Panel 2.3: gender dimensions and human rights aspects to responses and recovery

This is a summary of the presentations and discussion of the Gender Dimensions and Human Rights Aspects to Responses and Recovery of the Conference, Health Aspects of the Tsunami Disaster in Asia, convened by the World Health Organization (WHO) in Phuket, Thailand, 04-06 May 2005. The topics discussed included issues related to gender dimensions and human rights pertaining to the responses to the damage created by the Tsunami. It is presented in the following major sections: (1) gaps encountered and major issues; (2) limitations of response; (3) what could have been done better?; and (4) recommendations.     

Immunomodulatory activity of triphala on neutrophil functions

Immune activation is an effective as well as protective approach against emerging infectious diseases. The immunomodulatory activities of Triphala (Terminalia chebula, Terminalia belerica and Emblica officinalis) were assessed by testing the various neutrophil functions like adherence, phagocytosis (phagocytic index (P.I) and avidity index (A.I)) and nitro blue tetrazolium (NBT) reduction in albino rats. In recent years much attention is being focused on the immunological changes occur during stress. Noise (100 dB) stress for 4 h/d for 15 d, was employed to alter the neutrophil functions. The neutrophil function tests and corticosterone levels were carried out in eight different groups of animals, namely control, Triphala, noise-stress, Triphala noise-stress, and corresponding immunized groups were used. Sheep red blood cells (SRBC 5 x 10(9) cells per ml) were used for immunizing the animals that belongs to immunized groups. In Triphala administration (1 g/kg/d for 48 d), A.I was found to be significantly enhanced in the Triphala group, while the remaining neutrophil functions and steroid levels were not altered significantly. However the neutrophil functions were significantly enhanced in the Triphala immunized group with a significant decrease in corticosterone level was observed. Upon exposure to the noise-stress, the neutrophil functions were significantly suppressed and followed by a significant increase in the corticosterone levels were observed in both the noise-stress and the noise-stress immunized groups. These noise-stress-induced changes were significantly prevented by Triphala administration in both the Triphala noise-stress and the Triphala noise-stress immunized groups. Hence our study has divulged that oral administration of Triphala appears to stimulate the neutrophil functions in the immunized rats and stress induced suppression in the neutrophil functions were significantly prevented by Triphala.     

Elevated serum interferon‐α activity in juvenile dermatomyositis: Associations with disease activity at diagnosis and after thirty‐six months of therapy

Objective

Interferon‐α (IFNα) has been implicated in the pathogenesis of juvenile dermatomyositis (DM). The aim of this study was to examine serum IFNα activity in a cohort of children with juvenile DM to determine relationships between IFNα and indicators of disease activity and severity.

Methods

Thirty‐nine children with definite/probable juvenile DM were included in the study. Serum samples were obtained at the time of diagnosis from 18 untreated patients with juvenile DM. Second samples from 11 of these patients were obtained at 24 months, while they were receiving treatment, and third samples were obtained from 7 of these patients at 36 months. The remaining 21 children were studied 36 months after their initial diagnosis. Serum IFNα activity was measured using a functional reporter cell assay.

Results

Patients with juvenile DM had higher serum IFNα activity than both pediatric and adult healthy control subjects. In untreated patients, serum IFNα activity was positively correlated with serum muscle enzyme levels (P < 0.05 for creatine kinase, aspartate aminotransferase, and aldolase) and inversely correlated with the duration of untreated disease (P = 0.017). The tumor necrosis factor α −308A allele was associated with higher serum IFNα levels only in untreated patients (P = 0.030). At 36 months, serum IFNα levels were inversely correlated with muscle enzyme levels in those patients still requiring therapy and with the skin Disease Activity Score in those patients who had completed therapy (P = 0.002).

Conclusion

Serum IFNα activity was associated with higher serum levels of muscle‐derived enzymes and a shorter duration of untreated disease in patients with newly diagnosed juvenile DM and was inversely correlated with measures of chronic disease activity at 36 months postdiagnosis. These data suggest that IFNα could play a role in disease initiation in juvenile DM.

     

Auer rod-like inclusions in myeloma cells in a patient with IgG multiple myeloma

Various inclusions have been reported in the past in plasma cells as well as myeloma cells. Most of these represent light chains of immunoglobulins which are concentrated within these cells. Auer rod-like inclusions in myeloma cells have been infrequently reported. They do not influence prognosis in patients with multiple myeloma but are more of a morphological variance. We report a patient of IgG myeloma with auer rod-like inclusions in myeloma cells in the bone marrow aspirates.     

Risk factors and associated problems in the management of infections with methicillin resistant Staphylococcus aureus

Purpose: It is necessary to define the problem of methicillin resistant Staphylococcus aureus (MRSA) in every hospital to evolve control strategies. The objectives of this study were to determine factors influencing the persistence of MRSA in patients with hospital acquired infection and to identify alternate cost effective antibiotics. Methods: A six month study was carried out for 50 patients with MRSA infection. Treatment modalities and risk factors were determined by a preset protocol. Minimum inhibitory concentration of commonly used antibiotics was determined. Results: The risk factors were prolonged postoperative morbidity, prior antibiotic therapy and emergency admissions. Seventy percent of the isolates were from postoperative cases undergoing emergency surgeries. Isolation was highest during the second week of hospital stay. Emergency admissions had a significantly higher chance of early isolation. Prior treatment with multiple antibiotics in 38% was found to be another major risk factor. Ofloxacin was seen to be efficacious in a small percentage of cases. Rifampicin in combination with ofloxacin and clindamycin were found to be other good alternatives. Ofloxacin was found to be the cheapest and vancomycin the most expensive, for a full course of treatment. Conclusions: Minimizing risk factors and attention to alternate cost effective combination therapy may ease the problem of management of infections with MRSA.     

Reduced global longitudinal and radial strain with normal left ventricular ejection fraction late after effective repair of aortic coarctation: a CMR feature tracking study

We sought to determine whether global and regional left ventricular (LV) strain parameters were altered in repaired coarctation of the aorta (COA) with normal LV ejection fraction (EF) when compared with healthy adult controls, and whether such alterations were related to LV hypertrophy (LVH). We identified 81 patients after COA repair (31 female, age 25 ± 8.5 years) with inclusion criteria at follow-up CMR of: age ≥13 years, time post-repair ≥10 years, no aortic valve disease, LV-EF >50 %). LV deformation indices derived using CMR-feature tracking and volumetric EF were compared between COA patients and normal controls (n = 20, 10 female, age 37 ± 7 years), and between COA with versus without LVH. In repaired COA versus controls, LV-EF (%) was 62 ± 7.2 versus 58 ± 3.0 (p = 0.01), and LV mass (g/m²) 66 ± 16.8 versus 57.7 ± 6.0 (p = 0.0001). LV global longitudinal strain (GLS) was decreased to ?17.0 ± 4.7 % in COA (?20 ± 5 % in controls, p = 0.02), and global radial strain (GRS) reduced to 40 ± 15 % (50 ± 12.4 % in controls, p = 0.003). The global circumferential strain (GCS) was preserved in COA at ?23 ± 4.7 % (?24.6 ± 2.4 % in controls, p = 0.14). Regionally, LS decrease was marked in the basal segments (septal, p = 0.005, lateral, p = 0.013). In COA with LVH (n = 45, mass 76.3 ± 12.8 g/m²) versus without LVH (n = 36, mass 52.2 ± 10 g/m²), GLS was more markedly decreased (?15.7 ± 4.8 vs. ?18.5 ± 4.2 %, p = 0.016, but GRS and GCS were similar (p = 0.49 and 0.27). In post-repair COA with normal LV-EF, GLS and GRS are reduced whilst GCS is preserved. GLS reduction is more pronounced in the presence of LVH. GLS may qualify as indicator of early LV dysfunction.     

The co-occurrence of childhood sexual abuse, adult sexual assault, intimate partner violence, and sexual harassment: a mediational model of posttraumatic stress disorder and physical health outcomes

This study examined the co-occurrence of childhood sexual abuse, adult sexual assault, intimate partner violence, and sexual harassment in a predominantly African American sample of 268 female veterans, randomly sampled from an urban Veterans Affairs hospital women's clinic. A combination of hierarchical and iterative cluster analysis was used to identify 4 patterns of women's lifetime experiences of violence co-occurrence. The 1st cluster experienced relatively low levels of all 4 forms of violence; the 2nd group, high levels of all 4 forms; the 3rd, sexual revictimization across the lifespan with adult sexual harassment; and the 4th, high intimate partner violence with sexual harassment. This cluster solution was validated in a theoretically driven model that examined the role of posttraumatic stress disorder (PTSD) as a mediator of physical health symptomatology. Structural equation modeling analyses revealed that PTSD fully mediated the relationship between violence and physical health symptomatology. Consistent with a bio-psycho-immunologic theoretical model, PTSD levels more strongly predicted pain-related physical health symptoms compared to nonpain health problems. Implications for clinical interventions to prevent PTSD and to screen women for histories of violence in health care settings are discussed.     

Surface colonization by Azospirillum brasilense SM in the indole-3-acetic acid dependent growth improvement of sorghum

The key to improving plant productivity is successful bacterial-plant interaction in the rhizosphere that can be maintained in the environment. The results presented here confirm Azospirillum brasilense strain SM as a competent plant growth promoting bacterium over mid- and long-term associations with sorghum. This study establishes that plant growth can be directly correlated with the associated bacterium's indole-3-acetic acid (IAA) production capability as IAA over-expressing variants, SMp30 and SMΔi3-6 fared better than the wild type strain. The auxin antagonist, p-chlorophenoxy isobutyric acid confirmed the role of bacterial IAA in plant growth promotion and verified the presence of larger amount of IAA available to the seeds on inoculation with IAA over-expressing mutants. Microscopic analysis identified the bacterial association at root tips, root-shoot junction and elongation zone and their surface colonizing nature. Scanning electron microscopy identified larger number of root hairs and extensive exopolysaccharide covering in comparison to untreated ones. In addition, vibroid-shaped Azospirilla attached by means of fibrillar material were dispersed along the elongation zone. The notable difference with IAA over-expressing variants was enhanced number of root hairs. Thus, the variant strains may be more efficient surface colonizers of the sorghum root and used as superior bio-inoculants for improving plant productivity.     

Case report: high prenatal bisphenol a exposure and infant neonatal neurobehavior

Context: Most of the U.S. population is exposed to the high-production-volume chemical bisphenol A (BPA), but targetable sources of exposure remain to be determined. Animal studies and one human study suggest that BPA is a neurotoxicant.Case presentation: A mother in the Health Outcomes and Measures of the Environment (HOME) Study, a prospective birth cohort examining prenatal and postnatal environmental toxicants and childhood health outcomes, had a urinary BPA concentration of 583 µg/g creatinine at 27 weeks of pregnancy, which was the highest concentration observed in this cohort (median, 2.0 µg/g creatinine) and the general population. We used prenatal questionnaire data and a follow-up interview to identify potential sources of exposure that included daily plastic use and consumption of canned beverages and foods. Her male infant had a normal newborn neurobehavioral assessment but presented with abnormalities at the 1-month examination that prompted physician referral. Subsequently, the child had normal neurobehavioral testing results at annual evaluations from 1 to 5 years of age.Discussion: Investigations into sources of high gestational urinary BPA concentrations provide an opportunity to identify potential targets for reduction of BPA exposure. This case highlights a potential link between gestational BPA exposure and transient neurobehavioral changes that is hypothesis generating and can serve to alert researchers to potential areas for examination in future studies.Relevance to clinical practice: It is important to educate health care practitioners regarding potential sources of BPA exposure and anticipatory guidance on minimization of exposures during vulnerable periods of development.