Shed some light on darkness: will Tanzania reach the millennium development goals?

The overall picture of health in sub-Saharan Africa can easily be painted in dark colours. The aim of this viewpoint is to discuss epidemiological data from Tanzania on overall health indicators and the burden of malaria and HIV. Is the situation in Tanzania improving or deteriorating? Are the health-related millennium development goals (MDG) on reducing under-five mortality, reducing maternal mortality and halting HIV and malaria within reach

Polychromatic neutron phase contrast imaging of weakly absorbing samples enabled by phase retrieval

We demonstrate the use of a phase retrieval technique for propagation-based phase contrast neutron imaging with a polychromatic beam. This enables imaging samples with low absorption contrast and/or improving the signal-to-noise ratio to facilitate e.g. time resolved measurements. A metal sample, designed to be close to a pure phase object, and a bone sample with canals partially filled with D2O were used for demonstrating the technique. These samples were imaged with a polychromatic neutron beam followed by phase retrieval. For both samples the signal-to-noise ratio were significantly improved and in case of the bone sample, the phase retrieval allowed for separation of bone and D2O, which is important for example for in situ flow experiments. The use of deuteration-contrast avoids the use of chemical contrast enhancement and makes neutron imaging an interesting complementary method to X-ray imaging of bone

Experiences of young adults growing up with innate or early acquired HIV infection--a qualitative study

Aim. To explore the experience of young adults growing up and living with HIV in urban Sweden. Background. HIV has become a widespread pandemic. Effective antiretroviral treatment has dramatically increased the survival rate of infected individuals such that HIV-infection is currently considered a chronic disease where treatment is available. Data concerning the experience of living with HIV since early childhood is scarce and more empirical knowledge is needed in order to direct the development of adequate care and interventions for this growing demographic. Design. Exploratory qualitative study. Method. Semi-structured interviews were conducted with ten HIV-infected young adults over the period from January to August 2008. Transcripts of the interviews were analysed using qualitative content analysis. Findings. The analysis revealed five categories illustrating the experiences of growing up and living with HIV in Sweden: 1) to protect oneself from the risk of being stigmatised, 2) to be in control, 3) losses in life but HIV is not a big deal, 4) health care/health care providers, and 5) belief in the future. Conclusion. It is essential to offer a safe, trustworthy and professional health-care environment during the upbringing of HIV-infected children. Evidence-based interventions are needed to improve care and support, particularly regarding the handling of stigma and discrimination

Autonomic symptoms in hypertensive patients with post-acute minor ischemic stroke

Background Most studies regarding autonomic dysfunction in ischemic stroke are limited to heart rate and blood pressure changes during the acute phase. However, there are few data on quantitative assessment of autonomic symptoms. We sought to assess autonomic symptoms in hypertensive ischemic stroke patients. Methods In 100 hypertensive patients (45 with symptomatic ischemic stroke (6 months after stroke onset) and 55 without stroke), we assessed autonomic symptoms using the Scale for Outcomes in Parkinson disease-Autonomic (SCOPA-AUT). Results The age (mean ± standard deviation) for the stroke group was 66 ± 12 and 63 ± 15 for the without stroke group (P = 0.8). Orthostatic hypotension occurred in 3.6% of the stroke group and 4.4% in the group without stroke. The total SCOPA-AUT score was higher in the stroke group compared with the group without stroke (P = 0.001). Domain scores for gastrointestinal (P = 0.001), urinary (P = 0.005) and cardiovascular (P = 0.001) were higher in the stroke group. No differences were found when comparing the total SCOPA-AUT scores for stroke subtypes (P = 0.168) and for lateralization (P = 0.6). SCOPA AUT scores were correlated with depression scores (P = 0.001) but not with stroke severity (P = 0.2). Conclusion Autonomic symptoms, especially, gastrointestinal, urinary and cardiovascular function, were significantly increased in hypertensive patients with minor ischemic stroke. Symptoms were associated with depression but not with the characteristic of the stroke

Patient profiling for success after weight loss surgery (GO Bypass study):An interdisciplinary study protocol

Despite substantial research efforts, the mechanisms proposed to explain weight loss after gastric bypass (RYGB) and sleeve gastrectomy (SL) do not explain the large individual variation seen after these treatments. A complex set of factors are involved in the onset and development of obesity and these may also be relevant for the understanding of why success with treatments vary considerably between individuals. This calls for explanatory models that take into account not only biological determinants but also behavioral, affective and contextual factors. In this prospective study, we recruited 47 women and 8 men, aged 25–56 years old, with a BMI of 45.8 ± 7.1 kg/m2 from the waiting list for RYGB and SL at Køge hospital, Denmark. Pre-surgery and 1.5, 6 and 18 months after surgery we assessed various endpoints spanning multiple domains. Endpoints were selected on basis of previous studies and include: physiological measures: anthropometrics, vital signs, biochemical measures and appetite hormones, genetics, gut microbiota, appetite sensation, food and taste preferences, neural sensitivity, sensory perception and movement behaviors; psychological measures: general psychiatric symptom-load, depression, eating disorders, ADHD, personality disorder, impulsivity, emotion regulation, attachment pattern, general self-efficacy, alexithymia, internalization of weight bias, addiction, quality of life and trauma; and sociological and anthropological measures: sociodemographic measures, eating behavior, weight control practices and psycho-social factors.Joining these many endpoints and methodologies from different scientific disciplines and creating a multi-dimensional predictive model has not previously been attempted. Data on the primary endpoint are expected to be published in 2018. Trial registration: Clinicaltrials. gov ID NCT02070081. Keywords: Gastric bypass (RYGB), Sleeve gastrectomy, Weight loss, Interdisciplinary, Study protoco

Botulinum toxin in gastric submucosa reduces stimulated HCl production in rats

BACKGROUND: Botulinum toxin blocks acetylcholine release from nerve endings and acts as a long term, reversible inhibitor of muscle contraction as well as of salivary, sweat gland, adrenal and prostatic secretions. The aim of the present study is to investigate whether gastric submucosal injection of botulinum toxin type A reduces stimulated gastric production of HCl. METHODS: Sixty-four rats were randomized in two groups and laparotomized. One group was treated with botulinum toxin-A 10 U by multiple submucosal gastric injections, while the second group was injected with saline. Two weeks later, acid secretion was stimulated by pyloric ligation and acid output was measured. Body weight, food and water intake were also recorded daily. RESULTS: HCl production after pyloric ligation was found to be significantly lower in botulinum toxin-treated rats (657 ± 90.25 micromol HCl vs. 1247 ± 152. P = 0.0017). Botulinum toxin-treated rats also showed significantly lower food intake and weight gain. CONCLUSIONS: Botulinum toxin type A reduces stimulated gastric acidity. This is likely due either to inhibition of the cholinergic stimulation of gastric parietal cells, or to an action on the myenteric nervous plexuses. Reduction of growth and food intake may reflect both impaired digestion and decreased gastric motility

Less is more: Antibiotics at the beginning of life

Antibiotic exposure at the beginning of life can lead to increased antimicrobial resistance and perturbations of the developing microbiome. Early-life microbiome disruption increases the risks of developing chronic diseases later in life. Fear of missing evolving neonatal sepsis is the key driver for antibiotic overtreatment early in life. Bias (a systemic deviation towards overtreatment) and noise (a random scatter) affect the decision-making process. In this perspective, we advocate for a factual approach quantifying the burden of treatment in relation to the burden of disease balancing antimicrobial stewardship and effective sepsis management

Cerebrogenic cardiac arrhythmias:: Cortical lateralization and clinical significance

That the brain may be involved in cardiovascular regulation has been acknowledged for over a century. That cardiac arrhythmias may result from cortical derangement has been less well recognized. That cortical cardiac representation may be lateralized is even more controversial. Recent evidence implicates several cortical structures, especially the insula, in cardiac rate and rhythm control. Experimental models indicate that insular lesions may be arrhythmogenic. Accumulating data show similar lesion effects in humans. In the rat, monkey and man sympathetic cardiovascular control is generally represented in the right insula, although pronounced insulo-insular connectivity has been demonstrated. Proarrhythmic shifts in cardiac sympathovagal balance occur after human stroke, including left insular lesions. This evidence implicates the cortex in the promotion and even generation of cardiovascular dysfunction under appropriate circumstances