Predictors of Anemia Among HIV Patients in Uganda

HIV-related anemia is associated with increased risk of death. Prior studies suggest an inverse relationship between CD4 cell count and anemia, and a positive relationship between HIV-clinical stage and anemia. However, none have assessed the role of antiretroviral therapy (ART) treatment combinations in these relationships. Therefore, we conducted a cross-sectional study to evaluate the relationship between CD4 cell count, HIV clinical stage and anemia among 4803 Ugandan HIV-patients, and assessed the role of ART treatment combinations. We included HIV patients (\u3e 15 years) receiving ART therapy combinations between 2010- 2015. We evaluated CD4 cell count and anemia using blood tests, and HIV-clinical staging was based upon the World Health Organization HIV-clinical staging system. Information on ART treatment combinations was obtained from patients’ medical records. Multinomial logistic regression was used to model the relationship between CD4 cell count, HIV clinical stages and anemia. We performed a sensitivity analysis to examine the role of ART treatment combinations. The odds of being severely anemic were highest among those classified in the low CD4 cell count category (\u3c200cells/μL), and those at WHO stage IV. Odds Ratios were 3.7 (95% CI; 1.48-9.26) and 3.2 (95% CI; 1.75-5.70), respectively. Stratification by ART treatment combinations (TDF-based versus ADZ-based combination treatment) indicated an increase in the odds of being anemic with increase in HIV-clinical stage (stage II, OR: 1.99, 95% CI; 1.44-2.78; stage III, OR:3.17, 95% CI; 2.21-4.54, & stage IV, OR; 4.42, 95% CI; 2.68-7.30), for individuals receiving TDF-based treatment only. Results suggest that HIV-patients with a low CD4 cell count and, those in advanced HIV-clinical stages should consider regular hemoglobin follow-up to identify and treat anemia at its earliest stages

トレンド カゾク エンジョ サービス ノ アタラシイ ケイタイ ニホン ニオケル RESPITE CARE SERVICE

障害児者とともに暮らす家族およびその他の介護者が地域で安心して生活できるようにするための家族支援活動のひとつであるrespite care serviceが、近年盛んに取り上げられるようになった。厚生省心身障害研究において平成2~4年度の研究課題となり、平成5年度より引き続き研究が進められる ..

Tumor-infiltrating effector cells of α-galactosylceramide-induced antitumor immunity in metastatic liver tumor

BACKGROUND: α-Galactosylceramide (α-GalCer) can be presented by CD1d molecules of antigen-presenting cells, and is known to induce a potent NKT cell-dependent cytotoxic response against tumor cells. However, the main effector cells in α-GalCer-induced antitumor immunity are still controversial. METHODS: In order to elucidate the cell phenotype that plays the most important role in α-GalCer-induced antitumor immunity, we purified and analyzed tumor-infiltrating leukocytes (TILs) from liver metastatic nodules of a colon cancer cell line (Colon26), comparing α-GalCer- and control vehicle-treated mice. Flow cytometry was performed to analyze cell phenotype in TILs and IFN-γ ELISA was performed to detect antigen-specific immune response. RESULTS: Flow cytometry analysis showed a significantly higher infiltration of NK cells (DX5+, T cell receptor αβ (TCR)-) into tumors in α-GalCer-treated mice compared to vehicle-treated mice. The DX5+TCR+ cell population was not significantly different between these two groups, indicating that these cells were not the main effector cells. Interestingly, the CD8+ T cell population was increased in TILs of α-GalCer-treated mice, and the activation level of these cells based on CD69 expression was higher than that in vehicle-treated mice. Moreover, the number of tumor-infiltrating dendritic cells (DCs) was increased in α-GalCer-treated mice. IFN-γ ELISA showed stronger antigen-specific response in TILs from α-GalCer-treated mice compared to those from vehicle-treated mice, although the difference between these two groups was not significant. CONCLUSIONS: In α-GalCer-induced antitumor immunity, NK cells seem to be some of the main effector cells and both CD8+ T cells and DCs, which are related to acquired immunity, might also play important roles in this antitumor immune response. These results suggest that α-GalCer has a multifunctional role in modulation of the immune response

Expression pattern of CXC chemokine receptor-4 is correlated with lymph node metastasis in human invasive ductal carcinoma

BACKGROUND: The stromal cell-derived factor-1/CXC chemokine receptor-4 (SDF-1/CXCR4) signal has been shown to be important in various immunological reactions. Recent studies have suggested that CXCR4 is expressed in certain cancer cells and that they use this chemokine receptor efficiently for metastasis formation. METHOD: The expression of CXCR4 was evaluated by immunohistochemical study in 79 surgically resected invasive ductal carcinomas, and the relation between the staining pattern and clinicopathological features was examined. RESULTS: CXCR4 was diffusely and homogeneously expressed in 59 cancers, which were further divided into 28 high-expression and 31 low-expression cancers by their staining intensity. The other 20 cancers showed heterogeneous immunoreactivity in tumor tissue, which was defined as focal type. In comparison with the diffuse type, focal type tumors showed significantly more extensive lymph node metastasis, because the number and extent of metastatic nodes were larger in the focal than the diffuse type. In the diffuse type, the rate of node-positive cases did not show a difference in staining intensity. However, high-CXCR4 tumors showed more extensive nodal metastasis in comparison with low-expression tumors. In contrast, the expression pattern of CXCR4 did not have a significant correlation with hematogeneous metastasis. The overall survival of these patients tended to be better in the diffuse type than in the focal type, although the difference was not statistically significant. CONCLUSION: The expression pattern of CXCR4 was significantly correlated with the degree of lymph node metastasis in breast cancers. Our data suggest that CXCR4 might be particularly important in facilitating metastasis through the lymphatic system

Circulating lymphocyte is an important determinant of the effectiveness of preoperative radiotherapy in advanced rectal cancer

<p>Abstract</p> <p>Background</p> <p>Although preoperative radiotherapy (RT) is widely used as the initial treatment for locally advanced rectal cancer (RC) in the neoadjuvant setting, factors determining clinical response have not been adequately defined. In order to find other factors possibly related with radiosensitivity, we evaluated the relationships between circulating blood cell counts and RT effects.</p> <p>Methods</p> <p>In 179 cases with advanced RC, we retrospectively examined hemoglobin (Hb) levels and counts of white blood cells (WBC), platelets and WBC subsets before and after RT and investigated their associations with the complete response (CR) rate together with other clinicopathological factors.</p> <p>Results</p> <p>The ratio of lymphocytes in WBC taken before RT was significantly greater in 15 CR cases as compared with those in non-CR cases. Patients with high lymphocyte percentages (25.7%) showed better outcome than the counterparts. Conversely, the ratio of neutrophiles was reduced in CR cases. The lymphocyte ratio showed an independent association with CR with multivariate analysis, and tended to be maintained at relatively high levels in CR cases.</p> <p>Conclusions</p> <p>In RC patients, peripheral blood lymphocytes have a significant impact on the CR rate in response to RT. Lymphocyte-mediated immune reactions are supposed to have positive roles on clinical response in radiotherapy for RC.</p

Relationship between Tomato Yellow Leaf Curl Viruses and the Whitefly Vector

Abstract · Tomato yellow leaf curl is prevalent in tomato growing districts of Uganda. The disease is known to be spread by a whitefly (Bemisia tabaci) in a persistent manner. Some of its symptoms are leaf curl, marginal leaf yellowing, malformation of fruits, stunting and dieback (in case of primary infection at early seedling stage), so the disease is economically important. Therefore, this study delved into the relationship between the disease and the vector in selected agro-ecosystems in the Country. The influence of weather and seasonality on the incidence of the disease and the vector was also investigated through a series of field experiments across a period of two years. New methods for trapping the vector were developed and applied to estimate its populations on individual plants and in the overall field environment. The findings were that whereas incidence of the disease is low at seedling stage, the whitefly population is highest at this stage. It was also found that the vector population is favoured by drought, so rainy conditions reduced it tremendously

Addressing silences in research on girls’ experiences of teacher sexual violence: insights from Uganda

Growing evidence from multiple countries in Africa documents sexual violence in schools. However, when that violence is committed by teachers it is shrouded in secrecy. This article identifies disconnects between quantitative and qualitative research, policy and practice, which have contributed to these silences. We address some of these silences through a dialogical analysis of mixed methods data from the Contexts of Violence in Adolescence Cohort study (CoVAC) with young people in Uganda. The analysis illuminates girls’ experiences of sexual violence by school staff, and patterns of discrimination and inequality that increase vulnerabilities. The data reveal how schools vary in their institutional responses and, in the absence of institutional support, girls develop strategies to resist sexual coercion. Overall, our analysis exposes significant disconnects between policies and practices of sexual exploitation in schools. We conclude that dialogical, mixed methods research approaches have strong potential to better understand and address silences in policy and practice on highly sensitive topics

Resovist-Enhanced MRI for Preoperative Assessment of Colorectal Hepatic Metastases: A Case of Multiple Bile Duct Hamartomas Associated with Colon Cancer

Extensive preoperative assessment of hepatic metastases is required in colon cancer patients. We report a case in whom the preoperative investigation by ultrasound scan and contrast-enhanced computed tomography revealed numerous cystic lesions of the liver, suspicious of von Meyenburg complex. Magnetic resonance and magnetic resonance cholangiographic images demonstrated typical features of von Meyenburg complex. Further Resovist-enhanced magnetic resonance imaging detected two hemangiomas in addition to the multiple cystic lesions. So-called Kupffer cell imaging strongly helped the detection of these hemangiomas, and a combination of various magnetic resonance pulse sequences was of great value for the differential diagnosis of cystic lesions and hemangiomas. In cases in whom conventional imaging studies fail to give a definite diagnosis, such as in the present case, superparamagnetic iron oxide-enhanced magnetic resonance imaging is meaningful for adequate preoperative staging