Syrian refugees, between rocky crisis in Syria and hard inaccessibility to healthcare services in Lebanon and Jordan

Around 3% of the world’s population (n = 214 million people) has crossed international borders for various reasons. Since March 2011, Syria has been going through state of political crisis and instability resulting in an exodus of Syrians to neighbouring countries. More than 1 million Syrian refugees are residents of Lebanon, Jordan, Turkey, Egypt and North Africa. The international community must step up efforts to support Syrian refugees and their host governments

(ARV-) Free State? The moratorium’s threat to patients’ adherence and the development of drug-resistant HIV

Despite early fears that people living with HIV (PLWHs) in Africa would not be able to adhere to antiretrovirals (ARVs).1, 2 Research has shown that the proportion of PLWH reporting ≥95% adherence in sub-Saharan Africa is higher than in North America.3 However, maintaining adherence is a complex phenomenon and different ecological factors affect patient ability to access and adhere to ARVs: patient characteristics and context, ARV line regimen, clinical situation and the patient-health staff relationship. 4 In October 2008, the new minister of health announced that 550,000 PLWHs were on ARVs in South Africa, which is the highest number in the world.5 This achievement was recently tarnished by increasing alarm over the Free State public sector ARV programme. The Free State has the third highest HIV prevalence in the country (31%) 6. Since December 2008, the department of health has stopped initiating new patients on ARVs 7 because of drug stock-out and lack of funds. It is estimated that in this province 30 PLWHs are dying every day the moratorium continues.8While it is clear that this moratorium will increase morbidity and mortality, the loss of trust in the health system and the potential impact of the ARVs crisis on existing patient adherence should also be considered. Campero et.al. reported that patients already on ARVs share their medication with neighbors, relatives and/or friends who are delayed to start on ARVs 9. This practice could lead to drug resistance development in both people sharing the medication if they will have differential exposure to ARVs, 10-13 and on a public health level, raises serious concerns about drug failure, subsequent more expensive drug regimens and the spread of drug resistant strains of HIV. Patients’ perceptions of staff attitudes and waiting time were reported to be key factors for patients’ ARV adherence. 14 It is plausible that PLWHs will seek care in other provinces, and would consequently be required to return to outlying clinics on a monthly basis to pick-up their ARVs. Transport costs and the time needed to reach clinics are risk factors to both adherence and retention in care.15, 16 Patients currently on treatment – in the Free State and elsewhere - are understandably anxious about the health system’s ability to guarantee life-long access to ARVs. It was shown estimated that 300 000 people had died of AIDS in a preventable manner if the South African government had only responded to the AIDS crisis quickly in a coherent manner. 17 How the government now contains and repairs the damage being done in the Free State will be a litmus test for the long-term success of South Africa’s ARV programme. References 1. Moatti JP, Spire B, Kazatchkine M. Drug resistance and adherence to HIV/AIDS antiretroviral treatment: against a double standard between the north and the south. Aids 2004;18 Suppl 3:S55-61. 2. Check E. Staying the course. Nature 2006;442:617-9. 3. Mills EJ, Nachega JB, Buchan I, et al. Adherence to Antiretroviral Therapy in Sub-Saharan Africa and North America. JAMA 2006;296:679-90. 4. Bangsberg DR, Ware N, Simoni JM. Adherence without access to antiretroviral therapy in sub-Saharan Africa? AIDS 2006;20:140-1. 5. Media room - Departmenf of health - South Africa. Speech by the minister of health Ms. Barbara Hogan at the HIV vaccine research conference (http://www.doh.gov.za/docs/sp/sp1013-f.html). In: Vaccine research conference; 2008; Cape Town Oct.13-16; 2008. 6. Department of Health - Pretoria - South Africa. National HIV and Syphilis Antenatal Sero-Prevalence Survey in South Africa 2006; 2007. 7. ART crisis - Free State province, Dec. 2008 (http://www.sahivsoc.org). 2009. (Accessed March 18, 2009, at 8. Thom A. 30 dying every day in the Free State - HIV Clinicians (http://www.health-e.org.za/news/article.php?uid=20032192). Health-e 2009 Feb. 19. 9. Campero L, Herrera C, Kendall T, Caballero M. Bridging the gap between antiretroviral access and adherence in Mexico. Qualitative Health Research 2007;17:599-611. 10. Bangsberg DR. Preventing HIV antiretroviral resistance through better monitoring of treatment adherence. JID 2008;197:S272-S8. 11. Bangsberg DR, Acosta EP, Gupta R, et al. Adherence-resistance relationships for protease and non-nucleoside reverse transcriptase inhibitors explained by virological fitness. AIDS 2006;20:223-31. 12. Boulle A, Ford N. Scaling up antiretroviral therapy in developing countries: what are the benefits and challenges? Sex Transm Inf 2007;83:503-5. 13. Gardner EM, Sharma S, Peng G, et al. Differential adherence to combination antiretroviral therapy is associated with virological failure with resistance. AIDS 2008;22:75-82. 14. Dahab M, Charalambous S, Hamilton R, et al. "That is why I stopped the ART": Patients' & providers' perspectives on barriers to and enablers of HIV treatment adherence in a South African workplace programme. BMC Public Health 2008;8:doi:10.1186/471-2458-8-63. 15. Murray LK, Semrau K, McCurley E, et al. Barriers to acceptance and adherence of antiretroviral therapy in urban Zambian women: a qualitative study. AIDS Care 2009;21:78-86. 16. Tuller DM, Bangsberg DR, Senkungu J, Ware NC, Emenyonu N, Weiser SD. Transportation Costs Impede Sustained Adherence and Access to HAART in a Clinic Population in Southwestern Uganda: A Qualitative Study. AIDS Behav 2009. 17. Chigwedere P, Seage GR, 3rd, Gruskin S, Lee TH, Essex M. Estimating the Lost Benefits of Antiretroviral Drug Use in South Africa. J Acquir Immune Defic Syndr 2008

Anticancer and Anti-metastatic Effects of Supercritical Extracts of Hops (Humulus lupulus L.) and Mango ginger (Curcuma amada Roxb.) in Human Glioblastoma

Glioblastoma is one of the most aggressive, lethal and incurable primary brain tumors with a dismal prognosis in humans. Mango ginger (Curcuma amada) and hops (Humulus lupulus) are two botanicals containing phytochemicals with potential anticancer effects. We have investigated the anticancer and antimetastatic properties of supercritical CO2 extract of mango ginger (CA) and ethanol extract of hops (HL) in the U-87MG human glioblastoma cell line. Both CA and HL individually demonstrate strong cytotoxicity against glioblastoma cells. CompuSyn analysis of cytotoxicity data confirms that CA and HL are synergistic for cytotoxicity with combination index (CI) values of <1.0. Additionally, CA and HL individually as well as the combination significantly inhibit MMP-2 and MMP-9 activity, tumor cell migration (transendothelial cell migration assay) and AKT phosphorylation in U-87MG cells. CA and HL inhibit glycolysis in U-87MG cells as indicated by the inhibition of ATP and lactate synthesis with the CA+HL combination demonstrating strong inhibition of glycolysis via the reduction of ATP and lactate synthesis compared to cells treated by each extract alone. CA and HL treatment down regulates the expression of proteins associated with metastasis, MMP-2 and MMP-9 and up regulates the expression of TIMP1. Proteins associated with apoptosis, inflammation and energy metabolism were also modulated by CA and HL treatment of glioblastoma cells. These results suggest that CA and HL can be combined for the therapeutic management of glioblastomas

Variation in the optical sensing properties of dithiocarbamate polymer microspheres as function of surface morphology

Three polymers with N-ethanolamino-, N-benzylamino-, and N-t-butylamino-dithiocarbamate groups were synthesized from polyvinylbenzylchloride. Each of the three polymers was incorporated in a hydrogel membrane (PVA) cross-linked with glutaraldehyde to form a sensing element. The latter was, then, evaluated for its optical sensing behavior by subjecting it to varying concentrations (1.0x10-5 up to 0.1 M) of metal ions (Zn2+, Cd2+, Pb2+, Hg2+,Ca2+, Mg2+, K+, Na+, Cr3+, Ni2+, Cu2+). Significant response was observed for the Hg2+ ions while the others showed negligible or no response. The turbidity absorbance increased consecutively from the dithiocarbamate polymer derived from N-t-butylamine towards that from ethanolamine as the concentration of the Hg2+ solution increased. The response time measured for the three polymer microspheres ranged between 2 and 30 minutes. The aminodithiocarbamate polymers were stable at normal temperatures (25ο - 40 ο C) and as pH was changed between 2 and 7. In addition, the polymers demonstrated excellent stability with time and a capacity of 3.967, 3.787, 3.355 mmol Hg2+ ions per gram of polymer for the N-ethanolamino-, N-benzylamino-, and N-t-butylamino-dithiocarbamate respectively. SEM and Eds analyses showed an increase in size of about 25% in the case of complexation with N-ethanolamino-, no size change with N-benzylamino-, and a 16.6% decrease in size with N-t-butylamino-dithiocarbamate.We are grateful to professor W.R.Seitz and his research group, of the University of New Hampshire (USA) for supplying us with the polymer polyvinylbenzylchloride.We are also grateful to professor M.Khamis of Al-Quds University for financial support for the SEM analyses

Hexavalent Chromium Removal and Reduction to Cr (III) by Polystyrene Tris(2-aminoethyl)amine

A commercially available chelating polymer, polystyrene tris(2-aminoethyl)amine, was used for the removal of chromium from aqueous solution. The influence of pH, contact time, adsorbent dosage and initial Cr (VI) concentration on adsorption was studied. The optimum pH for the removal of Cr (VI) was at pH 5, while optimum contact time and adsorbent dosage were 120 minutes and 10 g/L, respectively. Total chromium and Cr (VI) concentrations were analyzed by ICP-MS and UVVisible. Adsorption isotherms using Langmuir and Freundlich isotherm models revealed that the data fitted Langmuir isotherm model better than Freundlich with a maximum adsorption capacity of 312.27 mg/g. FTIR spectroscopy, Scanning electron microscopy (SEM) and Energy Dispersive Spectrometry (EDS) analyses were performed on the adsorbent before and after binding Cr (VI). All analyses confirmed the complexation of Cr (VI) to the adsorbent. Desorption experiments using KCl solution indicated 89.3% release of chromium, rendering this method of high potential for adsorbent regeneration.We wish to thank Professor Dr. Z. Abdeen for his valuable financial support which made this work possible. We also wish to thank the Aquatic and Aquaculture Research Laboratory at Al-Quds University for performing the ICP-MS analysis