Relationship of vitamin A deficiency, iron deficiency, and inflammation to anemia among preschool children in the Republic of the Marshall Islands

INTRODUCTION: Although vitamin A deficiency, iron deficiency, and inflammation may contribute to anemia, their relative contribution to anemia has not been well characterized in preschool children in developing countries. OBJECTIVE: To characterize the contributions of vitamin A and iron deficiencies and inflammation to anemia among preschool children in the Republic of the Marshall Islands. SUBJECTS AND METHODS: A community-based survey, the Republic of the Marshall Islands Vitamin A Deficiency Study, was conducted among 919 preschool children. The relationship of vitamin A and iron status and markers of inflammation, tumor necrosis factor-alpha, alpha1-acid glycoprotein, and interleukin-10, to anemia were studied in a subsample of 367 children. RESULTS: Among the 367 children, the prevalence of anemia was 42.5%. The prevalence of severe vitamin A deficiency (serum vitamin A < 0.35 micromol/l) and iron deficiency (serum ferritin < 12 microg/dl) were 10.9 and 51.7%, respectively. The respective prevalence of iron deficiency anemia (hemoglobin < 110 g/l and iron deficiency), anemia with inflammation (anemia with TNF-alpha > 2 pg/ml and/or AGP > 1000 mg/l), and severe vitamin A deficiency combined with anemia was 26.7, 35.6, and 7.6%. In multivariate linear regression models that adjusted for age, sex, and inflammation, both iron deficiency (odds ratio (OR) 1.74, 95% confidence interval (CI) 1.08-2.83, P = 0.023) and severe vitamin A deficiency (OR 4.85, 95% CI 2.14-10.9, P < 0.0001) were significantly associated with anemia. CONCLUSIONS: Both iron and vitamin A deficiencies were independent risk factors for anemia, but inflammation was not a significant risk factor for anemia among these preschool children.     

Comparability of two fundus photograph reading centers in grading cytomegalovirus retinitis progression

PURPOSE: To compare grading of cytomegalovirus retinitis progression by two different fundus photograph reading centers (FPRCs). DESIGN: Patients with AIDS followed in an ophthalmology service were enrolled in a prospective epidemiologic study of the prevalence and incidence of resistant cytomegalovirus in vitro. METHODS: We compared masked replicate gradings by two different FPRCs of monthly fundus photographs for retinitis progression (onset of a separate new lesion or expansion of an existing lesion by > or =one-half disk diameter). RESULTS: For 77 patients, Kaplan-Meier plots of progression over time were similar between FPRCs (median time to progression, 65 vs 69 days). Agreement between FPRCs was 51% (kappa [kappa] =.37, "fair") on exact visit of progression (28 patients) or on absence of progression through follow-up (11 patients) and 62% (kappa =.38) on progression visit +/- 1 month. Eight of 12 patients with progression graded as more than 1 month apart were only 2 months apart. Considering each monthly visit as a choice point, overall agreement on progression was 78% (kappa =.55, "moderate"). Baseline evaluation of retinitis showed 95% agreement on presence/absence and a concordance correlation coefficient of.75 for extent in combined zones 1 and 2. Rates of retinal loss over follow-up were estimated as 2.8%/month vs 2.0%/month (P =.015). CONCLUSIONS: By adopting similar protocols and procedures, different FPRCs can achieve good agreement on presence and extent of cytomegalovirus retinitis. Further efforts to harmonize evaluation through ongoing comparison of gradings would likely improve agreement on retinitis progression.     

Immunogenicity of Plasmodium vivax merozoite surface protein-9 recombinant proteins expressed in E. coli

Merozoite surface protein-9 of Plasmodium vivax (PvMSP-9) is highly conserved and present in several malaria species. Here, we present the immunogenic properties of two recombinant glutathione S-transferase (GST) fusion proteins comprising the N-terminus (PvMSP-9-Nt) and the second block of tandem repeats (PvMSP-9-RepII) of PvMSP9. These recombinants proteins were used to immunize BALB/c mice. The specificity and subtyping of the antibodies and the cellular immune responses were evaluated by enzyme-linked immunosorbent assay (ELISA) and ELISPOT, respectively, using the recombinant proteins as antigens. Our results demonstrate that both the N-terminal and the tandem repeat regions of MSP9 are immunogenic in mice. The ELISA antibody titers elicited by PvMSP-9-Nt were significantly higher (1:819,200) than the antibody titers elicited by PvMSP-9-RII (1:409,600). Analysis of IgG subclasses showed that both recombinant proteins induce similar antibody patterns where IgG1, IgG2a and IgG2b were most predominant. Moreover, all sera from mice immunized with either PvMSP-9-Nt or PvMSP-9-RII, which were positive by ELISA showed reactivity with P. vivax, P. cynomolgi, P. knowlesi and P. coatneyi schizonts by immunofluorescence assays (IFA). Similar results were observed in western immunoblot analyses using parasite extracts. Furthermore, immunization of mice with the PvMSP-9-Nt upon stimulation with PvMSP-9-Nt secreted IFN-gamma and IL-5. We have also used the two PvMSP-9 recombinant constructs to show that individuals exposed to P. vivax infections in an endemic area of Brazil had IgG antibodies reactive with the recombinant proteins.     

Discrimination of gays and lesbians: a social justice perspective

The existence of discrimination against America's gay and lesbian citizens is widely supported in the research literature of many disciplines. This article provides a specific analysis of this discrimination and demonstrates the stark contrast between the discrimination of gays and lesbians in American society and the social justice concepts of equality and fairness. The works of Rawls, and later the works of Nussbaum, provide the theoretical framework highlighting the factors related to this discrimination and inequality. In the concluding section, specific implications for future policy development are presented that are designed to ensure that gays and lesbians are not further discriminated against. Areas examined include civil unions, gay marriages, adoptions, hate crime legislation and cessation of the U.S. military's "Don't Ask, Don't Tell, Don't Pursue" policy, advocating for inclusion of open gays and lesbians in military positions and commandership.     

Bochdalek's hernia in adults

Bochdalek hernia is a congenital defect of the posterolateral region of the diaphragm, usually on the left side, and is most often seen in infants, rare in the adult. In a bibliographical review of the literature we found 100 cases reported of Bochdalek hernia in the adult. We present the case of a 52 year old man with Bochdalek hernia, he presented gastric symptoms of upper gastrointestinal bleeding. Upper gastrointestinal barium study showed the stomach inside the thoracic cavity, endoscopy showed ischemical changes in gastric mucosa The surgical repair was done through left thoracotomy without surgical complications, four years later the patient is asymptomatic.     

Varieties of health services utilization by underserved Mexican American women

Varieties of health services utilization by medically underserved patients were examined in 250 Mexican American women attending a primary care clinic in San Diego, California. Less than half (48.4 percent) of these medically underserved women had obtained clinical preventive services conforming to recommended guidelines, 34.4 percent reported having obtained an annual physical examination in the past year, and 66.0 percent reported visiting a doctor only when they were sick. Lack of any form of health insurance, including Medi-Cal, was associated with underutilization of primary care services to a greater degree than the other variables examined. However, other factors such as full-time employment, low education, dissatisfaction with primary care delivery, and cultural preference for traditional ethnomedical alternative forms of health care, constitute important barriers to utilization of primary care services. Efforts to provide health care to the medically underserved must take these barriers into consideration if they are to be successful.     

Suppression of alcohol delirium tremens by baclofen administration: a case report

Delirium tremens (DT) is a clinical condition that appears in some patients affected by severe alcohol withdrawal syndrome (AWS). DT represents a serious complication, being characterized by elevated morbidity and mortality. Benzodiazepines are presently the drug of choice; however their use is related to several side effects. Baclofen is a stereoselective gamma-aminobutyric acid (GABAB) receptor agonist. Recent studies show that baclofen is able to suppress alcohol withdrawal symptoms. At present there are no data on the effects of baclofen administration in AWS complicated by DT. Here, we report a case of DT successfully treated with baclofen. This result indicates that the efficacy of baclofen in the treatment of DT should be examined in future clinical trials.