Effects of a community-based data for decision-making intervention on maternal and newborn health care practices in Ethiopia: a dose-response study

Background

Community participation and community health volunteer programs are an essential part of the health system so that health services are responsive and accountable to community needs. Information systems are necessary for community health volunteer programs to be effective, yet effectiveness evaluations of such information systems implemented at scale are rare. In October 2010, a network of female volunteers with little or no literacy, the Women’s Development Army (WDA), was added to extend Ethiopia’s Health Extension Program services to every household in the community. Between July 2013 and January 2015, a health management information system for the WDA’s Community-Based Data for Decision-Making (CBDDM) strategy was implemented in 115 rural districts to improve the demand for and utilization of maternal and newborn health services. Using the CBDDM strategy, Health Extension Workers (HEWs) fostered the WDA and community leaders to inform, lead, own, plan, and monitor the maternal and newborn health interventions in their kebeles (communities). This paper examines the effectiveness of the CBDDM strategy.

Methods

Using data from cross-sectional surveys in 2010–11 and 2014–15 from 177 kebeles, we estimated self-reported maternal and newborn care practices from women with children aged 0 to 11 months (2124 at baseline and 2113 at follow-up), and a CBDDM implementation strength score in each kebele. Using kebele-level random-effects models, we assessed dose-response relationships between changes over time in implementation strength score and changes in maternal and newborn care practices between the two surveys.

Results

Kebeles with relatively high increases in CBDDM implementation strength score had larger improvements in the coverage of neonatal tetanus-protected childbirths, institutional deliveries, clean cord care for newborns, thermal care for newborns, and immediate initiation of breastfeeding. However, there was no evidence of any effect of the intervention on postnatal care within 2 days of childbirth.

Conclusions

This study shows the extent to which an information system for community health volunteers with low literacy was implemented at scale, and evidence of effectiveness at scale in improving maternal and newborn health care behaviors and practices.

     

IgE-reactivity to seven Malassezia species

BACKGROUND: Malassezia yeasts play a role in the pathogenesis of atopic eczema/dermatitis syndrome (AEDS). The revised genus Malassezia includes several species which all are natural habitants of the human skin. In this study, we evaluated the presence of immunoglobulin E (IgE) antibodies to different Malassezia spp. in AEDS patients to allow optimization of the characterization of the IgE antibody profile of IgE-associated AEDS. METHODS: Ninety-six adult patients, with a clinical diagnosis of AEDS, were included in the study. Seventeen of the patients had IgE antibodies to M. sympodialis, ATCC 42132 (m70 ImmunoCAP, Pharmacia, Diagnostic AB, Uppsala, Sweden). The IgE antibodies to seven Malassezia spp. were measured and inhibition immunoblotting was performed to investigate whether M. sympodialis contains all the allergen components present in the other Malassezia spp. RESULTS: Twenty per cent of 79 AEDS patients with a negative m70 ImmunoCAP test had IgE antibodies to at least one of the other six Malassezia spp. tested. Our inhibition studies indicated that Malassezia spp. to a great extent, share allergenic determinants. However, Malassezia species also contained species-specific allergens. CONCLUSION: The use of only one species of Malassezia is not sufficient to detect all patients IgE sensitized to Malassezia. To obtain an optimal allergen preparation both common allergenic components as well as species-specific allergens have to be considered.     

Identification of allergen components of the opportunistic yeast Pityrosporum orbiculare by monoclonal antibodies

The yeast Pityrosporum orbiculare (P. orbiculare) is a member of the normal human cutaneous flora, but it is also associated with several clinical manifestations of the skin. We have previously observed IgE-binding components in P. orbiculare extracts, using sera from patients with atopic dermatitis. In the present study, we raised several monoclonal antibodies (MoAbs) against P. orbiculare to characterize some of its antigens, and used Candida albicans (C. albicans) as a control. We obtained several IgGI MoAbs which specifically recognized P. orbiculare in ELISA. Two of these were selected for immunoblotting studies on P. orbiculare and two patterns of reactivity emerged. Firstly, one MoAb showed a distinct band at a molecular mass of 67 kDa. In the second pattern, a sharp band at about 37 kDa appeared. In contrast, the IgM antibodies raised reacted with a 14-kDa component; but they reacted with C. albicans in addition to P. orbiculare The IgGI antibodies seemed to react with proteins, as their ability to react in ELISA with extract pretreated with protease was greatly reduced. In contrast, IgM MoAbs were much less affected, suggesting that they recognized nonprotein components. To determine whether these MoAbs-binding components were also recognized by human IgE, we adopted a radioimmunoassay (RIA) using the MoAbs as catcher antibodies. Both the 67-kDa and the 37-kDa components were IgE-binding proteins. P. orbicular RAST positive sera were scored as positive in the RIA, whereas the control serum was not.     

Passive immunisation against Pseudomonas aeruginosa recombinant flagellin in an experimental model of burn wound sepsis

Background

This study was aimed to investigate whether anti-recombinant flagellin type A (anti r-fla-A) immunoglobulin G (IgG) provides protection in a mouse burn model of infection, and to determine the role of anti r-fla-A IgG as an opsonin and motility inhibitor in local and systemic infections.

Methods

Following the preparation of r-flagellin type A, rabbit polyclonal IgG was prepared. Specificity of anti r-flagellin for r-flagellin was evaluated by immunoblot analysis. After burn and challenge, mortality rate was screened in the mice treated with anti r-fla-A IgG. The ability of antiserum to promote phagocytosis of bacteria was assessed by the opsonophagocytosis testing. Functional activity of anti r-fla-A IgG was assessed in vitro by motility inhibition assay. Bacterial quantity in skin and internal organs was evaluated to study systemic infection.

Results

In vivo administration of anti r-fla-A IgG resulted in a significant improvement in survival in mice infected by a homologous strain of Pseudomonas aeruginosa from 16.6% to 75% compared with the control IgG. By contrast, this rate was 33.3% in the mice infected by the heterologous strain, PAO1 (type B flagellated strain). Protection was improved by giving a second treatment of r-flagellin antisera at 24-h post-burn and infection. Furthermore, anti r-fla-A IgG enhanced considerably the phagocytosis of the homologous strain but it was slight in the heterologous strain. The antiserum against r-flagellin type A was able to inhibit the motility of the PAK strain (type A flagellated strain), but slight inhibition was observed against PAO1. Meanwhile, anti r-fla-A IgG inhibited the systemic spread of PAK strain from the site of infection to internal organs.

Conclusion

In this study, passive immunisation with anti r-fla-A IgG was active against a homologous strain of infecting P. aeruginosa, but lost most of its efficiency against a heterologous strain. Therefore, passive treatment with anti r-fla-A IgG might protect burned mice against local and systemic infection of P. aeruginosa.     

Mesenchymal Stem Cells on Horizon: A New Arsenal of Therapeutic Agents

Over 10 years, mesenchymal stem cells (MSCs) have been considered as valuable and suitable cells for cell-based therapy applications, particularly in clinical trials. In any case, they are as yet not utilized routinely in clinics. At first, it was believed that MSCs play their roles, especially in regenerative medicine due to their differentiation and cell replacement properties. Interestingly, it is well-known that MSCs mainly exert their therapeutic effects through their vast bioactive factors. These findings turned scientists’ consideration toward cell-free therapy concepts. From this point of view, MSCs can be considered as an arsenal of natural bioreactors in variety of therapeutic agents. MSCs inherently express various important therapeutic agents such as growth factors and cytokines that can be manufactured, handled and stored as a prepared-to-go biologic product. In this review, we provide a vision, highlight as well as discuss in order to introduce competitive natural robust bioreactor MSCs on the horizon.     

Efficient IL-2R signaling differentially affects the stability,function, and composition of the regulatory T-cell pool

Signaling via interleukin-2 receptor (IL-2R) is a requisite for regulatory T (Treg) cell identity and function. However, it is not completely understood to what degree IL-2R signaling is required for Treg cell homeostasis, lineage stability and function in both resting and inflammatory conditions. Here, we characterized a spontaneous mutant mouse strain endowed with a hypomorphic Tyr129His variant of CD25, the α-chain of IL-2R, which resulted in diminished receptor expression and reduced IL-2R signaling. Under noninflammatory conditions, Cd25^Y129H mice harbored substantially lower numbers of peripheral Treg cells with stable Foxp3 expression that prevented the development of spontaneous autoimmune disease. In contrast, Cd25^Y129H Treg cells failed to efficiently induce immune suppression and lost lineage commitment in a T-cell transfer colitis model, indicating that unimpaired IL-2R signaling is critical for Treg cell function in inflammatory environments. Moreover, single-cell RNA sequencing of Treg cells revealed that impaired IL-2R signaling profoundly affected the balance of central and effector Treg cell subsets. Thus, partial loss of IL-2R signaling differentially interferes with the maintenance, heterogeneity, and suppressive function of the Treg cell pool.     

Protective effects of sinapic acid against cyclophosphamide-induced testicular toxicity via inhibiting oxidative stress,caspase-3 and NF-kB activity in BALB/c mice

Cyclophosphamide (CP), as a chemotherapeutic agent, with the generation of oxidative stress leads to testicular toxicity. Sinapic acid (SA), as a phenylpropanoid compound has therapeutic activities. This research was planned to evaluate the improving effects of SA versus testicular injury induced by CP. Forty-eight mice were distributed into six groups: untreated, SA (5 and 10 mg/kg), CP (200 mg/kg) and CP + SA (5 and 10 mg/kg). SA was administrated for 7 successive days and CP was administered intraperitoneally on the 3rd day of study. On the 10th day of research, testicular toxicity was evaluated by sperm parameters test, tissue (oxidative stress parameters) and serum (testosterone) biochemical, histopathological, and immunohistochemical (Caspase-3 and NF-kB) assays. The findings illustrated that CP induces atypical appearance in tissue structure, disorder of sperm parameters dysfunction, decrease of testosterone, oxidative stress (an increase of MDA and decrease of GSH), apoptosis and inflammation in testicular tissue. SA administration protected testis from oxidative stress and improves testosterone level and structure. Moreover, immunohistochemical findings also showed that SA can inhibit Caspase-3 and NF-kB activity. Data have confirmed that SA could protect testis structure and its functions against CP-induced injury through antioxidant, anti-inflammatory and anti-apoptotic activities.     

Acute idiopathic frosted branch angiitis.

This is a case of acute idiopathic frosted branch angiitis in a 4-year-old African American girl with history of sickle cell trait. She developed bilateral, subacute vision loss attributed to acute idiopathic frosted branch angiitis and was treated with systemic corticosteroids with a good recovery of vision. Acute idiopathic frosted branch angiitis is a rare disease, usually with a good prognosis. This is, to our knowledge, the 10th reported case in the United States.