The synergy between TB and HIV co-infection on perceived stigma in Ethiopia

<p>Abstract</p> <p>Background</p> <p>The synergy between tuberculosis (TB) and human immunodeficiency virus (HIV) co-infection on perceived stigma is not well studied. The objective of this study was to assess the effect of TB/HIV co-infection on perceived stigma in selected hospitals of Oromiya region, Ethiopia. A cross sectional study was conducted from February to April, 2009 in Adama, Nekemet and Jimma Specialized hospitals. Data were collected by trained HIV counselors. A structured questionnaire which consisted of socio-demographic variables, clinical information, perceived stigma, and depression was used to collect the data</p> <p>Findings</p> <p>A total of 591 participants were included in the study of whom 124 (20.9%) were co-infected with TB/HIV. The stigma items were highly reliable (Cronbach's alpha = 0.93) and had strong inter dimension correlation. Respondents who were co-infected with TB and HIV were more likely to have perceived stigma compared to non-co-infected HIV patients, [OR = 1.4, (95% CI: 1.2, 2.0)]. Non-literate individuals [OR = 1.9, (95% CI: 1.2, 3.0)] and females [OR = 1.6, (95% CI: 1.2, 2.3)] had also more perceived stigma.</p> <p>Conclusions</p> <p>TB/HIV co-infected patients, non-literate individuals and females were more likely to have high perceived stigma. Behavioral Change Communication should focus on these segments of the population to rectify the high perceived stigma.</p

Informing the design of a national screening and treatment programme for chronic viral hepatitis in primary care: qualitative study of at-risk immigrant communities and healthcare professionals

n Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise statedThis paper presents independent research funded by the National Institute for Health Research (NIHR) under the Programme Grants for Applied Research programme (RP-PG-1209-10038).

Tie2-Dependent Neovascularization of the Ischemic Hindlimb Is Mediated by Angiopoietin-2

<div><p>The angiopoietins (ANGPT) are ligands for the endothelial cell (EC) receptor tyrosine kinase, Tie2. Angpt-1 is a Tie2 agonist that promotes vascular maturation and stabilization, whereas Angpt-2 is a partial agonist/antagonist involved in the initiation of postnatal angiogenesis. Therefore, we hypothesized that overexpression of Angpt-2 would be more effective than Angpt-1 for enhancing the perfusion recovery in the ischemic hindlimb. Perfusion recovery was markedly impaired in Tie2-deficient animals at day 35 in a model of chronic hindlimb ischemia. Injections of <em>Angpt-2</em> or <em>VEGFA</em> plasmid at 7 days post femoral artery resection enhanced recovery and improved arteriogenesis as assessed by angiographic scores, whereas <em>Angpt-1</em> or null plasmid had no effect. In addition, Angpt-2 together with VEGF resulted in greater improvement in perfusion and collateral vessel formation than VEGF alone. Similarly, conditional overexpression of Angpt-2 in mice improved ischemic limb blood flow recovery, while Angpt-1 overexpression was ineffective. These data from Tie2 heterozygote deficient mice demonstrate, for the first time, the importance of the Tie2 pathway in spontaneous neovascularization in response to chronic hindlimb ischemia. Moreover, they show that overexpression of the partial agonist, Angpt-2, but not Angpt-1, enhanced ischemic hind limb perfusion recovery and collateralization, suggesting that a coordinated sequence antagonist and agonist activity is required for effective therapeutic revascularization.</p> </div

Limb survival dependence on Tie2 in the autoamputation model.

<p>(a) Representative laser doppler perfusion images showing post-surgical, unilateral reduction of hindlimb perfusion on day 0 (top) with signs of limb salvage in wild-type and early limb loss in Tie2+/− mice on day 7 (bottom). In color-coded images, normal perfusion is depicted in a range from high (red/white) to low (blue). Photographic image of distal forefoot loss defined as leg autoamputation. Graph shows limb survival curve after induction of ischemia (time 0) in wild-type (^___, n = 9) and Tie2+/− (—, n = 8) mice as obtained by Kaplan-Mayer's method and analyzed using log-rank test. *denotes p<0.05. (b) Tie2+/− mice display reduced perfusion restoration compared to wild-type mice by laser doppler perfusion imaging in wild-type (n = 10) and Tie2+/− (n = 11) mice on day 0, 14 and 35 after femoral arteriectomy. (c) Quantitative evaluation of perfusion expressed as a ratio of ischemic to non-ischemic limb perfusion in wild-type (solid bars) and Tie2+/− mice (shaded bars); *denotes p<0.001. (d) Movement score assessing functional impairment in follow-up after hindlimb ischemia in wild-type (solid lines, n = 6) and Tie2+/− (shaded lines, n = 6) mice. *denotes p<0.05. (e) Tie2 deficiency decreases restoration of microvascular perfusion capacity in response to ischemia imaged with confocal microscopy on whole-mount tissue specimens using fluorescence microangiography. Nonischemic muscle in both Tie2+/− and wild-type contain numerous perfused blood vessels that dramatically drop in number after surgical induction of hindlimb ischemia. (f) Quantification of adductor muscle perfusion capacity on day 14 expressed as a vessel score that is a composite of vessel branching point number, length and end points number. Perfusion capacity of the ischemic limb is improved in wild-type (n = 5) versus Tie2+/− (n = 4) mice on day 14. *denotes p<0.01.</p

Three independent lines of transgenic mice were used to induce conditional overexpression of human Angpt-1 (hAngpt-1) and human Angpt-2 (hAngpt-2).

<p>The tetracycline-responsive transactivator (tTA), expressed from the LAP promoter (driver line) associates with the tTA binding site (Tet^OS) located upstream of the hAngpt-1 or hAngpt-2 cDNA (responder line). In the presence of the tetracycline analog, doxycycline (DOX), hAngpt-1 or hAngpt-2 expression is suppressed. In the absence of DOX, hAngpt-1 or hAngpt-2 are expressed.</p

Laser doppler perfusion imaging serial assessment of hindlimb perfusion.

<p>(a) Representative laser doppler perfusion imaging scans of rats treated with intramuscular injections of plasmids encoding for human Angpt-1 alone (-□-, n = 7), Angpt-2 alone (-○-, n = 8), VEGF alone (-Δ-, n = 9) or combination of Angpt-1+VEGF (-□-, n = 8), Angpt-2+VEGF (-○-, n = 7). Controls received null plasmid (-Δ-, n = 9). Animals were imaged on days 0, 7 and 35 after surgically-induced left hindlimb ischemia. Blood flow is displayed by color-coded pixels where blue indicates low perfusion and red-white denotes high perfusion. Assessment of perfusion was performed on the lower leg and foot. (b) A serial quantitative evaluation of hindlimb blood perfusion expressed as a ratio of ischemic leg perfusion to that in the non-ischemic contralateral limb (I/NI) is shown for all single gene transfer groups. Combination gene transfer groups are shown in (c). (d) The increment in perfusion recovery (%) from day 7 (time of gene injection) to day 35. ^* denotes p<0.05 versus controls and Angpt-1 treated. # denotes p<0.05 versus VEGF and Angpt-2 treated animals.</p