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A comparison of real-time PCR and reverse line blot hybridization in detecting feline haemoplasmas of domestic cats and an analysis of risk factors associated with haemoplasma infections
(2012-07-02) Georges, Karla; Ezeokoli, Chuckwudozi; Auguste, Tennille; Seepersad, Nisshi; Pottinger, Akua; Sparagano, Olivier; Tasker, Séverine
Abstract Background Three species of feline haemoplasma are recognised: Mycoplasma haemofelis (Mhf), and#8216;Candidatus Mycoplasma haemominutumand#8217; (CMhm) and and#8216;Candidatus Mycoplasma turicensis (CMt). This study compared a reverse line blot hybridization (RLB) assay for simultaneous detection of Mhf, CMhm with three separate quantitative real-time polymerase chain reaction (qPCR) assays used for diagnosis of Mhf, CMhm and CMt. The RLB and qPCR assays were applied to DNA extracted from blood samples collected from 154 cats from Trinidad and Tobago. Results CMhm and Mhf DNA were detected using both RLB and qPCR. CMt DNA was detected by qPCR only. Comparing RLB and qPCR for the detection of CMhm DNA, 40 (26.3%) and 48 (31.6%) cats, respectively, were positive. The difference was more marked for Mhf, with RLB detecting a total of only 11 (7.2%) positive cats whereas qPCR detected 41 (27.0%) positive cats. Using qPCR as a gold standard, haemoplasma infected cats were more likely to be retrovirus positive (ORand#8201;=and#8201;5.68, Pand#8201;=and#8201;0.02) and older (median age 5.5 years), than non-infected cats. In addition, CMhm positive cats were more likely to be male (ORand#8201;=and#8201;3.4, Pand#8201;=and#8201;0.04). Conclusions Overall the qPCR was more sensitive than RLB. In addition, age (median 5.5 years) and retrovirus positivity were risk factors for infection with the feline haemoplasmas in this study population. Further studies on feline haemoplasma infections in cats are needed to determine the significance of detecting small amounts of haemoplasma DNA, feline retrovirus infection and other associated risk factors on the clinical manifestation of disease.
A customized Web portal for the genome of the ctenophore Mnemiopsis leidyi
(2014-04-28) Moreland, R T; Nguyen, Anh-Dao; Ryan, Joseph F; Schnitzler, Christine E; Koch, Bernard J; Siewert, Katherine; Wolfsberg, Tyra G; Baxevanis, Andreas D
Abstract Background Mnemiopsis leidyi is a ctenophore native to the coastal waters of the western Atlantic Ocean. A number of studies on Mnemiopsis have led to a better understanding of many key biological processes, and these studies have contributed to the emergence of Mnemiopsis as an important model for evolutionary and developmental studies. Recently, we sequenced, assembled, annotated, and performed a preliminary analysis on the 150-megabase genome of the ctenophore, Mnemiopsis. This sequencing effort has produced the first set of whole-genome sequencing data on any ctenophore species and is amongst the first wave of projects to sequence an animal genome de novo solely using next-generation sequencing technologies. Description The Mnemiopsis Genome Project Portal (http://research.nhgri.nih.gov/mnemiopsis/) is intended both as a resource for obtaining genomic information on Mnemiopsis through an intuitive and easy-to-use interface and as a model for developing customized Web portals that enable access to genomic data. The scope of data available through this Portal goes well beyond the sequence data available through GenBank, providing key biological information not available elsewhere, such as pathway and protein domain analyses; it also features a customized genome browser for data visualization. Conclusions We expect that the availability of these data will allow investigators to advance their own research projects aimed at understanding phylogenetic diversity and the evolution of proteins that play a fundamental role in metazoan development. The overall approach taken in the development of this Web site can serve as a viable model for disseminating data from whole-genome sequencing projects, framed in a way that best-serves the specific needs of the scientific community.
A mixed ecologic-cohort comparison of physical activity and weight among young adults from five populations of African origin
(2014-04-24) Luke, Amy; Bovet, Pascal; Plange-Rhule, Jacob; Forrester, Terrence E; Lambert, Estelle V; Schoeller, Dale A; Dugas, Lara R; Durazo-Arvizu, Ramon A; Shoham, David A; Cao, Guichan; Brage, Soren; Ekelund, Ulf; Cooper, Richard S
Abstract Background Examination of patterns and intensity of physical activity (PA) across cultures where obesity prevalence varies widely provides insight into one aspect of the ongoing epidemiologic transition. The primary hypothesis being addressed is whether low levels of PA are associated with excess weight and adiposity. Methods We recruited young adults from five countries (500 per country, 2500 total, ages 25and#8211;45and#160;years), spanning the range of obesity prevalence. Men and women were recruited from a suburb of Chicago, Illinois, USA; urban Jamaica; rural Ghana; peri-urban South Africa; and the Seychelles. PA was measured using accelerometry and expressed as minutes per day of moderate-to-vigorous activity or sedentary behavior. Results Obesity (BMIand#8201;and#8805;and#8201;30) prevalence ranged from 1.4% (Ghanaian men) to 63.8% (US women). South African men were the most active, followed by Ghanaian men. Relatively small differences were observed across sites among women; however, women in Ghana accumulated the most activity. Within site-gender sub-groups, the correlation of activity with BMI and other measures of adiposity was inconsistent; the combined correlation across sites was -0.17 for men and -0.11 for women. In the ecological analysis time spent in moderate-to-vigorous activity was inversely associated with BMI (rand#8201;=and#8201;-0.71). Conclusion These analyses suggest that persons with greater adiposity tend to engage in less PA, although the associations are weak and the direction of causality cannot be inferred because measurements are cross-sectional. Longitudinal data will be required to elucidate direction of association.
A unique strain of community-acquired Clostridium Difficile in severe complicated infection and death of a young adult
(2013-07-01) Heslop, Orville D; Roye-Green, Karen; Coard, Kathleen; Mulvey, Michael R
Abstract Background Clostridium difficile is the major cause of nosocomial antibiotic-associated diarrhoea with the potential risk of progressing to severe clinical outcomes including death. It is not unusual for Clostridium difficile infection to progress to complications of toxic megacolon, bowel perforation and even Gram-negative sepsis following pathological changes in the intestinal mucosa. These complications are however less commonly seen in community-acquired Clostridium difficile infection than in hospital-acquired Clostridium difficile infection. To the best of our knowledge, this was the first case of community-acquired Clostridium difficile infection of its type seen in Jamaica. Case presentation We report a case of a 22-year-old female university student who was admitted to the University Hospital of the West Indies, Jamaica with a presumptive diagnosis of pseudomembranous colitis PMC. She presented with a 5-day history of diarrhoea following clindamycin treatment for coverage of a tooth extraction due to a dental abscess. Her clinical condition deteriorated and progressed from diarrhoea to toxic megacolon, bowel perforation and Gram-negative sepsis. Clostridium difficile NAP12/ribotype 087 was isolated from her stool while blood cultures grew Klebsiella pneumoniae. Despite initial treatment intervention with empiric therapy of metronidazole and antibiotic clearance of Klebsiella pneumoniae from the blood, the patient died within 10and#160;days of hospital admission. Conclusions We believe that clindamycin used for coverage of a dental abscess was an independent risk factor that initiated the disruption of the bowel micro-flora, resulting in overgrowth of Clostridium difficile NAP12/ribotype 087. This uncommon strain, which is the same ribotype (087) as ATCC 43255, was apparently responsible for the increased severity of the infection and death following toxic megacolon, bowel perforation and pseudomembranous colitis involving the entire large bowel. K. pneumoniae sepsis, resolved by antibiotic therapy was secondary to Clostridium difficile infection. The case registers community-acquired Clostridium difficile infection as producing serious complications similar to hospital-acquired Clostridium difficile infection and should be treated with the requisite importance.
Acanthosis nigricans in type 2 diabetes: prevalence, correlates and potential as a simple clinical screening tool - a cross-sectional study in the Caribbean
(2014-07-09) Bahadursingh, Sarasvati; Mungalsingh, Catherine; Seemungal, Terence; Teelucksingh, Surujpal
Abstract Background This study aimed to evaluate the role of acanthosis nigricans (AN) as a marker of Type 2 Diabetes Mellitus (T2DM) by studying its prevalence and relationship with age, ethnicity, anthropometry and other risk factors for T2DM in the Trinidadian population. Methods 311 successive adult patients with T2DM were recruited at diabetic clinics and inpatient wards across Trinidad. The presence, severity and texture of AN at the neck were assessed. Demographic, clinical and anthropometric characteristics were also measured, and logistic regression was used to model their relationship with presence of AN. Results The mean (SD) age was 58.1and#160;years (12.6). 55.6% were female. 61.1% were East Indian, 24.4% African and 14.5% mixed ethnicity. The mean (SD) BMI was 27.3 kg/m2 (6.0) and the mean (SD) waist circumference was 96.7and#160;cm (14.2). Prevalence of AN was 52.7% (95% CI 47.2, 58.3).There was a greater odds of AN among diabetic patients who were: younger (pand#8201;andlt;and#8201;0.001); female (OR 1.67; 95% CI 1.06, 2.62); or East Indian rather than African (0.45; 0.26, 0.77) or mixed (0.43; 0.22, 0.84) descendents. There was a greater age-, sex- and ethnicity-adjusted odds of AN among those: overweight (3.98; 2.10, 7.55) or obese (8.31; 3.84, 18.00) versus normal BMI; centrally obese (4.72; 2.65, 8.43); with history of hypertension (2.19; 1.27, 3.79) or history of hypercholesterolemia (1.72; 1.02, 2.90), but there was no evidence of this demographic-adjusted association (pand#8201;andgt;and#8201;0.4) between AN and history of previous MI or CVA, family history of T2DM, T2DM treatment regimen, duration of T2DM or random blood glucose.On further multivariable analysis, only age, sex, ethnicity, BMI and waist circumference were independently associated with AN (pand#8201;andlt;and#8201;0.05) and the effect of BMI varied with ethnicity. Conclusions There was a high prevalence of AN both overall and across age, sex and ethnic groups of diabetic patients. AN exhibited much potential as a valuable addition to T2DM risk assessment in the Trinidadian and similar settings.
Accessory renal arteries in a Caribbean population: a computed tomography based study
(2013-09-08) Johnson, Peter B; Cawich, Shamir O; Shah, Sundeep D; Aiken, William; McGregor, Roy G; Brown, Hilary; Gardner, Michael T
Abstract Introduction The commonest variation to the classic anatomic description of renal arterial supply is the presence of accessory renal arteries. The incidence varies widely according to ethnicity. There is no data on the prevalence of these anomalies in persons of Caribbean ethnicity. Methods All CT scans done over two years from July 1, 2010 to June 30, 2012 were retrospectively evaluated. The anatomy of the renal arterial supply was reported from these studies and the anatomy of accessory renal arteries was documented. Results There were 302 CT scans evaluated and accessory renal arteries were present in 109/302 (36.1%) CT scans, 95% confidence interval 30.6%, 41.4%. There were 71/309 (23.5%) patients with accessory arteries on the left and 54/309 (17.9%) had them on the right (p 0.087). Of these, 16 (14.7%) patients had bilateral accessory renal arteries present. The most common origin for the accessory arteries was the abdominal aorta in 108 (99.1%) cases and in 1 case the accessory artery arose from the coeliac trunk. There were 80 left sided accessory renal arteries: 17 (21.3%) upper polar and 27 (33.8%) lower polar arteries. Of 62 right sided accessory arteries, 14 (22.6%) were upper polar and 26 (42%) were lower polar arteries. Conclusion This is the first population-based report of anatomic anomalies in renal arterial supply in a Caribbean population. These are important findings that may affect vascular and urologic procedures on persons of Caribbean ethnicity.
An ethnobotanical survey of medicinal plants in Trinidad
(2015-09-15) Clement, Y. N; Baksh-Comeau, Y. S; Seaforth, C. E
Abstract Background An ethnobotanical survey was conducted on the Caribbean island of Trinidad to identify medicinal plants commonly used in traditional medicine to treat a variety of medical conditions. Methods A pilot survey was conducted to identify the top ten most common ailments where medicinal plants were used. The results of the foregoing study guided a wider national survey conducted between October 2007 and July 2008. A total of 450 households from 50 rural communities were interviewed using the TRAMIL (Traditional Medicine in the Islands) questionnaire for data collection. Details of plants, part(s) used, and remedy formulations were elicited from informants and voucher specimens collected for identification at the National Herbarium of Trinidad and Tobago. The TRAMIL methodology set a limit of a plant with 20 % or more citations for any particular ailment as having significant or popular use. Results At the end of the survey 917 single plant remedies were identified. The majority of species were from the following families; Asteraceae, Lamiaceae, Leguminosae, Verbenaceae and Poaceae. Applying the TRAMIL 20 % citation of a plant for popular use as significant, Leonotis nepetifolia (for cough/common cold), Gomphrena globosa (for “stoppage-of-water”), Curcuma longa and Senna occidentalis (for “afterbirth”), Cymbopogon citratus and Neurolaena lobata (for fever), and Citrus limon (for kidney stones) qualified in our study. Those not reaching the TRAMIL 20 % significant (popular) use were Stachytarpheta jamaicensis (L.) Vahl, Senna alata (L.) Roxb.and Momordica charantia L. which were widely used as “‘cooling/cleanser’” in our survey. Conclusions Our survey showed significant retention of traditional knowledge of medicinal plants in rural Trinidad. More interestingly, a large remnant of medico-cultural concepts such as “cooling/cleanser”, “afterbirth”, “stoppage-of-water” and “womb infection” persist in the rural population. Although the scientific literature show that some of the cited plants possessed antimicrobial, anti-inflammatory and related pharmacological activities in laboratory studies, these results must be taken with caution until clinical trials are conducted to establish safety and efficacy.
An ethnobotanical survey of medicinal plants in Trinidad
(2015-09-15) Clement, Y. N; Baksh-Comeau, Y. S; Seaforth, C. E
Abstract Background An ethnobotanical survey was conducted on the Caribbean island of Trinidad to identify medicinal plants commonly used in traditional medicine to treat a variety of medical conditions. Methods A pilot survey was conducted to identify the top ten most common ailments where medicinal plants were used. The results of the foregoing study guided a wider national survey conducted between October 2007 and July 2008. A total of 450 households from 50 rural communities were interviewed using the TRAMIL (Traditional Medicine in the Islands) questionnaire for data collection. Details of plants, part(s) used, and remedy formulations were elicited from informants and voucher specimens collected for identification at the National Herbarium of Trinidad and Tobago. The TRAMIL methodology set a limit of a plant with 20 % or more citations for any particular ailment as having significant or popular use. Results At the end of the survey 917 single plant remedies were identified. The majority of species were from the following families; Asteraceae, Lamiaceae, Leguminosae, Verbenaceae and Poaceae. Applying the TRAMIL 20 % citation of a plant for popular use as significant, Leonotis nepetifolia (for cough/common cold), Gomphrena globosa (for “stoppage-of-water”), Curcuma longa and Senna occidentalis (for “afterbirth”), Cymbopogon citratus and Neurolaena lobata (for fever), and Citrus limon (for kidney stones) qualified in our study. Those not reaching the TRAMIL 20 % significant (popular) use were Stachytarpheta jamaicensis (L.) Vahl, Senna alata (L.) Roxb.and Momordica charantia L. which were widely used as “‘cooling/cleanser’” in our survey. Conclusions Our survey showed significant retention of traditional knowledge of medicinal plants in rural Trinidad. More interestingly, a large remnant of medico-cultural concepts such as “cooling/cleanser”, “afterbirth”, “stoppage-of-water” and “womb infection” persist in the rural population. Although the scientific literature show that some of the cited plants possessed antimicrobial, anti-inflammatory and related pharmacological activities in laboratory studies, these results must be taken with caution until clinical trials are conducted to establish safety and efficacy.
Analysis of immune responses induced by avian pathogenic Escherichia coli infection in turkeys and their association with resistance to homologous re-challenge
(2014-02-14) Sadeyen, Jean-Rémy; Kaiser, Pete; Stevens, Mark P; Dziva, Francis
Abstract Avian pathogenic Escherichia coli (APEC) cause severe respiratory and systemic disease in poultry yet the nature and consequences of host immune responses to infection are poorly understood. Here, we describe a turkey sub-acute respiratory challenge model and cytokine, cell-mediated and humoral responses associated with protection against homologous re-challenge. Intra-airsac inoculation of turkeys with 105 colony-forming units of APEC O78:H9 strain and#967;7122nalR induced transient and mild clinical signs of colibacillosis followed by clearance of the bacteria from the lungs and visceral organs. Upon re-challenge with 107 and#967;7122nalR, primed birds were solidly protected against clinical signs and exhibited negligible bacterial loads in visceral organs, whereas age-matched control birds exhibited high lesion scores and bacterial loads in the organs. Levels of mRNA for signature cytokines suggested induction of a Th1 response in the lung, whereas a distinct anti-inflammatory cytokine profile was detected in the liver. Proliferative responses of splenocytes to either Concanavalin A or soluble and#967;7122nalR antigens were negligible prior to clearance of bacteria, but APEC-specific responses were significantly elevated at later time intervals and at re-challenge relative to control birds. Primary infection also induced significantly elevated and#967;7122nalR-specific serum IgY and bile IgA responses which were bactericidal against and#967;7122nalR and an isogenic and#916;rfb mutant. Bactericidal activity was observed in the presence of immune, but not heat-inactivated immune serum, indicating that the antibodies can fix complement and are not directed solely at the lipopolysaccharide O-antigen. Such data inform the rational design of strategies to control a recalcitrant endemic disease of poultry.
Aortic Dissection at the University Hospital of the West Indies: A 20-year Clinicopathological Study of Autopsy Cases
(2011-09-09) Coard, Kathleen CM
Abstract Background An autopsy study of aortic dissection (AD) at our institution was previously reported. In the approximately 20 years since then, however, many aspects of diagnosis and treatment of this disease have changed, with a fall in mortality reported in many centers around the world. An impression amongst our pathologists that, there might be an increase in the prevalence of AD in the autopsy service at our hospital, since that earlier report, led to this repeated study, in an attempt to validate that notion. We also sought to identify any changes in clinicopathological features between the two series or any occurring during this study period itself. Findings All cases of AD identified at autopsy, during the 20-year period since the conclusion of the last study, were collected and pertinent clinical and pathological data were analyzed and compared, both within the two decades of this study period and against the results of the last study. Fifty-six cases comprised this study group including 36 males and 20 females, with a mean age of 63.9 years. There were, more patients in the second decade (n = 33; 59%) compared with the first decade (n = 23; 41%). Hypertension as a risk factor was identified in 52 (93%) cases and rupture occurred in 49 (88%) cases. A clinical diagnosis of AD was considered prior to surgery or autopsy in 25 (45%) cases overall, more during the second decade. Surgery was attempted in 25% of all cases with an increase in the second decade compared with the first. Conclusions Compared with the earlier review, a variety of changes in the profile of patients with AD in the autopsy service has been noted, including a reversal in the female predominance seen previously. Other observations include an increase in cases where the correct clinical diagnosis was considered and in which surgical treatment was attempted, changes also evident when the second decade of the present study was compared with the earlier decade. Overall, there were many positive trends. However, areas that could still be improved include an increased index of suspicion for the diagnosis of AD and perhaps in the initiation of treatment, earlier, in those cases where the correct diagnosis was considered.
ApoC-III and visceral adipose tissue contribute to paradoxically normal triglyceride levels in insulin-resistant African-American women
(2013-12-23) Sumner, Anne E; Furtado, Jeremy D; Courville, Amber B; Ricks, Madia; Younger-Coleman, Novie; Tulloch-Reid, Marshall K; Sacks, Frank M
Abstract Background African-Americans are more insulin-resistant than whites but have lower triglyceride (TG) concentrations. The metabolic basis for this is unknown. Our goal was to determine in a cross-sectional study the effect of insulin resistance, visceral adipose tissue (VAT) and the apolipoproteins, B, C-III and E, on race differences in TG content of very low density lipoproteins (VLDL). Methods The participants were 31 women (16 African-American, 15 white) of similar age (37and#8201;and#177;and#8201;9 vs. 38and#8201;and#177;and#8201;11y (meanand#8201;and#177;and#8201;SD), P =and#8201;0.72) and BMI (32.4and#8201;and#177;and#8201;7.2 vs. 29.3and#8201;and#177;and#8201;6.0and#160;kg/m2, P =and#8201;0.21). A standard diet (33% fat, 52% carbohydrate, 15% protein) was given for 7and#160;days followed by a test meal (40% fat, 40% carbohydrate, 20% protein) on Day 8. Insulin sensitivity index (SI) was calculated from the minimal model. VAT was measured at L2-3. The influence of race, SI, VAT and apolipoproteins on the TG content of VLDL was determined by random effects models (REM). Results African-Americans were more insulin-resistant (SI: 3.6and#8201;and#177;and#8201;1.3 vs. 5.6and#8201;and#177;and#8201;2.6and#160;mU/L-1.min-1, P andlt;and#8201;0.01) with less VAT (75and#8201;and#177;and#8201;59 vs. 102and#8201;and#177;and#8201;71and#160;cm2, P andlt;and#8201;0.01). TG, apoB and apoC-III content of light and dense VLDL were lower in African-Americans (all P andlt;and#8201;0.05 except for apoC-III in light VLDL, P =and#8201;0.11). ApoE content did not vary by race. In REM, VAT but not SI influenced the TG concentration of VLDL. In models with race, SI, VAT and all apolipoproteins entered, race was not significant but apoC-III and VAT remained significant determinants of TG concentration in light and dense VLDL. Conclusions Low concentrations of apoC-III and VAT in African-Americans contribute to race differences in TG concentrations. Trial registration ClinicalTrials.gov Identifier: NCT00484861
Applying the Stages of Change model to Type 2 diabetes care in Trinidad: A randomised trial.
(2011-10-11) Partapsingh, V A; Maharaj, R G; Rawlins, J M
Abstract Objective To improve glycaemic control among Type 2 diabetics using patient-physician consultations guided by the Stages of Change (SOC) model. Design and Methods A randomised trial was conducted. After ensuring concealment of allocation, Type 2 diabetics were randomly assigned to receive the intervention or the control. The intervention consisted of identifying each patient's Stage of Change for managing their diabetes by diet, exercise and medications, and applying personalised, stage-specific care during the patient-physician consultations based on the SOC model. Patients in the control group received routine care. The variables of interest were effect on glycaemic control (measured by the difference in HbA1c levels) and patients' readiness to change (measured by identifying patients' SOC for managing their diabetes by diet, exercise and medications). Results Participants were primarily over age 50, male and Indo-Trinidadian. Most had received only a primary school education and over 65% had a monthly income of $320 USD/month or less. Sixty-one Type 2 diabetics participated in each arm. Three patients were lost to follow-up in the intervention arm. After 48 weeks, there was an overall increase in HbA1c of 0.52% (SE 0.17) and 1.09% (SE 0.18) for both the intervention and control groups respectively. There was a relative reduction in HbA1c of 0.57% (95% CI 0.07, 1.07) with the intervention group compared to the control (p = 0.025). For exercise and diet there was an overall tendency for participants in the intervention arm to move to a more favourable SOC, but little change was noted with regards medication use. Conclusions The result suggests a tendency to a worsening of glycaemic control in this population despite adopting more favourable SOC for diet and exercise. We hypothesized that harsh social conditions prevailing at the time of the study overrode the clinical intervention.
Are primary care practitioners in Barbados following hypertension guidelines? - A chart audit.
(2010-11-22) Adams, O PETER; Carter, Anne O
Abstract Background About 55% of the population 40 to 80 years of age in Barbados is hypertensive. The quality of hypertension primary care compared to available practice guidelines is uncertain. Findings Charts of hypertensive and diabetic patients were randomly sampled at all public and 20 private sector primary care clinics. Charts of all hypertensive patients and#8805; 40 years of age were then selected and processes of care and blood pressure (BP) maintenance andlt; 140/90 documented. 343 charts of hypertensive patients (170 public, and 173 private) were audited. Patients had the following characteristics: mean age 64 years, female gender 63%, mean duration of diagnosis 9.1 years, and diabetes diagnosed 58%. Patients had an average of 4.7 clinic visits per year, 70% were prescribed a thiazide diuretic, 42% a calcium channel blocker, 40% an angiotensin receptor blocker, and 19% a beta blocker. Public patients compared to private patients were more likely to be female (73% vs. 52%, p andlt; 0.01); have a longer duration of diagnosis (11.7 vs. 6.5 years, p andlt; 0.01), and more clinic visits per year (5.0 vs. 4.5, p andlt; 0.01). Over a 2 year period, the proportion of charts with the following recorded at least once was: BP 98%, weight 80%, total cholesterol 71%, urine tested for albumin 67%, serum creatinine 59%, dietary advice 55%, lipid profile 48%, exercise advice 45%, fasting blood glucose for non-diabetics 39%, dietician referral 21%, tobacco advice 17%, retinal examination 16%, body mass index 1%, and waist circumference 0%. Public patients were more likely to have recorded: weight (92% vs. 68%, p = andlt; 0.01); tests for total cholesterol (77% vs. 67%, p = 0.04), albuminuria (77% vs. 58%, p = andlt; 0.01), serum creatinine (75% vs. 43%, p andlt; 0.01), and fasting blood glucose for non-diabetics (49% vs. 30%, p = 0.02); dietician referral (34% vs. 9%, p andlt; 0.01), and tobacco advice (24% vs. 10%, p andlt; 0.01). Most (92%) diastolic BP readings ended in 0 or 5 (72% ended in 0). At the last visit 36% of patients had a BP andlt; 140/90 mmHg. Conclusions Improvements are needed in following guidelines for basic interventions such as body mass assessment, accurate BP measurement, use of thiazide diuretics and lifestyle advice. BP control is inadequate.
Asking the right questions: developing evidence-based strategies for treating HIV in women and children
(2011-05-25) Abdool Karim, Quarraisha; Banegura, Anchilla; Cahn, Pedro; Christie, Celia DC; Dintruff, Robert; Distel, Manuel; Hankins, Catherine; Hellmann, Nicholas; Katabira, Elly; Lehrman, Sandra; Montaner, Julio; Purdon, Scott; Rooney, James F; Wood, Robin; Heidari, Shirin
Abstract In July 2010, the World Health Organization (WHO) issued formal revisions of its guidelines on the use of highly active antiretroviral therapy for HIV. The new guidelines greatly expand eligibility for treatment of adults and children, as well as for pregnant women seeking prophylaxis for vertical HIV transmission. WHO's new recommendations bring the guidelines closer to practices in developed countries, and its shift to earlier treatment alone will increase the number of treatment-eligible people by 50% or more. Scaling up access to HIV treatment is revealing important gaps in our understanding of how best to provide for all those in need. This knowledge gap is especially significant in developing countries, where women and children comprise a majority of those living with HIV infection. Given the magnitude and significance of these populations, the International AIDS Society, through its Industry Liaison Forum, prioritized HIV treatment and prophylaxis of women and children. In March 2010, the International AIDS Society and 15 partners launched a Consensus Statement outlining priority areas in which a relative lack of knowledge impedes delivery of optimal prevention of mother to child transmission (PMTCT) and treatment to women and children. The Consensus Statement, "Asking the Right Questions: Advancing an HIV Research Agenda for Women and Children", makes a special appeal for a more gender-sensitive approach to HIV research at all stages, from conception to design and implementation. It particularly emphasizes research to enhance the understanding of sex-based differences and paediatric needs in treatment uptake and response. In addition to clinical issues, the statement focuses on programmatic research that facilitates access and adherence to antiretroviral regimens. Better coordination of HIV management with sexual and reproductive healthcare delivery is one such approach. We discuss here our knowledge gaps concerning effective, safe PMTCT and treatment for women and children in light of the expansion envisioned by WHO's revised guidelines. The guideline's new goals present an opportunity for advancing the women and children's agenda outlined in the Consensus Statement.
Association between smoking and total energy expenditure in a multi-country study
(2014-10-04) Gonseth, Semira; Dugas, Lara; Viswanathan, Barathi; Forrester, Terrence; Lambert, Vicki; Plange-Rhule, Jacob; Durazo-Arvizu, Ramon; Luke, Amy; Schoeller, Dale A; Bovet, Pascal
Abstract Background The association between smoking and total energy expenditure (TEE) is still controversial. We examined this association in a multi-country study where TEE was measured in a subset of participants by the doubly labeled water (DLW) method, the gold standard for this measurement. Methods This study includes 236 participants from five different African origin populations who underwent DLW measurements and had complete data on the main covariates of interest. Self-reported smoking status was categorized as either light (andlt;7 cig/day) or high (and#8805;7 cig/day). Lean body mass was assessed by deuterium dilution and physical activity (PA) by accelerometry. Results The prevalence of smoking was 55% in men and 16% in women with a median of 6.5 cigarettes/day. There was a trend toward lower BMI in smokers than non-smokers (not statistically significant). TEE was strongly correlated with fat-free mass (men: 0.70; women: 0.79) and with body weight (0.59 in both sexes). Using linear regression and adjusting for body weight, study site, age, PA, alcohol intake and occupation, TEE was larger in high smokers than in never smokers among men (difference of 298and#160;kcal/day, pand#8201;=and#8201;0.045) but not among women (162and#160;kcal/day, pand#8201;=and#8201;0.170). The association became slightly weaker in men (254and#160;kcal/day, pand#8201;=and#8201;0.058) and disappeared in women (and#8722;76and#160;kcal/day, pand#8201;=and#8201;0.380) when adjusting for fat-free mass instead of body weight. Conclusion There was an association between smoking and TEE among men. However, the lack of an association among women, which may be partly related to the small number of smoking women, also suggests a role of unaccounted confounding factors.
Bone mineral density in Jamaican men on androgen deprivation therapy for prostate cancer
(2011-09-23)
Abstract Background Androgen deprivation therapy (ADT) has been reported to reduce the bone mineral density (BMD) in men with prostate cancer (CaP). However, Afro-Caribbeans are under-represented in most studies. The aim was to determine the effect of androgen deprivation therapy (ADT) on the bone mineral density (BMD) of men with prostate cancer in Jamaica. Methods The study consisted of 346 Jamaican men, over 40 years of age: 133 ADT treated CaP cases (group 1), 43 hormone-naand#239;ve CaP controls (group 2) and 170 hormone naand#239;ve controls without CaP (group 3). Exclusion criteria included metastatic disease, bisphosphonate therapy or metabolic disease affecting BMD. BMD was measured with a calcaneal ultrasound and expressed in S.D. units relative to young adult men (T score), according to the World Health Organization definition. Patient weight, height and BMI were assessed. Results Mean and#177; sd, age of patients in group 1 (75and#177; 7.4 yrs) was significantly greater than groups 2 and 3 (67 and#177; 8.1 yrs; 65and#177;12.0 yrs). There was no significant difference in weight and BMI between the 3 groups. . The types of ADT (% of cases, median duration in months with IQR) included LHRH (Luteinizing hormone releasing hormone) analogues (28.6%, 17.9, IQR 20.4), oestrogens (9.8%, 60.5, IQR 45.6) anti-androgens (11.3%, 3.3, IQR 15.2) and orchiectomy (15.7%, 43.4, IQR 63.9). Unadjusted t score of group 1, mean and#177; sd, (-1.6and#177; 1.5) was significantly less than group 2 (-0.9and#177;1.1) and group 3 (-0.7and#177;1.4), p andlt;0.001. Ninety three (69.9%), 20 (45%) and 75 (42%) of patients in groups 1, 2 and 3 respectively were classified as either osteopenic or osteoporotic (pandlt;0.001). Adjusting for age, there was a significant difference in t scores between groups 1 and 2 as well as between groups 1 and 3 (pandlt;0.001). Compared with oestrogen therapy and adjusting for duration of therapy, the odds of low bone mineral density (osteopenia or osteoporosis) with LHRH analogue was 4.5 (95%CI, 14.3 to 3.4); with anti-androgens was 5.9 (95%CI, 32.7 to 5); with orchiectomy was 7.3 (95%CI, 30 to 5.8) and multiple drugs was 9.2 ((95%CI, 31 to 7.1). Conclusions ADT is associated with lower BMD in Jamaican men on hormonal therapy for prostate cancer.
Cancer incidence and mortality rates and trends in Trinidad and Tobago
(2018-07-04) Warner, Wayne A; Lee, Tammy Y; Badal, Kimberly; Williams, Tanisha M; Bajracharya, Smriti; Sundaram, Vasavi; Bascombe, Nigel A; Maharaj, Ravi; Lamont-Greene, Marjorie; Roach, Allana; Bondy, Melissa; Ellis, Matthew J; Rebbeck, Timothy R; Slovacek, Simeon; Luo, Jingqin; Toriola, Adetunji T; Llanos, Adana A M
Abstract Background Cancer is the second leading cause of death in the Caribbean, including the islands of Trinidad and Tobago (TT). The population of TT consists of over 1.3 million people with diverse ancestral and sociocultural backgrounds, both of which may influence cancer incidence and mortality. The objective of this study was to examine incidence and mortality patterns and trends in TT. Methods Cancer surveillance data on 29,512 incident cancer cases reported to the Dr. Elizabeth Quamina Cancer Registry (population-based cancer registry of TT) between 1995 and 2009 were analyzed. Age-standardized rates, overall and by sex, ancestry, and geography, were reported. Results The highest incidence and mortality rates were observed for cancers related to reproductive organs in women, namely, breast, cervical, and uterine cancers, and prostate, lung and colorectal cancers among men. Average incidence rates were highest in areas covered by the Tobago Regional Health Authority (TRHA) (188 per 100,000), while average mortality rates were highest in areas covered by the North West Regional Health Authority (108 per 100,000). Nationals of African ancestry exhibited the highest rates of cancer incidence (243 per 100,000) and mortality (156 per 100,000) compared to their counterparts who were of East Indian (incidence, 125 per 100,000; mortality, 66 per 100,000) or mixed ancestry (incidence, 119 per 100,000; mortality, 66 per 100,000). Conclusions Our findings highlight the need for national investment to improve the understanding of the epidemiology of cancer in Trinidad and Tobago, and to ultimately guide much needed cancer prevention and control initiatives in the near future.
Characterization of a broad-based mosquito yeast interfering RNA larvicide with a conserved target site in mosquito semaphorin-1a genes
(2019-05-22) Mysore, Keshava; Li, Ping; Wang, Chien-Wei; Hapairai, Limb K; Scheel, Nicholas D; Realey, Jacob S; Sun, Longhua; Severson, David W; Wei, Na; Duman-Scheel, Molly
Abstract Background RNA interference (RNAi), which has facilitated functional characterization of mosquito neural development genes such as the axon guidance regulator semaphorin-1a (sema1a), could one day be applied as a new means of vector control. Saccharomyces cerevisiae (baker’s yeast) may represent an effective interfering RNA expression system that could be used directly for delivery of RNA pesticides to mosquito larvae. Here we describe characterization of a yeast larvicide developed through bioengineering of S. cerevisiae to express a short hairpin RNA (shRNA) targeting a conserved site in mosquito sema1a genes. Results Experiments conducted on Aedes aegypti larvae demonstrated that the yeast larvicide effectively silences sema1a expression, generates severe neural defects, and induces high levels of larval mortality in laboratory, simulated-field, and semi-field experiments. The larvicide was also found to induce high levels of Aedes albopictus, Anopheles gambiae and Culex quinquefasciatus mortality. Conclusions The results of these studies indicate that use of yeast interfering RNA larvicides targeting mosquito sema1a genes may represent a new biorational tool for mosquito control.
Chemokine Ligand 5 (CCL5) and chemokine receptor (CCR5) genetic variants and prostate cancer risk among men of African Descent: a case-control study
(2012-11-20) Kidd, LaCreis R; Jones, Dominique Z; Rogers, Erica N; Kidd, Nayla C; Beache, Sydney; Rudd, James E; Ragin, Camille; Jackson, Maria; McFarlane-Anderson, Norma; Tulloch-Reid, Marshall; Morrison, Seian; Brock, Guy N; Barve, Shirish S; Kimbro, Kevin S
Abstract Background Chemokine and chemokine receptors play an essential role in tumorigenesis. Although chemokine-associated single nucleotide polymorphisms (SNPs) are associated with various cancers, their impact on prostate cancer (PCA) among men of African descent is unknown. Consequently, this study evaluated 43 chemokine-associated SNPs in relation to PCA risk. We hypothesized inheritance of variant chemokine-associated alleles may lead to alterations in PCA susceptibility, presumably due to variations in antitumor immune responses. Methods Sequence variants were evaluated in germ-line DNA samples from 814 African-American and Jamaican men (279 PCA cases and 535 controls) using Illuminaand#8217;s Goldengate genotyping system. Results Inheritance of CCL5 rs2107538 (AA, GA+AA) and rs3817655 (AA, AG, AG+AA) genotypes were linked with a 34-48% reduction in PCA risk. Additionally, the recessive and dominant models for CCR5 rs1799988 and CCR7 rs3136685 were associated with a 1.52-1.73 fold increase in PCA risk. Upon stratification, only CCL5 rs3817655 and CCR7 rs3136685 remained significant for the Jamaican and U.S. subgroups, respectively. Conclusions In summary, CCL5 (rs2107538, rs3817655) and CCR5 (rs1799988) sequence variants significantly modified PCA susceptibility among men of African descent, even after adjusting for age and multiple comparisons. Our findings are only suggestive and require further evaluation and validation in relation to prostate cancer risk and ultimately disease progression, biochemical/disease recurrence and mortality in larger high-risk subgroups. Such efforts will help to identify genetic markers capable of explaining disproportionately high prostate cancer incidence, mortality, and morbidity rates among men of African descent.
Cognitive behavioural therapy (CBT) for anxiety in people with dementia: study protocol for a randomised controlled trial
(2012-10-23) Spector, Aimee; Orrell, Martin; Lattimer, Miles; Hoe, Juanita; King, Michael; Harwood, Kate; Qazi, Afifa; Charlesworth, Georgina
Abstract Background Many people with dementia experience anxiety, which can lead to decreased independence, relationship difficulties and increased admittance to care homes. Anxiety is often treated with antipsychotic medication, which has limited efficacy and serious side effects. Cognitive behavioural therapy (CBT) is widely used to treat anxiety in a range of populations, yet no RCTs on CBT for anxiety in dementia exist. This study aims to develop a CBT for anxiety in dementia manual and to determine its feasibility in a pilot RCT. Methods/design Phase I involves the development of a CBT for anxiety in dementia manual, through a process of (1) focus groups, (2) comprehensive literature reviews, (3) expert consultation, (4) a consensus conference and (5) field testing. Phase II involves the evaluation of the manual with 50 participants with mild to moderate dementia and anxiety (and their carers) in a pilot, two-armed RCT. Participants will receive either ten sessions of CBT or treatment as usual. Primary outcome measures are anxiety and costs. Secondary outcome measures are participant quality of life, behavioural disturbance, cognition, depression, mood and perceived relationship with the carer, and carer mood and perceived relationship with the person with dementia. Measures will be administered at baseline, 15 weeks and 6 months. Approximately 12 qualitative interviews will be used to gather service-users' perspectives on the intervention. Discussion This study aims to determine the feasibility of CBT for people with anxiety and dementia and provide data on the effect size of the intervention in order to conduct a power analysis for a definitive RCT. The manual will be revised according to qualitative and quantitative findings. Its publication will enable its availability throughout the NHS and beyond. Trial registration ISRCTN64806852

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