South Asians living in the UK and adherence to coronary heart disease medication: a mixed- method study.

Background The prevalence of coronary heart disease amongst South Asian population in the UK is higher compared to the general population. Objective This study sought to investigate beliefs and experiences of South Asian patients regarding coronary heart disease and medication taking behaviour. Setting A London Heart Attack Centre. Methods This mixed method study is part of an original pilot randomised study on 71 patients involving a pharmacy-led intervention to improve medication adherence in coronary heart disease patients. South Asian patients from the randomised study took part in qualitative semi-structured telephone interviews. Both South Asian and non-South Asian patients completed the questionnaire about adherence and beliefs regarding medicines using Morisky Scale and the Belief About Medicines Questionnaire-Specific at 2 weeks, 3 and 6 months. Outcome Patients' beliefs about coronary heart disease and medication adherence. Results Seventeen South Asian patients and 54 non-South Asian patients took part. Qualitative data from 14 South Asian patients showed that while some attributed coronary heart disease to genetic, family history for their illness, others attributed it to their dietary patterns and 'god's will' and that little could be done to prevent further episodes of coronary heart disease. On the Belief About Medicines Questionnaire-Specific in South Asian patients, beliefs about necessity of medicines outweighed concerns. South Asian patients (n = 17) showed a similar pattern of adherence compared to non-Asian patients (n = 54). Adherence decreased with time in both populations, adherence measured by Morisky Scale. Conclusion South Asian patients in this study often attributed coronary heart disease to additional causes besides the known risk factors. Future studies on their understanding of the importance of cultural context in their attitudes to prevention and lived experience of the disease is warranted

T-Cell Artificial Focal Triggering Tools: Linking Surface Interactions with Cell Response

T-cell activation is a key event in the immune system, involving the interaction of several receptor ligand pairs in a complex intercellular contact that forms between T-cell and antigen-presenting cells. Molecular components implicated in contact formation have been identified, but the mechanism of activation and the link between molecular interactions and cell response remain poorly understood due to the complexity and dynamics exhibited by whole cell-cell conjugates. Here we demonstrate that simplified model colloids grafted so as to target appropriate cell receptors can be efficiently used to explore the relationship of receptor engagement to the T-cell response. Using immortalized Jurkat T cells, we monitored both binding and activation events, as seen by changes in the intracellular calcium concentration. Our experimental strategy used flow cytometry analysis to follow the short time scale cell response in populations of thousands of cells. We targeted both T-cell receptor CD3 (TCR/CD3) and leukocyte-function-associated antigen (LFA-1) alone or in combination. We showed that specific engagement of TCR/CD3 with a single particle induced a transient calcium signal, confirming previous results and validating our approach. By decreasing anti-CD3 particle density, we showed that contact nucleation was the most crucial and determining step in the cell-particle interaction under dynamic conditions, due to shear stress produced by hydrodynamic flow. Introduction of LFA-1 adhesion molecule ligands at the surface of the particle overcame this limitation and elucidated the low TCR/CD3 ligand density regime. Despite their simplicity, model colloids induced relevant biological responses which consistently echoed whole cell behavior. We thus concluded that this biophysical approach provides useful tools for investigating initial events in T-cell activation, and should enable the design of intelligent artificial systems for adoptive immunotherapy

Transcriptional Analysis Implicates Endoplasmic Reticulum Stress in Bovine Spongiform Encephalopathy

Bovine spongiform encephalopathy (BSE) is a fatal, transmissible, neurodegenerative disease of cattle. To date, the disease process is still poorly understood. In this study, brain tissue samples from animals naturally infected with BSE were analysed to identify differentially regulated genes using Affymetrix GeneChip Bovine Genome Arrays. A total of 230 genes were shown to be differentially regulated and many of these genes encode proteins involved in immune response, apoptosis, cell adhesion, stress response and transcription. Seventeen genes are associated with the endoplasmic reticulum (ER) and 10 of these 17 genes are involved in stress related responses including ER chaperones, Grp94 and Grp170. Western blotting analysis showed that another ER chaperone, Grp78, was up-regulated in BSE. Up-regulation of these three chaperones strongly suggests the presence of ER stress and the activation of the unfolded protein response (UPR) in BSE. The occurrence of ER stress was also supported by changes in gene expression for cytosolic proteins, such as the chaperone pair of Hsp70 and DnaJ. Many genes associated with the ubiquitin-proteasome pathway and the autophagy-lysosome system were differentially regulated, indicating that both pathways might be activated in response to ER stress. A model is presented to explain the mechanisms of prion neurotoxicity using these ER stress related responses. Clustering analysis showed that the differently regulated genes found from the naturally infected BSE cases could be used to predict the infectious status of the samples experimentally infected with BSE from the previous study and vice versa. Proof-of-principle gene expression biomarkers were found to represent BSE using 10 genes with 94% sensitivity and 87% specificity

HIV-associated neurocognitive disorders in sub-Saharan Africa: a pilot study in Cameroon

<p>Abstract</p> <p>Background</p> <p>The disease burden of human immunodeficiency virus (HIV) - acquired immunodeficiency syndrome (AIDS) is highest in sub-Saharan Africa but there are few studies on the associated neurocognitive disorders in this region. The objectives of this study were to determine whether Western neuropsychological (NP) methods are appropriate for use in Cameroon, and to evaluate cognitive function in a sample of HIV-infected adults.</p> <p>Methods</p> <p>We used a battery of 19 NP measures in a cross-sectional study with 44 HIV+ adults and 44 demographically matched HIV- controls, to explore the validity of these NP measures in Cameroon, and evaluate the effect of viral infection on seven cognitive ability domains.</p> <p>Results</p> <p>In this pilot study, the global mean z-score on the NP battery showed worse overall cognition in the HIV+ individuals. Significantly lower performance was seen in the HIV+ sample on tests of executive function, speed of information processing, working memory, and psychomotor speed. HIV+ participants with AIDS performed worse than those with less advanced HIV disease.</p> <p>Conclusions</p> <p>Similar to findings in Western cohorts, our results in Cameroon suggest that HIV infection, particularly in advanced stages, is associated with worse performance on standardized, Western neurocognitive tests. The tests used here appear to be promising for studying NeuroAIDS in sub-Saharan Africa.</p

Misoprostol for uterine evacuation during miscarriage: A systematic review

Miscarriage is an important cause of morbidity and mortality especially in developing countries. Traditionally, miscarriage is treated by surgical curettage. Misoprostol has been introduced in recent years for treatment of miscarriage. In this review, we systematically searched for and combined the evidence from randomized controlled trials comparing misoprostol with surgical curettage. The objective of this study was to evaluate the effectiveness and safety of misoprostol compared with surgical curettage for the management of miscarriage. The HINARI (Health InterNetwork Access to Research Initiative), the MEDLINE and the Cochrane Controlled Trials Register were systematically searched up to June 15, 2004. The reference lists of the retrieved articles were also searched. Trial quality was assessed and data extracted for analysis which was performed using RevMan software. Four studies were included in the review. Patients on misoprostol were 19 times more likely to have incomplete uterine evacaution than those who underwent curettage (OR 19.38, 95% CI 11.34 to 33.12). Misoprostol was associated with a significantly higher incidence of nausea, diarrhoea and need for pain relief, but reduced the risk of uterine perforation and severe bleeding. In conclusion misoprostol is less effective than surgical curettage in terms of complete Mother and Child Health Clinics Vol. 1(3) 2004: 188-19

Premature rupture of membranes: many questions still unanswered

Management of premature rupture of membranes (PROM) still remains a subject of controversy among obstetricians. Although prompt delivery is generally recommended at term to reduce the risk of perinatal morbidity and mortality, some authors recommend expectant management especially in cases of poor Bishop's score to reduce caeserean delivery rate. Preterm PROM remote from term is even more challenging to obstetricians. Conservative management where possible should be pursued to reduce the risk of prematurity. Although available evidence supports the use of short-term antibioprophylaxis to reduce infectious morbidity and prolong the pregnancy, the choice of antibiotics still remains controversial. Current evidence indicates that antenatal corticosteroid in preterm PROM before term enhances neonatal outcome without increasing the risk of perinatal infection. Yet, there is no consensus as when to give steroids especially in the setting of black Africa where foetal lung maturation is now known to take place earlier than in the white race. The use of tocolysis has not been shown to be of any value in PROM, although some clinicians either practice prophylactic tocolysis or therapeutic tocolysis or both. Although neonatal outcome is improved by caeserean delivery especially in preterm babies with breech presentation, the route of delivery still remains a dilemma between obstetricians. Managementof PROM should be based on gestational age-based approach and individual assessment of the maternofoetal and neonatal risks should expeditious delivery or conservative management be pursued. Future research should be directed towards the determination of the choice of antibioprophylaxis in developing countries; the role of steroids in black Africa and the role of tocolytic agents and the mode of delivery in case of PROM before term needs to be evaluated. Clinics in Mother and Child Health Vol. 1(2) 2004: 115-12