Chronic hepatosplenomegaly in African school children: a common but neglected morbidity associated with schistosomiasis and malaria.

Chronic hepatosplenomegaly, which is known to have a complex aetiology, is common amongst children who reside in rural areas of sub-Saharan Africa. Two of the more common infectious agents of hepatosplenomegaly amongst these children are malarial infections and schistosomiasis. The historical view of hepatosplenomegaly associated with schistosomiasis is that it is caused by gross periportal fibrosis and resulting portal hypertension. The introduction of ultrasound examinations into epidemiology studies, used in tandem with clinical examination, showed a dissociation within endemic communities between presentation with hepatosplenomegaly and ultrasound periportal fibrosis, while immuno-epidemiological studies indicate that rather than the pro-fibrotic Th2 response that is associated with periportal fibrosis, childhood hepatosplenomegaly without ultrasound-detectable fibrosis is associated with a pro-inflammatory response. Correlative analysis has shown that the pro-inflammatory response is also associated with chronic exposure to malarial infections and there is evidence of exacerbation of hepatosplenomegaly when co-exposure to malaria and schistosomiasis occurs. The common presentation with childhood hepatosplenomegaly in rural communities means that it is an important example of a multi-factorial disease and its association with severe and subtle morbidities underlies the need for well-designed public health strategies for tackling common infectious diseases in tandem rather than in isolation

Imported malaria in a cosmopolitan European city: A mirror image of the world epidemiological situation

© 2008 Millet et al; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution Licens

Barriers to receiving hepatitis C treatment for people who inject drugs: Myths and evidence

Background: Alcohol consumption, current injecting drug use, and pre-existing mental illness have been identified as 3 of the main reasons for excluding patients from treatment for hepatitis C. Objectives: We reviewed the literature to obtain an evidence base for these common exclusion criteria. Materials and Methods: We reviewed original research and meta-analyses investigating the effects of alcohol consumption, current injecting drug use, and pre-existing mental illness. Results: We identified 66 study reports relevant to the review, but found only limited evidence to support withholding of treatment on the basis of the 3 previously mentioned exclusion criteria. Conclusions: Currently, there is a lack of evidence for many of the barriers faced by patients in availing treatment for hepatitis C. Adherence to treatment routine was found to be a better predictor of sustained virological response than injecting drug or alcohol consumption during treatment period or the presence of a pre-existing mental disorder. Although several challenges remain, we need to ensure that treatment decisions are based on the best available evidence and the treatment is performed appropriately on a case-by-case basis. © 2011 Kowsar M.P.Co. All rights reserved

APOE ε4 moderates abnormal CSF-abeta-42 levels, while neurocognitive impairment is associated with abnormal CSF tau levels in HIV+ individuals – a cross-sectional observational study

Background: Cerebrospinal fluid (CSF) biomarkers Aβ1-42, t-tau and p-tau have a characteristic pattern in Alzheimer’s Disease (AD). Their roles in HIV-associated neurocognitive disorder (HAND) remains unclear. Methods: Adults with chronic treated HIV disease were recruited (n = 43, aged 56.7 ± 7.9; 32% aged 60+; median HIV duration 20 years, \u3e95% plasma and CSF HIV RNA \u3c50 cp/mL, on cART for a median 24 months). All underwent standard neuropsychological testing (61% had HAND), APOE genotyping (30.9% carried APOE ε4 and 7.1% were ε4 homozygotes) and a lumbar puncture. Concentrations of Aβ1-42, t-tau and p-tau were assessed in the CSF using commercial ELISAs. Current neurocognitive status was defined using the continuous Global Deficit Score, which grades impairment in clinically relevant categories. History of HAND was recorded. Univariate correlations informed multivariate models, which were corrected for nadir CD4-T cell counts and HIV duration. Results: Carriage of APOE ε4 predicted markedly lower levels of CSF Aβ1-42 in univariate (r = -.50; p = .001) and multivariate analyses (R2 = .25; p \u3c .0003). Greater levels of neurocognitive impairment were associated with higher CSF levels of p-tau in univariate analyses (r = .32; p = .03) and multivariate analyses (R2 = .10; p = .03). AD risk prediction cut-offs incorporating all three CSF biomarkers suggested that 12.5% of participants had a high risk for AD. Having a CSF-AD like profile was more frequent in those with current (p = .05) and past HIV-associated dementia (p = .03). Conclusions: Similarly to larger studies, APOE ε4 genotype was not directly associated with HAND, but moderated CSF levels of Aβ1-42 in a minority of participants. In the majority of participants, increased CSF p-tau levels were associated with current neurocognitive impairment. Combined CSF biomarker risk for AD in the current HIV+ sample is more than 10 times greater than in the Australian population of the same age. Larger prospective studies are warranted

Evidence of Rickettsia and Orientia Infections Among Abattoir Workers in Djibouti.

Of 49 workers at a Djiboutian abattoir, eight (16%, 95% confidence interval [CI]: 9-29) were seropositive against spotted fever group rickettsiae (SFGR), two (4%, 95% CI: 1-14) against typhus group rickettsiae, and three (6%, 95% CI: 2-17) against orientiae. One worker (9%, 95% CI: 2-38) seroconverted against orientiae during the study period. This is the first evidence of orientiae exposure in the Horn of Africa. SFGR were also identified by polymerase chain reaction in 32 of 189 (11%, 95% CI: 8-15) tick pools from 26 of 72 (36%) cattle. Twenty-five (8%, 95% CI: 6-12) tick pools were positive for Rickettsia africae, the causative agent of African tick-bite fever. Health-care providers in Djibouti should be aware of the possibility of rickettsiae infections among patients, although further research is needed to determine the impact of these infections in the country

Epidemiology of imported malaria among children and young adults in Barcelona (1990-2008)

<p>Abstract</p> <p>Background</p> <p>Increasing international travel and migration is producing changes in trends in infectious diseases, especially in children from many European cities. The objective of this study was to describe the epidemiology and determine the trends of imported malaria in patients under 20 years old in the city of Barcelona, Spain, during an 18-year period.</p> <p>Methods</p> <p>The study included malaria cases that were laboratory confirmed and reported to the malaria register at the Public Health Agency of Barcelona from 1990 to 2008, residing in Barcelona and less than 20 years old. Patients were classified as natives (born in Spain) or immigrants. Differences in the distribution of demographic, clinical characteristics, and incidence per 100,000 person-year evolution were analysed. Natives and immigrants were compared by logistic regression by calculating the <it>odds ratio </it>(OR) with a 95% confidence interval (CI) and Chi-square for a linear trend (p < 0.05).</p> <p>Results</p> <p>Of the total 174 cases, 143 (82.1%) were immigrants, 100 (57.5%) were female, 121 (69.5%) <it>Plasmodium falciparum</it>, and 108 (62.1%) were visiting friends and relatives (VFR) as the reason for travel. Among the immigrants, 99 (67.8%) were from Equatorial Guinea. Immigrant cases more frequently travelled to Africa than natives (p = 0.02). The factors associated with imported malaria among immigrant residents was travelling for VFR (OR: 6.2 CI 1.9-20.2) and age 15-19 (OR: 3.7 CI 1-13.3). The incidence increased from 1990 to 1999 (p < 0.001) and decreased from 2000 to 2008 (p = 0.01), although the global linear trend was not statistically significant (p = 0.41). The fatality rate was 0.5%.</p> <p>Conclusions</p> <p>The majority of cases of malaria in population less than 20 years in Barcelona were immigrants, travelling to Africa for VFR and <it>Plasmodium falciparum </it>was most frequently detected. The trend analysis of the entire study period did not show a statistically significant decline. It is recommended to be aware of malaria, especially among children of immigrants who travel to their parent's home country for VFR. Better access to pre travel advice should be provided.</p

Effect of methadone on depression, anxiety and quality of life in addicts

Introduction: Addiction treatment and breaking the vicious cycle that is difficult and expensive. And want comprehensive treatment system with different approaches to drug therapy, psychotherapy and rehabilitation. In this study, was assessed the effects of methadone therapy on depression, anxiety and quality of life in addicts referred to addiction Treatment of Health Center of Shahid Ahmadi Tehran. Materials & methods: This study was semi experimental that in 1389- 90 years was performed on addicts refer to addiction treatment center of ShahidAhmadi Tehran with available sampling method. Overall 96 people entered the study. The questionnaire consisted of 4 parts: Demographic information, Beck's depression inventory, STAI anxiety and quality of life, was complete before the start of treatment with methadone and one month after of treatment with methadone. Data were analyzed by using spss16 and paired t-test and wilcoxon. Findings: The results showed that 72 addict, were depressed before the treatment with methadone. One month after treatment, the prevalence of depression in patients was reduced to 46 persons. This decrease was statistically significant. Level of anxiety was reduced after taking the methadone. Also the quality of life after treatment with methadone was significantly more than ago. Conclusion: Use of alternative treatments such as methadone therapy can be effective in reduction the prevalence and severity of depression, anxiety and increase the quality of life

Development of polytoxicomania in function of defense from psychoticism

Introduction. Polytoxicomanic proportions in subpopulations of youth have been growing steadily in recent decades, and this trend is pan-continental. Psychoticism is a psychological construct that assumes special basic dimensions of personality disintegration and cognitive functions. Psychoticism may, in general, be the basis of pathological functioning of youth and influence the patterns of thought, feelings and actions that cause dysfunction. Objective. The aim of this study was to determine the distribution of basic dimensions of psychoticism for commitment of youth to abuse psychoactive substances (PAS) in order to reduce disturbing intrapsychic experiences or manifestation of psychotic symptoms. Methods. For the purpose of this study, two groups of respondents were formed, balanced by age, gender and family structure of origin (at least one parent alive). The study applied a DELTA-9 instrument for assessment of cognitive disintegration in function of establishing psychoticism and its operationalization. The obtained results were statistically analyzed. From the parameters of descriptive statistics, the arithmetic mean was calculated with measures of dispersion. A cross-tabular analysis of variables tested was performed, as well as statistical significance with Pearson’s χ2-test, and analysis of variance. Results. Age structure and gender are approximately represented in the group of polytoximaniacs and the control group. Testing did not confirm the statistically significant difference (p&gt;0.5). Statistical methodology established that they significantly differed in most variables of psychoticism, polytoxicomaniacs compared with a control group of respondents. Testing confirmed a high statistical significance of differences of variables of psychoticism in the group of respondents for p&lt;0.001 to p&lt;0.01. Conclusion. A statistically significant representation of the dimension of psychoticism in the polytoxicomaniac group was established. The presence of factors concerning common executive dysfunction was emphasized

Identification of Mycobacterium tuberculosis clinical isolates in Bangladesh by a species distinguishable multiplex PCR

<p>Abstract</p> <p>Background</p> <p>Species identification of isolates belonging to the <it>Mycobacterium tuberculosis </it>complex (MTC) seems to be important for the appropriate treatment of patients, since <it>M. bovis </it>is naturally resistant to a first line anti-tuberculosis (TB) drug, pyrazinamide, while most of the other MTC members are susceptible to this antimicrobial agent. A simple and low-cost differentiation method was needed in higher TB burden countries, such as Bangladesh, where the prevalence of <it>M. bovis </it>among people or cattle has not been investigated.</p> <p>Methods</p> <p>Genetic regions <it>cfp32</it>, RD9 and RD12 were chosen as targets for a species distinguishable multiplex PCR and the system was evaluated with twenty reference strains of mycobacterial species including non-tubercular mycobacteria (NTM). A total of 350 clinical MTC isolates obtained in Bangladesh were then analyzed with this multiplex PCR.</p> <p>Results</p> <p>All of the MTC reference strains gave expected banding patterns and no non-specific amplifications were observed in the NTM strains. Out of 350 clinical isolates examined by this method, 347 (99.1%) were positive for all of the <it>cfp32</it>, RD9 and RD12 and determined as <it>M. tuberculosis</it>. Two isolates lacked <it>cfp32 </it>PCR product and one lacked RD12, however, those three samples were further examined and identified as <it>M. tuberculosis </it>by the sequence analyses of <it>hsp65 </it>and <it>gyrB</it>.</p> <p>Conclusions</p> <p>The MTC-discrimination multiplex PCR (MTCD-MPCR) developed in this study showed high specificity and was thought to be very useful as a routine test because of its simplicity. In the current survey, all the 350 MTC isolates obtained from Bangladesh TB patients were determined as <it>M. tuberculosis </it>and no other MTC were detected. This result suggested the general TB treatment regimen including pyrazinamide to be the first choice in Bangladesh.</p

Going back to the soil: An integrated approach to farming.

Agricultural productivity is often constrained by nutrient availability; as such, copious amounts of synthetic fertilizers are applied to maintain productivity. However, the intensive use of synthetic fertilizers has reduced the capacity of the soil to carry out crucial roles such as nutrient cycling because of shifts in the microbial community composition and structure. In addition, much of the applied synthetic fertilizers become lost to the environment through run-off, which contributes to soil degradation. With the increasing demand on agricultural systems to provide food and fibre and the adverse impacts of agricultural production on the soil resource, amendments that support soil productivity are required to supply plant nutrients. One way of sustainably improving nutrient acquisition and retention is by improving soil fertility; this can be achieved through integrative farming strategies that increase organic matter levels and stimulate the microbial community. In this greenhouse study, an integrative approach that relied on plant-soil-microbe interactions was used to evaluate the usage of an agromineral as a slow-release fertilizer. This assessment was done by comparing the effects of an agromineral, the Spanish River Carbonatite (SRC), and a synthetic fertilizer (Nitrogen-Phosphorus-Potassium (NPK), 20-20-20) on soil pH, microbial abundance and respiration, as well as on the legume-Rhizobium symbiosis. I hypothesized that the SRC, rich in calcium and other essential plant nutrients, would raise soil pH, stimulate microbial abundance and respiration, and enhance the legume-Rhizobium symbiosis in comparison to the synthetic fertilizer. In addition, the microbial abundance and respiration would differ depending on the plants grown. A mix of leguminous and non-leguminous cover crops was grown for 56 days in soils treated with three soil amendments: SRC, ammonium nitrate, and NPK synthetic fertilizer. The cover crops were grown in the following pairs: 1) alfalfa and chicory and 2) red clover and oilseed radish. At harvest, soil treated with SRC had higher pH values (pH raised by 1.2 units) and exhibited a higher abundance of heterotrophic and symbiotic nitrogen-fixing bacteria than those soils lacking the SRC amendment. This effect of SRC was observed in the rhizosphere of both cover crop combinations. However, the effect of soil amendments on the phosphate-solubilizing bacteria varied between cover crop combinations. The relative abundance of phosphate-solubilizing bacteria was enhanced by the SRC amendment in the rhizosphere of red clover and oilseed radish plants; in contrast, in the rhizosphere of intercropped alfalfa and chicory, the NPK fertilizer was the amendment that stimulated the abundance of the phosphate-solubilizer bacteria. Additionally, microbial respiration was reduced in soils treated with SRC compared to that of ammonia nitrate- and NPK fertilizer-treated soils. The results indicate that soil amendments were the drivers of soil pH and abundance of symbiotic nitrogen-fixing and heterotrophic microorganisms, as well as the drivers of microbial respiration, while the plant combination had more pronounced effects on the abundance of phosphate-solubilizing bacteria. Furthermore, the SRC amendment appeared to have enhanced the legume-Rhizobium symbiosis compared to amendments lacking SRC. These preliminary findings suggest that SRC as a slow-release fertilizer may be useful as part of an integrative strategy to improve soil fertility by stimulating microbial activity