Endangered edible orchids and vulnerable gatherers in the context of HIV/AIDS in the Southern Highlands of Tanzania

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Bezlotoxumab for Prevention of Recurrent Clostridium difficile Infection

BACKGROUND Clostridium difficile is the most common cause of infectious diarrhea in hospitalized patients. Recurrences are common after antibiotic therapy. Actoxumab and bezlotoxumab are human monoclonal antibodies against C. difficile toxins A and B, respectively. METHODS We conducted two double-blind, randomized, placebo-controlled, phase 3 trials, MODIFY I and MODIFY II, involving 2655 adults receiving oral standard-of-care antibiotics for primary or recurrent C. difficile infection. Participants received an infusion of bezlotoxumab (10 mg per kilogram of body weight), actoxumab plus bezlotoxumab (10 mg per kilogram each), or placebo; actoxumab alone (10 mg per kilogram) was given in MODIFY I but discontinued after a planned interim analysis. The primary end point was recurrent infection (new episode after initial clinical cure) within 12 weeks after infusion in the modified intention-to-treat population. RESULTS In both trials, the rate of recurrent C. difficile infection was significantly lower with bezlotoxumab alone than with placebo (MODIFY I: 17% [67 of 386] vs. 28% [109 of 395]; adjusted difference, −10.1 percentage points; 95% confidence interval [CI], −15.9 to −4.3; P<0.001; MODIFY II: 16% [62 of 395] vs. 26% [97 of 378]; adjusted difference, −9.9 percentage points; 95% CI, −15.5 to −4.3; P<0.001) and was significantly lower with actoxumab plus bezlotoxumab than with placebo (MODIFY I: 16% [61 of 383] vs. 28% [109 of 395]; adjusted difference, −11.6 percentage points; 95% CI, −17.4 to −5.9; P<0.001; MODIFY II: 15% [58 of 390] vs. 26% [97 of 378]; adjusted difference, −10.7 percentage points; 95% CI, −16.4 to −5.1; P<0.001). In prespecified subgroup analyses (combined data set), rates of recurrent infection were lower in both groups that received bezlotoxumab than in the placebo group in subpopulations at high risk for recurrent infection or for an adverse outcome. The rates of initial clinical cure were 80% with bezlotoxumab alone, 73% with actoxumab plus bezlotoxumab, and 80% with placebo; the rates of sustained cure (initial clinical cure without recurrent infection in 12 weeks) were 64%, 58%, and 54%, respectively. The rates of adverse events were similar among these groups; the most common events were diarrhea and nausea. CONCLUSIONS Among participants receiving antibiotic treatment for primary or recurrent C. difficile infection, bezlotoxumab was associated with a substantially lower rate of recurrent infection than placebo and had a safety profile similar to that of placebo. The addition of actoxumab did not improve efficacy. (Funded by Merck; MODIFY I and MODIFY II ClinicalTrials.gov numbers, NCT01241552 and NCT01513239.

Herbal remedy knowledge acquisition and transmission among the Yucatec Maya in Tabi, Mexico: a cross-sectional study

BACKGROUND: Ethnobotanical knowledge continues to be important for treating illness in many rural communities, despite access to health care clinics and pharmaceuticals. However, access to health care clinics and other modern services can have an impact on the distribution of medical ethnobotanical knowledge. Many factors have been shown to be associated with distributions in this type of knowledge. The goal of the sub-analyses reported in this paper was to better understand the relationship between herbal remedy knowledge, and two such factors, age and social network position, among the Yucatec Maya in Tabi, Yucatan. METHODS: The sample consisted of 116 Yucatec Maya adults. Cultural consensus analysis was used to measure variation in herbal remedy knowledge using competence scores, which is a measure of participant agreement within a domain. Social network analysis was used to measure individual position within a network using in-degree scores, based on the number of people who asked an individual about herbal remedies. Surveys were used to capture relevant personal attributes, including age. RESULTS: Analysis revealed a significant positive correlation between age and the herbal medicine competence score for individuals 45 and under, and no relationship for individuals over 45. There was an insignificant relationship between in-degree and competence scores for individuals 50 and under and a significant positive correlation for those over 50. CONCLUSIONS: There are two possible mechanisms that could account for the differences between cohorts: 1) knowledge accumulation over time; and/or 2) the stunting of knowledge acquisition through delayed acquisition, competing treatment options, and changes in values. Primary ethnographic evidence suggests that both mechanisms may be at play in Tabi. Future studies using longitudinal or cross-site comparisons are necessary to determine the whether and how the second mechanism is influencing the different cohorts.This item is part of the UA Faculty Publications collection. For more information this item or other items in the UA Campus Repository, contact the University of Arizona Libraries at [email protected]

Local knowledge of medicinal plants in three artisanal fishing communities (Itapoá, Southern Brazil), according to gender, age, and urbanization Conhecimento local sobre plantas medicinais em três comunidades de pescadores artesanais (Itapoá, sul do Brasil), de acordo com gênero, idade e urbanização

This article analyzes some of the factors affecting the distribution of knowledge about medicinal plants of three artisanal fishing communities in Itapoá Municipality, in the state of Santa Catarina, Brazil. Ninety semi-structured interviews were performed, which resulted in 109 cited plant species. The sample included both men (n=46) and women (n=44), in different age categories: 18-40 years old (n=18), 41-50 (n=21), 51-60 (n=28), and 61+ years old (n=23), and in three different communities: Barra do Saí (n=17), Itapema do Norte (n=31) and Pontal do Norte (n=42). Leaves are the plant parts most used by the communities (62%), and are obtained primarily through cultivation. Cordia curassavica (Jacq.) Roem. & Schult. (Boraginaceae) is the species most cited in the interviews, locally known as 'erva-baleeira' or 'erva-de-baleia'. The elderly have greater knowledge of species, but no gender differences were noticed. Less knowledge of plants was noticed in the more urbanized area when compared to the less urbanized areas. The most used plants are not related to the most frequent ailments. Medicinal plant use is an important resource for the health of these fishing communities, but it is declining mostly due to the lack of interest on the part of the younger members, and to improved access to public health services.<br>Este artigo analisa alguns dos fatores que afetam a distribuição do conhecimento sobre plantas medicinais em três comunidades de pescadores artesanais do Município de Itapoá, Santa Catarina, Brasil. Noventa entrevistas semi-estruturadas foram realizadas, o que resultou em 109 espécies de plantas citadas. A amostra foi composta por homens (n = 46) e mulheres (n = 44), em diferentes categorias de idade: 18-40 anos (n = 18), 41-50 (n = 21), 51-60 (n = 28), e 61 anos ou mais (n = 23), e em três diferentes comunidades: Barra do Saí (n = 17), Itapema do Norte (n = 31) e Pontal do Norte (n = 42). Folhas são as partes da plantas mais utilizadas (62%), sendo obtidas principalmente por cultivo. Cordia curassavica (Jacq.) Roem. & Schult. (Boraginaceae) é a espécie mais citada nas entrevistas, localmente chamada de "erva-baleeira" ou "erva-de-baleia". Os idosos têm um maior conhecimento sobre as espécies, mas não houve diferenças em relação ao sexo dos entrevistados. Um menor conhecimento sobre as plantas foi observado na área mais urbanizada, quando comparada com as áreas menos urbanizadas. As plantas mais utilizadas não estão relacionadas com as doenças mais freqüentes. As plantas medicinais são um recurso importante para a saúde dessas comunidades de pescadores, mas este conhecimento pode estar se deteriorando devido principalmente à falta de interesse dos membros mais jovens e à melhoria do acesso aos serviços públicos de saúde

Use and traditional knowledge of Byrsonima crassifolia and B. coccolobifolia (Malpighiaceae) in a Makuxi community of the Roraima savanna, northern Brazil

ABSTRACT Byrsonima crassifolia and B. coccolobifolia, popularly known as mirixis, muricis, mantecos or nances, are common fruit species in the Amazonian savannas. Their fruits are used in the preparation of juices and other beverages, while the other parts of the plants are used for different purposes in some indigenous communities. The aim of the present ethnobotanical study was to investigate the knowledge and traditional uses of mirixis in the Darora Indigenous Community, of the Makuxi ethnicity, in the São Marcos Indigenous Land, state of Roraima, northern Brazil. The knowledge on these species among the residents was analyzed considering their gender and age. A survey was carried out by means of semi-structured interviews with 60 respondents (36 men and 24 women), between 18 and 84 years of age. Data from the interviewees was compared between genders and two age groups (< 40 and &#8805; 40 years of age). Ethnobotanical indices (Informant diversity value; Informant equability value) were calculated, and no significant differences were found in the diversity of uses between genders (U = 283.0000, p > 0.05) and age groups (U = 359.5000, p > 0.05), indicating that the knowledge on the species is evenly distributed among residents. Results show that both species are used for different purposes in the food, fuelwood and medicinal categories in the Darora Community, and this knowledge is widely shared among adult men and women of all ages