Global burden of human brucellosis : a systematic review of disease frequency

BACKGROUND: This report presents a systematic review of scientific literature published between 1990-2010 relating to the frequency of human brucellosis, commissioned by WHO. The objectives were to identify high quality disease incidence data to complement existing knowledge of the global disease burden and, ultimately, to contribute towards the calculation of a Disability-Adjusted Life Years (DALY) estimate for brucellosis.METHODS/PRINCIPAL FINDINGS: Thirty three databases were searched, identifying 2,385 articles relating to human brucellosis. Based on strict screening criteria, 60 studies were selected for quality assessment, of which only 29 were of sufficient quality for data analysis. Data were only available from 15 countries in the regions of Northern Africa and Middle East, Western Europe, Central and South America, Sub-Saharan Africa, and Central Asia. Half of the studies presented incidence data, six of which were longitudinal prospective studies, and half presented seroprevalence data which were converted to incidence rates. Brucellosis incidence varied widely between, and within, countries. Although study biases cannot be ruled out, demographic, occupational, and socioeconomic factors likely play a role. Aggregated data at national or regional levels do not capture these complexities of disease dynamics and, consequently, at-risk populations or areas may be overlooked. In many brucellosis-endemic countries, health systems are weak and passively-acquired official data underestimate the true disease burden.CONCLUSIONS: High quality research is essential for an accurate assessment of disease burden, particularly in Eastern Europe, the Asia-Pacific, Central and South America and Africa where data are lacking. Providing formal epidemiological and statistical training to researchers is essential for improving study quality. An integrated approach to disease surveillance involving both human health and veterinary services would allow a better understand of disease dynamics at the animal-human interface, as well as a more cost-effective utilisation of resources

Dietary Supplementation with Soluble Plantain Non-Starch Polysaccharides Inhibits Intestinal Invasion of Salmonella Typhimurium in the Chicken

Soluble fibres (non-starch polysaccharides, NSP) from edible plants but particularly plantain banana (Musa spp.), have been shown in vitro and ex vivo to prevent various enteric pathogens from adhering to, or translocating across, the human intestinal epithelium, a property that we have termed contrabiotic. Here we report that dietary plantain fibre prevents invasion of the chicken intestinal mucosa by Salmonella. In vivo experiments were performed with chicks fed from hatch on a pellet diet containing soluble plantain NSP (0 to 200 mg/d) and orally infected with S.Typhimurium 4/74 at 8 d of age. Birds were sacrificed 3, 6 and 10 d post-infection. Bacteria were enumerated from liver, spleen and caecal contents. In vitro studies were performed using chicken caecal crypts and porcine intestinal epithelial cells infected with Salmonella enterica serovars following pre-treatment separately with soluble plantain NSP and acidic or neutral polysaccharide fractions of plantain NSP, each compared with saline vehicle. Bacterial adherence and invasion were assessed by gentamicin protection assay. In vivo dietary supplementation with plantain NSP 50 mg/d reduced invasion by S.Typhimurium, as reflected by viable bacterial counts from splenic tissue, by 98.9% (95% CI, 98.1–99.7; P<0.0001). In vitro studies confirmed that plantain NSP (5–10 mg/ml) inhibited adhesion of S.Typhimurium 4/74 to a porcine epithelial cell-line (73% mean inhibition (95% CI, 64–81); P<0.001) and to primary chick caecal crypts (82% mean inhibition (95% CI, 75–90); P<0.001). Adherence inhibition was shown to be mediated via an effect on the epithelial cells and Ussing chamber experiments with ex-vivo human ileal mucosa showed that this effect was associated with increased short circuit current but no change in electrical resistance. The inhibitory activity of plantain NSP lay mainly within the acidic/pectic (homogalacturonan-rich) component. Supplementation of chick feed with plantain NSP was well tolerated and shows promise as a simple approach for reducing invasive salmonellosis

Synergistic effect p-phenylenediamine and n,n diphenylthiourea on the electrochemical corrosion behaviour of mild steel in dilute acid media

Electrochemical studies of the synergistic effect of p-phenylenediamine and n,n diphenylthiourea (TPD) as corrosion inhibitor of mild steel in dilute sulphuric and hydrochloric acid through weight loss and potentiodynamic polarization at ambient temperature were performed. Experimental results showed the excellent performance of TPD with an optimal inhibition efficiency of 88.18 and 93.88 %in sulphuric and 87.42 and 87.15 %in hydrochloric acid from both tests at all concentration studied. Polarization studies show the compound to be a mixed-type inhibitor. Adsorption of deanol on the steel surface was observed to obey the Langmuir and Frumkin isotherm models. X-ray diffractometry confirmed the absence of corrosion products and complexes. Optical microscopy confirmed the selective inhibition property of TPD to be through chemical adsorption on the steel surfac

Association between Knowledge and Drug Adherence in Patients with Hypertension in Quetta, Pakistan

Purpose: To evaluate the association between patient’s knowledge of hypertension management and medication adherence.Methods: A cross-sectional study was undertaken with 385 hypertensive patients who visited outpatient departments in two public hospitals in Quetta City, Pakistan. Besides demographic and disease-relatedquestions, two validated questionnaires (Hypertension Fact Questionnaire and Drug Attitude Inventory) were used for data collection. Descriptive statistics were to determine the demographic and diseasecharacteristics of the patients while Spearman rank correlation was employed to measure the association between knowledge and drug adherence.Results: Out of 385 patients, 236 (61.3 %) of the patients had average knowledge about hypertension while 249 (64.7 %) were categorized as poor adherent. No patient was considered as good adherent in the study. Correlation coefficient between total score of knowledge and total adherence was – 0.170 (p < 0.001), indicating an inverse association between knowledge scores and adherence level.Conclusion: Although the level of knowledge was average, patients were unsure of the benefits of continuous medication use which resulted in non-adherence to regimens. Educating patients about the benefits of medications and clarifying doubts regarding medication use should result in better control of hypertension

Consensus on circulatory shock and hemodynamic monitoring. Task force of the European Society of Intensive Care Medicine.

OBJECTIVE: Circulatory shock is a life-threatening syndrome resulting in multiorgan failure and a high mortality rate. The aim of this consensus is to provide support to the bedside clinician regarding the diagnosis, management and monitoring of shock. METHODS: The European Society of Intensive Care Medicine invited 12 experts to form a Task Force to update a previous consensus (Antonelli et al.: Intensive Care Med 33:575-590, 2007). The same five questions addressed in the earlier consensus were used as the outline for the literature search and review, with the aim of the Task Force to produce statements based on the available literature and evidence. These questions were: (1) What are the epidemiologic and pathophysiologic features of shock in the intensive care unit ? (2) Should we monitor preload and fluid responsiveness in shock ? (3) How and when should we monitor stroke volume or cardiac output in shock ? (4) What markers of the regional and microcirculation can be monitored, and how can cellular function be assessed in shock ? (5) What is the evidence for using hemodynamic monitoring to direct therapy in shock ? Four types of statements were used: definition, recommendation, best practice and statement of fact. RESULTS: Forty-four statements were made. The main new statements include: (1) statements on individualizing blood pressure targets; (2) statements on the assessment and prediction of fluid responsiveness; (3) statements on the use of echocardiography and hemodynamic monitoring. CONCLUSIONS: This consensus provides 44 statements that can be used at the bedside to diagnose, treat and monitor patients with shock

Effect of Ultrasound Cavitation on lumbar hyperlordosis in Obese Postnatal Women with Diastasis Recti: A randomized controlled trial

Objective: This study was conducted to determine the effect of ultrasound cavitation (UC) on lumbar hyperlordosis in obese postnatal women with diastasis recti. Subjects and Methods: Sixty obese multiparous women with diastasis rectus abdominis (DRA), their ages ranged from 25 to 35 years, their BMI was more than 30 Kg/ m2. All women had lumbar hyper lordosis, and their mode of delivery was normal vaginal delivery. All women were divided randomly into two equal groups (A &amp; B). Each group consist of 30 women, Group A (control group) treated by low caloric diet regimen only (1600- 2000 Kcal/ day) designed by nutritionist throughout the whole treatment program for two months. Group B (study group) treated by ultrasound cavitation on the abdominal area for 30 minutes, twice weekly for two months in addition to low caloric diet regimen   for two months. The lumbar lordotic angle was measured using the spinal mouse before and after two months of treatment for each woman in both groups (A &amp; B). Results: Within groups, there was statistically significant improvement post-treatment versus pre-treatment in lumbar lordotic angle) (p &lt; 0.05), between groups; pre-treatment, there was no significant difference between both groups (A &amp; B) in lumbar lordotic angle. While, post treatment, there was a significant difference between both groups (A &amp; B) in lumbar lordotic angle (more decrease in group B). Conclusion: Using UC on the abdominal area was effective on reducing lumbar hyper lordosis in obese postnatal women with diastasis recti

Studies of the Effect of Schistosoma Mansoni Infection on Work Capacity

Estimates of labour productivity loss due to schistosomiasis have been put as high as 40% but there are no satisfactory objective measurements of deterioration in physical working capacity to support these claims. The effect of s. mansoni infection on work performance in the Sudan has been investigated in the present study using the criteria of maximal aerobic power measured in the laboratory and the habitual activity pattern verified by energy expenditure measurements in the field. The study relates to economically active males aged between 18 and 45 years: infected and non-infected villagers, heavily infected canal-cleaners, hospital patients, physically trained soldiers and non-infected townspeople. All had received anti-malarial prophylaxis. Laboratory measurements included anthropometric, sociological, haematologic and biochemlcul investigations together with pulmonary function tests and bicycle ergometer measurements of aerobic work output using a semi-automated system. In 37 non-infected and 147 schistosomiasis-infected villagers no differences were found in pulmonary function, submaximal exercise performance and predicted maximum aerobic power. Statistically significant reductions in all these parameters were, however, found in a group of heavily infected canal cleaners. A changing pattern of quantitative egg excretion from moderate (2000 eggs/g) egg loads was shown to bo associated with decrements of up to 20% in maximum aerobic power. The results wore not attributable to anthropometric (particularly leg muscle volume which affects performance on the bicycle ergometer) or to nutritional differences between the groups, but predicted maximum aerobic power, egg load and haemoglobin concentrations were significantly correlated. In a further study of anti-schistosomal (hycanthone) treatment on two groups of villagers, one of which served as a control, a significant improvement in physiological work capacity occurred after treatment. The empirical findings presented in this thesis provide abasis for a clearer understanding of the relationship between schistosomiasis infection, tropical productivity and health of an infected community

Assessment of the drug therapy for sexually transmitted diseases in the White .ile State – Sudan

Back ground:Irrational drug prescribing is a global problem. It results in development of resistance to antimicrobials, ineffective treatment, adverse effects and economic burden on patient and society.Objectives: This study was carried out to assess the use of drugs for treatment of sexually transmitted diseases (STDs) and to determine their prevalence in the White Nile State-Sudan 2002-2003.Material and Methods: Twenty urban health centers were selected randomly, 30 prescriptions were collected from each health center and assessed against recommended standard therapy.Results: The appropriate drug therapy according to diagnosis was selected in only 10.6% of the collected prescriptions, only 42.2% of them were with appropriate doses and duration of therapy, poly pharmacy was detected in 28.8%, generic prescribing in 35.5% and possible drug- drug interactions in 17.3% of the total collected sample. The prevalence of STDs among total patients was 1.9%. 78.8% of the cases were females, 59.3% were 15-29 years old and Kenana Health Centers showed the highest prevalence of STDs 3.4%. (P&lt;0.05)Conclusion: The results of the present study revealed that prescribing practices for the treatment of STDs were illogical; the reference chart prepared by federal ministry of health Sudan National HIV/AIDS/STD program must be reevaluated, because it is inappropriate and illogical. Continuous training courses are urgently needed locally and nationally to raise the updating levels of medical

Human BRCA1-BARD1 ubiquitin ligase activity counters chromatin barriers to DNA resection

The opposing activities of 53BP1 and BRCA1 influence pathway choice of DNA double-strand break repair. How BRCA1 counters the inhibitory effect of 53BP1 on DNA resection and homologous recombination is unknown. Here we identify the site of BRCA1-BARD1 required for priming ubiquitin transfer from E2~ubiquitin. We demonstrate that BRCA1-BARD1’s ubiquitin ligase activity is required for repositioning 53BP1 on damaged chromatin. We confirm H2A ubiquitylation by BRCA1-BARD1 and show that an H2A-ubiquitin fusion protein promotes DNA resection and repair in BARD1 deficient cells. We show BRCA1-BARD1 function in homologous recombination requires the chromatin remodeler SMARCAD1. SMARCAD1 binding to H2A-ubiquitin, optimal localization to sites of damage and activity in DNA repair requires its ubiquitin-binding CUE domains. SMARCAD1 is required for 53BP1 repositioning and the need for SMARCAD1 in Olaparib or camptothecin resistance is alleviated by 53BP1 loss. Thus BRCA1- BARD1 ligase activity and subsequent SMARCAD1-dependent chromatin remodeling are critical regulators of DNA repair