitric oxide precursor L-arginine, via the cationic amino acid transporter-1 (CAT1), contributes to endothelial dysfunction in cardiovascular disease. In this study, we tested the hypothesis that abnormal L-arginine transport may be a key mediator of obesity-induced hypertension.

METHODS

Mean arterial pressure (MAP) was monitored by telemetry in conscious wild-type (WT; n = 13) mice, and transgenic mice with endothelial-specific overexpression of CAT1 (CAT+; n = 14) fed a normal or a high fat diet for 20 weeks. Renal angiotensin II (Ang II), CAT1 mRNA and plasma nitrate/nitrite levels were then quantified. In conjunction, plasma nitrate/nitrite levels were assessed in obese normotensive (n = 15) and obese hypertensive subjects (n = 15).

RESULTS

Both genotypes of mice developed obesity when fed a high fat diet (P ≤ 0.002). Fat fed WT mice had 13% greater MAP and 78% greater renal Ang II content, 42% lesser renal CAT1 mRNA levels and 42% lesser plasma nitrate/nitrite levels, than WT mice fed a normal fat diet (P ≤ 0.02). In contrast, none of these variables were significantly altered by high fat feeding in CAT+ mice (P ≥ 0.36). Plasma nitrate/nitrite levels were 17% less in obese hypertensives compared with obese normotensives (P = 0.02).

CONCLUSION

Collectively, these data indicate that obesity-induced down-regulation of CAT1 expression and subsequent reduced bioavailability of nitric oxide may contribute to the development of obesity-induced hypertension.

Comparison of AMG 416 and cinacalcet in rodent models of uremia

Background

AMG 416 is a novel peptide agonist of the calcium-sensing receptor (CaSR). This report describes the activity of AMG 416 in two different rodent models of uremia, compared in each case to cinacalcet, an approved therapeutic for secondary hyperparathyroidism (SHPT) in patients with chronic kidney disease on dialysis.

Methods

AMG 416 was administered as a single intravenous (IV) bolus in a severe, acute model of renal insufficiency (the “1K1C” model) and plasma parathyroid hormone (PTH) and serum calcium levels were monitored for 24 hours. In a chronic, less severe model of renal dysfunction, the 5/6 nephrectomy (5/6 Nx) model, AMG 416 was administered as a once-daily IV bolus for 28 days. Both studies included a control (vehicle) group and a comparison cinacalcet group (po dosing at 30 mg/kg and 10 mg/kg for the 1K1C and 5/6 Nx studies, respectively).

Results

Administration of AMG 416 by IV bolus injection into rats with acute renal dysfunction (1K1C model) resulted in a sustained reduction in plasma PTH from the initial elevated values. Following a single IV bolus (0.5 mg/kg), AMG 416 caused a substantial drop in PTH levels which remained approximately 50% below their initial level at 24 hrs. In the same model, oral treatment with cinacalcet (30 mg/kg) resulted in an acute drop in PTH which almost returned to the starting level by 24 hours after dosing. In the 5/6 Nx chronic uremia model, daily IV dosing of AMG 416 over 4 weeks (1 mg/kg) resulted in a sustained reduction in PTH, with approximately 50% of the initial level observed 48 hours post treatment throughout the study. Cinacalcet treatment (10 mg/kg) in the same model resulted in acutely lowered plasma PTH levels which returned to placebo levels by 24 hours post-dose. Consistent with the reductions in plasma PTH, reductions in serum calcium were observed in both AMG 416- and cinacalcet-treated animals.

Conclusions

As a long-acting CaSR agonist suitable for administration by the IV route, AMG 416 is a potential new therapy for the treatment of CKD patients with SHPT receiving hemodialysis.

Analysis of submicromolar concentrations of adenosine in plasma using reversed phase high-performance liquid chromatography

A method is described for the determination of adenosine in small samples of plasma (< 1 ml) using reversed-phase high-performance liquid chromatography (HPLC) in either a simple isocratic or a gradient elution system which gives a clear separation of adenosine from other plasma constituents. Acetone is used to deproteinize plasma and chloroform to remove unwanted lipid soluble material prior to HPLC. 6-Methyladenosine is used as an internal standard for making corrections for changes in concentration during sample processing. Adenosine in plasma could be reliably detected at concentrations lower than its minimum effector concentration as a vasodilator (4 x 10(-8) Mol l(-1) using the isocratic system and 1.9 x 10(-8) Mol l(-1) with gradient elution). The recoveries of adenosine added to blood at concentrations ranging from 2 x 10(-8) Mol l(-1) to 1.4 x 10(-6) Mol l(-1) were from 101.4 +/- 16.9% (n = 4) to 100.0 +/- 3.6% (n = 5). The present method provides a simple, sensitive and selective assay for submicromolar concentrations of adenosine in plasma with good recovery.

Assessing Environmental and Health Impact of Drought in the Northwest Bangladesh

Drought, the result of regional climatic variability is one of the dominant threats to environment. This study focuses on the biophysical, environmental and health issues concerning drought occurrence in northwest region of Bangladesh. Using both primary and secondary data, the analysis revealed that, during the drought period, rainfall as the dominant factor of supplying surface water and normalizing the dryness of the nature was almost 46% lower than the previous (normal) years. Similarly, average monthly sunshine hours in the drought year was about 7% higher compared to that of the normal year. On an average, groundwater level declined more than one meter compared to the previous years. Thus, many of the tubewells turned dry or failed to supply the required quantity of water for household and irrigation purposes. A significant number of surface water bodies including ponds, ditches, canals and streams had little volume of low quality water. In normal years, almost all households used hand tubewells (HTWs) as the major source of drinking water, while in the drought period only 90% households could use HTW water since substantial proportion of the HTWs turned dry. People had to collect drinking and domestic water from far distance to meet the basic requirements. Increase in temperature and prevalence of severe dust during drought periods compared to the normal years caused different health hazards including dysentery and diarrhoea due to unsafe drinking water. DOI: http://dx.doi.org/10.3329/jesnr.v4i2.10141 J. Environ. Sci. & Natural Resources, 4(2): 89-97, 2011  

Why are tuberculosis patients not treated earlier? A study of informal health practitioners in Bangladesh

SETTING

Five districts and four cities of Bangladesh.

OBJECTIVE

To study the role of informal health practitioners in delays in initiating tuberculosis (TB) treatment in new smear-positive TB patients.

DESIGN

A cross-sectional study of all patients registered within specific projects in Bangladesh using routine records from projects. Definitions were as follows: 1) total delay: duration from onset of symptoms to initiation of treatment; 2) patient delay: onset of symptoms to first visit to any practitioner; and 3) health system delay: first visit to practitioner to treatment initiation.

RESULTS

A total of 7280 cases were enrolled. Prolonged delay was calculated as ≥ 5 weeks for patient delay, ≥ 10 weeks for health system delay and ≥ 13 weeks for total delay. Prolonged patient delay was less frequent when patients first consulted informal as compared to qualified health practitioners (30% vs. 68%). Similar figures for prolonged health system delay were respectively 52% and 16%, while those for total delay were 47% and 27%. The differences were statistically significant (P < 0.05).

CONCLUSION

Patients seeking care from informal practitioners access care more promptly, but have prolonged delays in initiating treatment. Further investigation on how to involve these practitioners in the programme should be evaluated.

Community perceptions of tuberculosis: A qualitative exploration from a gender perspective

OBJECTIVE

To explore community laypersons' perspective on tuberculosis (TB)-related illness experiences, meanings, behaviours and impact with reference to gender.

STUDY DESIGN

Qualitative, conducted in rural Bangladesh.

METHODS

Eleven focus group discussions (FGDs) were conducted (six female and five male) in five subdistricts where the non-governmental organization BRAC operates. On average, seven purposively chosen poor, illiterate, non-TB patients participated in each FGD. Discussions were audiotaped, translated verbatim into English and analysed using MAXQDA software for qualitative data analysis, used it to assign codes to text segments to identify themes from participants' narratives.

RESULTS

TB was recognized as a deadly disease that could affect anyone. The discussants were fairly aware of the psychological, financial and social impacts of TB. Women faced with adverse consequences more often than men, such as trouble in ongoing and prospective marital affairs. Coughing up sputum in public by women is culturally frowned upon, resulting in enormous suffering. Women tended to describe the clinical features more vaguely than men, and often specified fewer characteristic symptoms such as blood in sputum.

CONCLUSIONS

The gender differences in the health and socio-economic impact of TB included perceived causality, curability, stigma, family and community support, fear of disclosure, and use of self-help or home remedies. Interactive health education covering various consequences of TB could be indispensable to changing negative beliefs.

Female-male differences at various clinical steps of tuberculosis management in rural Bangladesh

A registry data-based study of 3,600 patients systematically drawn from out-patient clinic, laboratory and tuberculosis (TB) treatment registers (1200 from each) examined female-male differences at various clinical steps of TB management and compared selective indicators with published results. Female-to-male ratios (FMR) declined at the following clinical steps: respiratory patients seeking out-patient care (0.81), TB suspects submitting sputum for testing (0.52) and smear-positive test results (0.38), but the decline ceased at treatment initiation (0.41). Compared to 1997, the FMR in 2000 had decreased for out-patient clinics and sputum submission for testing, but had increased for smear-positive test results and treatment initiation. More female than male patients who underwent treatment achieved cure (93% vs. 89%). Lower female representation at the different clinical steps of TB management persists.

Gender and socio-cultural determinants of delay to diagnosis of TB in Bangladesh, India and Malawi

SETTING

Tuberculosis (TB) control programmes in Bangladesh, India and Malawi.

OBJECTIVE

To compare the interval from symptom onset to diagnosis of TB for men and women, and to assess socio-cultural and gender-related features of illness explaining diagnostic delay.

DESIGN

Semi-structured Explanatory Model Interview Catalogue (EMIC) interviews were administered to 100 or more patients at each site, assessing categories of distress, perceived causes and help seeking. Based on time from initial symptoms to diagnosis of TB, patients were classified with problem delay (>90 days), timely diagnosis (< or =30 days) or moderate delay. EMIC interview data were analysed to explain problem delay.

RESULTS

The median interval from symptom onset to diagnosis was longest in India and shortest in Malawi. With adjustment for confounding, female sex (Bangladesh), and status of married woman (India) and housewife (Malawi) were associated with problem delay. Prominent non-specific symptoms--chest pain (Bangladesh) and breathlessness (Malawi)--were also significant. Cough in India, widely associated with TB, was associated with timely diagnosis. Sanitation as a perceived cause linked to poor urban conditions was associated with delayed diagnosis in India. Specific prior help seeking with circuitous referral patterns was identified.

CONCLUSION

The study identified gender- and illness-related features of diagnostic delay. Further research distinguishing patient and provider delay is needed.

Cultural epidemiology of TB with reference to gender in Bangladesh, India and Malawi

SETTING

TB control programmes in Bangladesh, India and Malawi.

OBJECTIVE

To identify and compare socio-cultural features of tuberculosis (TB) and the distribution of TB-related experiences, meanings and behaviours with reference to gender across cultures in three high-endemic low-income countries.

DESIGN

Approximately 100 patients at three sites were interviewed with in-depth semi-structured Explanatory Model Interview Catalogue (EMIC) interviews inquiring about patterns of distress, perceived causes and help-seeking behaviours in the context of illness narratives.

RESULTS

Female patients reported more diverse symptoms and men more frequently focused on financial concerns. Most patients reported psychological and emotional distress. Men emphasised smoking and drinking alcohol as causes of TB, and women in Malawi reported sexual causes associated with HIV/AIDS. In Bangladesh, exaggerated concerns about the risk of spread despite treatment contributed to social isolation of women. Public health services were preferred in Malawi, and private doctors in India and Bangladesh.

CONCLUSION

Cross-site analysis of these studies has identified features of TB that influence the burden of disease and are likely to affect timely help seeking and adherence to treatment. Health systems benefit from sex-disaggregated epidemiological data complemented by cultural epidemiological study, which together clarify the role of gender and contribute to the knowledge base for TB control at various levels.

Gender and socio-cultural determinants of TB-related stigma in Bangladesh, India, Malawi and Colombia

SETTING

Tuberculosis (TB) control programmes in Bangladesh, India, Malawi and Colombia.

OBJECTIVE

Assess indicators of TB-related stigma and socio-cultural and gender-related features of illness associated with stigma.

DESIGN

Semi-structured Explanatory Model Interview Catalogue (EMIC) interviews were administered to 100 or more patients at each site, assessing categories of distress, perceived causes and help seeking. Indicators of self-perceived stigma were analysed individually and in a validated index, which was compared across sites and between men and women at each site. Cultural epidemiological explanatory variables for stigma and interactions with female sex were analysed at each site. Qualitative illness narratives were examined to explain the role and context of explanatory variables.

RESULTS

The overall stigma index was highest in India, lowest in Malawi and greater for women in Bangladesh. In India and Malawi, women were more likely to be concerned about impact on marital prospects. Associations with HIV/AIDS were linked to TB stigma in Malawi, where sexual contact as a perceived cause was more associated with stigma for men and less for women.

CONCLUSION

Stigma both influences and indicates the effectiveness of TB control. Cultural epidemiological methods clarify cross-cutting and local features of stigma and gender for TB control.

Identification of ras targets using a genetic approach

The Sevenless receptor tyrosine kinase is required for the development of the R7 photoreceptor cell in the Drosophila eye. Several components of the Sevenless signal transduction pathway have been identified in genetic screens for enhancers/suppressors of the sevenless phenotype. These studies suggest that activation of Sevenless leads to stimulation of Ras1 activity, whereas Gap1 appears to act as a negative regulator of the pathway. Inactivation of the Gap1 locus causes transformation of non-neuronal cone cells into supernumerary R7 cells. This same mutant phenotype is observed when activated Ras1 is expressed under the control of the sevenless promoter. While studies in other organisms have demonstrated a role for ras gene products in signal transduction, the effectors of Ras activity have not yet been identified. We are carrying out genetic screens for enhancers and suppressors of the Gap1 and activated Ras1 phenotypes in the hope of identifying genes encoding some of these effectors. We are conducting chemical mutagenesis screens and have also screened existing collections of P element lines. A molecular characterization of the most promising mutations is in progress.

Development of PKC Theta-Specific Inhibitors to Modulate T-Cell Activation (B35)

Autoimmune diseases such as psoriasis and rheumatoid arthritis involve inappropriate activation and infiltration of T lymphocytes. Protein Kinase C Theta (PKC Theta) activation is a critical step in the integrated TCR/CD28 co-stimulatory signaling cascade leading to productive T-cell activation. Mice deficient in PKC Theta have been shown to have attenuated T-cell response and are protected from antigen-induced arthritis. Efforts to develop small molecule (ATP-competitive) inhibitors of individual PKC isozymes for therapeutic applications have been largely unsuccessful due to the lack of specificity of such compounds. KAI Pharmaceuticals has developed highly selective peptide-based inhibitors for each PKC isozyme that overcome this limitation by modulating the unique intracellular translocation of individual isozymes. KAI is actively developing PKC Theta inhibitors to treat and modify autoimmune diseases. The development and characterization of these highly selective PKC Theta inhibitors/modulators will be discussed.

Bacterial safety of flash-heated and unheated expressed breastmilk during storage

Heat-treated breastmilk is one infant-feeding option recommended by the WHO to reduce mother-to-child transmission of HIV in developing countries. Flash-heat, a simple pasteurization method that a mother could perform in her home, has been shown to inactivate cell-free HIV-1. Since heating may affect the naturally occurring antimicrobial properties found in breastmilk, storing heated breastmilk may present a safety issue in resource-poor settings due to lack of refrigeration and potential contamination. To address this, we investigated the ability of flash-heat to eliminate bacteria and to prevent growth over time compared with unheated breastmilk. We collected breastmilk samples from 38 HIV positive mothers in South Africa and aliquoted them to flash-heated and unheated controls. Samples were stored at room temperature for 0, 2, 6 and 8 h and then plated and incubated for 24 h at 37 degrees C in CO(2). We performed total colony counts and identified Escherichia coli, Staphylocuccus aureus and Group A and Group B streptococci. Unheated samples had a significantly higher number of samples positive for bacterial growth at each time point (p < 0.0001), as well as mean colony-forming units (CFU)/ml in those samples that were positive at each time point (p < 0.0001). In addition, unheated samples had a significantly higher rate of bacterial propagation over time than flash-heated samples when comparing log values of CFU/ml across 0-8 h (p < 0.005). No pathogenic growth was observed in the flash-heated samples, while the unheated samples showed growth of E. coli (n = 1) and S. aureus (n = 6). Our data suggest that storage of flash-heated breastmilk is safe at room temperature for up to 8 h.

Poverty status and health equity: evidence from rural Bangladesh

Many studies have examined the health inequities between different social groups, often measured by individual independent variables, such as education, gender, ethnicity, geography, rich, poor, etc. Although inequities are increasingly widening, a few studies have looked at the health inequity between different poverty groups within the poor. The present study, using equity terms, examined the use of health services in two rural areas of Bangladesh. Using a multistage sampling method, a total of 80 villages were selected from the Bogra and Dinajpur sadar thanas (subdistricts) for the study. A total of 4003 households in these villages were visited for data collection on mortality and fertility, while data related to use of health services was collected from a subsample of 1032 households. A poverty index, constructed using three variables (household landholding, education level of head of household, and self-rated categorization of household's annual food security), categorized the households into three groups: extreme poor, moderate poor and non-poor. Overall, the data revealed considerable inequities in many study indicators between the poor and the non-poor. However, inequities of varying degrees were also found between the extreme poor and the moderate poor. Lower levels of inequities were found between the poor and the non-poor in the use of health services, which were easily accessible and free of charge (immunization, vitamin A capsule, etc.). On the whole, the extreme poor were less likely to use health services than the moderate poor and the non-poor, suggesting the need for a more appropriate programme to address their pressing health needs.

HIV Lipodystrophy Case Definition using Artificial Neural Network Modelling

Objective

A case definition of HIV lipodystrophy has recently been developed from a combination of clinical, metabolic and imaging/body composition variables using logistic regression methods. We aimed to evaluate whether artificial neural networks could improve the diagnostic accuracy.

Methods

The database of the case-control Lipodystrophy Case Definition Study was split into 504 subjects (265 with and 239 without lipodystrophy) used for training and 284 independent subjects (152 with and 132 without lipodystrophy) used for validation. Back-propagation neural networks with one or two middle layers were trained and validated. Results were compared against logistic regression models using the same information.

Results

Neural networks using clinical variables only (41 items) achieved consistently superior performance than logistic regression in terms of specificity, overall accuracy and area under the ROC curve. Their average sensitivity and specificity were 72.4 and 71.2%, as compared with 73.0 and 62.9% for logistic regression, respectively (area under the ROC curve, 0.784 vs 0.748). The discriminating performance of the neural networks was largely unaffected when built excluding 13 parameters that patients may not have readily available. The average sensitivity and specificity of the neural networks remained the same when metabolic variables were also considered (total 60 items) without a clear advantage against logistic regression (overall accuracy 71.8%). The performance of networks considering also body composition variables was similar to that of logistic regression (overall accuracy 78.5% for both).

Conclusions

Neural networks may offer a means to improve the discriminating performance for HIV lipodystrophy, when only clinical data are available and a rapid approximate diagnostic decision is needed. In this context, information on metabolic parameters is apparently not helpful in improving the diagnosis of HIV lipodystrophy, unless imaging and body composition studies are also obtained.

Rapid assessment of the prevalence of lower limb clinical rickets in Bangladesh

This study attempted to measure the prevalence of lower limb clinical rickets using a rapid assessment methodology in Cox's Bazaar, a coastal district of Bangladesh. The study populations were drawn from 28 random villages representing all seven 'thanas' (subdistricts) of the district. Data were collected on 25,891 children and young people aged 1-20 years in two phases. In the first phase, 30 trained, local, non-medical people listed 490 children suffering from visible signs of any physical disability. To achieve this, they demonstrated a multicolored poster showing the features of lower limb clinical rickets to key informants in the villages. In the second phase, two teams of medically trained people (physicians), each with one male and one female, validated the above cases for rickets. They verified and validated 278 cases in five thanas. Due to inclement weather and floods, they could not visit the other two thanas. Based on these data, the adjusted prevalence rates for lower limb clinical rickets were calculated to be 931 per 100,000 population (95% confidence intervals 795-1067). The prevalence was highest (1215) in children aged 1-4 years and lowest (498) amongst 17-20 year olds. Females had lower prevalence than males. Based on the study experience, a quick investigation using a similar methodology was performed in five other districts (Sunamganj, Noakhali, Bhola, Jessore and Gaibandha), and clinical signs of lower limb rickets were found in Sunamganj and Jessore. It thus indicates that rickets may be endemic, not only in Cox's Bazaar but also in some other parts of Bangladesh. The methodology used for this study was found to be rapid, simple, replicable and inexpensive.

Developmental control of blood cell migration by the Drosophila VEGF pathway

We show that a vascular endothelial growth factor (VEGF) pathway controls embryonic migrations of blood cells (hemocytes) in Drosophila. The VEGF receptor homolog is expressed in hemocytes, and three VEGF homologs are expressed along hemocyte migration routes. A receptor mutation arrests progression of blood cell movement. Mutations in Vegf17E or Vegf27Cb have no effect, but simultaneous inactivation of all three Vegf genes phenocopied the receptor mutant, and ectopic expression of Vegf27Cb redirected migration. Genetic experiments indicate that the VEGF pathway functions independently of pathways governing hemocyte homing on apoptotic cells. The results suggest that the Drosophila VEGF pathway guides developmental migrations of blood cells, and we speculate that the ancestral function of VEGF pathways was to guide blood cell movement.

Metabotropic glutamate receptor subtypes 1 and 5 are activators of extracellular signal-regulated kinase signaling required for inflammatory pain in mice

Metabotropic glutamate receptors are expressed abundantly in the spinal cord and have been shown to play important roles in the modulation of nociceptive transmission and plasticity. Most previous studies have focused on the group I metabotropic glutamate receptors (mGluR1 and mGluR5) and activation of phospholipase C signaling by these receptors in modulating nociception. Recently, it was shown that the extracellular signal-regulated kinases (ERKs)/mitogen-activated protein kinases are activated in spinal cord dorsal horn neurons in response to stimulation of nociceptors and that ERK signaling is involved in nociceptive plasticity. In the present studies, we sought to test the hypothesis that group I mGluRs modulate nociceptive transmission or plasticity via modulation of ERK signaling in dorsal horn neurons. We show that activation of mGluR1 and mGluR5 leads to activation of ERK1 and ERK2 in the spinal cord. Furthermore, we find that inflammation-evoked ERK activation, which is required for nociceptive plasticity, is downstream of mGluR1 and mGluR5. Finally, we show colocalization of group I mGluRs with activated ERK in dorsal horn neurons. These results show that mGluR1 and mGluR5 are activated in dorsal horn neurons in response to peripheral inflammation and that activation of these group I mGluRs leads to activation of ERK1 and ERK2, resulting in enhanced pain sensitivity.

Peripheral group I metabotropic glutamate receptors modulate nociception in mice

The metabotropic glutamate receptors (mGluRs) are found throughout the central nervous system, where they modulate neuronal excitability and synaptic transmission. Here we report the presence of phospholipase C-coupled group I mGluRs (mGluR1 and mGluR5) outside the central nervous system on peripheral unmyelinated sensory afferents. Given their localization on predominantly nociceptive afferents, we investigated whether these receptors modulate nociceptive signaling, and found that agonist-induced activation of peripheral group I mGluRs leads to increased sensitivity to noxious heat, a phenomenon termed thermal hyperalgesia. Furthermore, group I mGluR antagonists not only prevent, but also attenuate established formalin-induced pain. Taken together, these results suggest that peripheral mGluRs mediate a component of hyperalgesia and may be therapeutically targeted to prevent and treat inflammatory pain.

Drosophila p53 is a structural and functional homolog of the tumor suppressor p53

The importance of p53 in carcinogenesis stems from its central role in inducing cell cycle arrest or apoptosis in response to cellular stresses. We have identified a Drosophila homolog of p53 ("Dmp53"). Like mammalian p53, Dmp53 binds specifically to human p53 binding sites, and overexpression of Dmp53 induces apoptosis. Importantly, inhibition of Dmp53 function renders cells resistant to X ray-induced apoptosis, suggesting that Dmp53 is required for the apoptotic response to DNA damage. Unlike mammalian p53, Dmp53 appears unable to induce a G1 cell cycle block when overexpressed, and inhibition of Dmp53 activity does not affect X ray-induced cell cycle arrest. These data reveal an ancestral proapoptotic function for p53 and identify Drosophila as an ideal model system for elucidating the p53 apoptotic pathway(s) induced by DNA damage.

Training and retaining Shasthyo Shebika: reasons for turnover of community health workers in Bangladesh

Shasthyo Shebikas (SS) are community health workers forming the core of BRAC's Essential Health Care (EHC) programme. The SS dropout was 44 percent for study area and 32 percent for EHC programme. The SS discontinued their work due to lack of time, lack of "profit", and family's disapproval. The effects of the dropouts were decreased achievement of targets, and a loss of money in the amount of $24 (U.S.) per dropout SS for their training and supervision. The SS retention may increase if EHC strictly adheres to its existing guidelines when selecting trainees, and if it highlights during SS training that SS; s first and foremost role will be as that of a volunteer and then of a salesperson.

Beta-adrenoceptors in vascular capacitance responses to unloading of carotid baroreceptors in anesthetized dogs

The role of beta- and alpha-adrenoceptors in the total vascular capacitance responses to changing pressure in vascularly isolated carotid sinuses of anesthetized and atropinized dogs was investigated. A change in vascular capacitance was determined by measuring the shift of blood in and out of a reservoir that was connected to the aorta and maintained at a constant pressure. Changes in carotid sinus pressure from 135 to 57 mmHg and back to 137 mmHg resulted in a rapid vascular capacitance response of approximately 30 ml in the absence of adrenoceptor antagonists. Administration of a beta2-adrenoceptor antagonist (ICI-118551) caused a significant enhancement of the capacitance responses to similar decreases and increases in carotid sinus pressure (approximately 130%). Administration of a beta1-adrenoceptor antagonist (CGP-20712A) did not cause any further enhancement of the responses. However, an alpha-blocker (phentolamine) reduced the responses by 75%. The results suggest that in the presence of a beta2-adrenoceptor antagonist vascular capacitance responses to loading and unloading of baroreceptors are greatly enhanced and that patients suffering from orthostatic syncope may benefit from this kind of drug.

The status of ORT (oral rehydration therapy) in Bangladesh: how widely is it used?

During 1980-1990 BRAC, a Bangladeshi non-governmental organization, taught over 12 million mothers how to prepare oral rehydration therapy (ORT) at home with lobon (common salt) and gur (unrefined brown sugar). This was followed by a strong promotion and distribution of prepackaged ORS by various agencies including the government. In 1993 we assessed knowledge of ORT preparation, its local availability and its use for the management of diarrhoea. Over 9000 households in 90 villages were revisited; 306 government outreach health workers, 296 drug sellers, and 237 village doctors were interviewed; 152 government facilities and 495 pharmacies/shops were visited. ORT prepared by mothers in a sub-sample of the households was analyzed for chloride content and interviewers collected information on use of ORT for diarrhoeal episodes occurring in the preceding two weeks. The data quality was assessed through a resurvey of sample respondents within two weeks of the first interview. Over 70% of the mothers could prepare a chemically 'safe and effective' ORS. A significant proportion of these mothers were very young at the time of the mass campaigns using house to house teaching, implying an intergenerational transfer of the knowledge on ORT. ORT was found to be used in 60% of all diarrhoeal episodes, but the rate varied with the type of diarrhoea, being highest for daeria (severe watery diarrhoea) and lowest for amasha (dysentery). Drug sellers and village doctors now recommend ORT much more frequently than before. Members of the medical profession (qualified and unqualified) still lag behind in prescribing the use of ORT. The availability of pre-packaged ORS in rural pharmacies has improved enormously. There is convincing evidence that the widescale promotion in the past of ORS for dehydration in diarrhoea has led to this marked improvement today. Nevertheless the use of rice-based ORS, culturally appropriate messages and the promotion of ORS with food offer opportunities to further improve the utilization of ORT.

Role of 5-hydroxytryptamine3 (5-HT3) antagonists in the prevention of emesis caused by anticancer therapy

Most anticancer drugs are cytotoxic and produce various side-effects, among which nausea and vomiting are almost ubiquitous and usually extremely distressing to the patient. Cancer chemotherapy elicits two main phases of vomiting: an intense, acute phase of vomiting that occurs almost immediately following anti-cancer therapy and a milder, delayed phase of nausea and vomiting of longer duration. The mechanisms underlying the induction of nausea and vomiting after cancer chemotherapy are poorly understood but may be mediated by serotonin (5-hydroxytryptamine or 5-HT), particularly in the acute phase. Serotonin activates 5-HT3 receptors, which function as ligand-gated ion channels located either in the periphery and/or in the central nervous system to produce emesis, among other effects. The peripheral 5-HT3 receptors may be pharmacologically distinct from the central 5-HT3 receptors and may exhibit some association with GTP-binding proteins. In addition, different populations may exist as distinct subtypes of the same receptor. The 5-HT3 receptor antagonist ondansetron (GR 38032F) is effective in preventing the emesis induced by cytotoxic agents currently used in the treatment of many forms of cancer. Ondansetron has, comparatively, a much higher efficacy in the treatment of acute emesis following cancer chemotherapy than it does in the delayed phase, suggesting that the late phase of emesis may be mediated by other distinct mechanisms.

Spinal morphine/clonidine antinociceptive synergism: involvement of G proteins and N-type voltage-dependent calcium channels

When morphine and clonidine are coadministered into the spinal cord (intrathecally) the resulting antinociception is greater than would be expected if the drug responses were additive; thus, a synergistic interaction. The mechanism for this synergistic interaction was investigated using agents which alter calcium channel function and G protein function. Drugs were administered intrathecally to mice and antinociception was measured using the tail flick test. The L-type calcium channel antagonists nifedipine (15 micrograms) and verapamil (15 micrograms) and the N-type antagonist omega-conotoxin GVIA (3 and 30 ng) decreased ED50 values for both morphine and clonidine three-to five-fold. The L-type calcium channel activator Bay K 8644 had a biphasic effect; 1.7 ng increased, although 170 ng decreased, morphine and clonidine ED50 values. None of the calcium channel modifiers affected the morphine/clonidine synergism. In mice pretreated with pertussis toxin (PTX, one, 10-ng dose 21 days previously), the morphine ED50 value increased two-fold, although the clonidine ED50 value was not changed. PTX pretreatment did not alter the morphine/clonidine synergism. Also, in PTX-pretreated mice, nifedipine and 1.7 ng Bay K 8644 did not alter the morphine/clonidine synergism. However, in PTX-pretreated animals omega-conotoxin GVIA (3 ng) changed the morphine/clonidine synergism to an additive interaction. Thus, both N-type calcium channels and PTX-sensitive G proteins are likely involved in spinal morphine/clonidine synergism.

Loss of tramtrack gene activity results in ectopic R7 cell formation, even in a sina mutant background

We have screened a collection of transposable-element-induced mutations for those which dominantly modify the extra R7 phenotype of a hypomorphic yan mutation. The members of one of the identified complementation groups correspond to disruptions of the tramtrack (ttk) gene. As heterozygotes, ttk alleles increase the percentage of R7 cells in yan mutant eyes. Just as yan mutations increase ectopic R7 cell formation, homozygous ttk mutant eye clones also contain supernumerary R7 cells. However, in contrast to yan, the formation of these cells in ttk mutant eye tissue is not necessarily dependent on the activity of the sina gene. Furthermore, although yan mutations dominantly interact with mutations in the Ras1, Draf, Dsor1, and rolled (rl) genes to influence R7 cell development, ttk mutations only interact with yan and rl gene mutations to affect this signaling pathway. Our data suggest that yan and ttk both function to repress inappropriate R7 cell development but that their mechanisms of action differ. In particular, TTK activity appears to be autonomously required to regulate a sina-independent mechanism of R7 determination.

Regional differences in the negative inotropic effect of acetylcholine within the canine ventricle

1. Regional differences in the effects of ACh on sub-epicardial, mid-wall and sub-endocardial cells of the dog left ventricle have been studied. 2. ACh produced a dose-dependent, atropine-sensitive negative inotropic effect that was greatest in sub-epicardial cells and small or absent in sub-endocardial cells. 3. In sub-epicardial (but not sub-endocardial) cells, ACh also resulted in a dose-dependent decrease in action potential duration. The inotropic effect of ACh on sub-epicardial cells was primarily the result of the decrease of action potential duration, because during trains of voltage clamp pulses the inotropic effect of ACh was reduced or abolished. At a holding potential of -80 mV, 10(-5)M ACh decreased L-type Ca2+ current by approximately 8% and this is thought to be responsible for the small inotropic effect during trains of pulses. 4. Although 4-AP, a blocker of the transient outward current (I(to)), abolished the "spike and dome' morphology of the sub-epicardial action potential, it had little or no effect on the actions of ACh on sub-epicardial cells. ACh had no effect on I(to) in sub-epicardial cells in voltage clamp experiments. 5. ACh activated a Ba(2+)-sensitive outward current (IK,ACh) in sub-epicardial cells, but little or no such current in sub-endocardial cells. In sub-epicardial cells, ACh also inhibited the inward rectifier current, IK,1. 6. It is concluded that in left ventricular sub-epicardial cells, ACh activates IK,ACh. This results in a shortening of the action potential and, therefore, a negative inotropic effect. In subendocardial cells, ACh activates little or no IK,ACh and, therefore, it has little or no negative inotropic effect. This may result from a regional variation in the expression of the muscarinic K+ channel.