Oral cholera vaccination strategy: Self-administration of the second dose in urban Dhaka,Bangladesh

Cholera remains a major public health problem in many developing countries including Bangladesh. The oral cholera vaccine (OCV) is now considered a key component of the public health response to cholera. Although maintaining cold chain and organizing human resource are the major challenges of vaccine delivery to the community. Here we applied an innovative approach to second dose OCV delivery to minimize financial and logistic burdens. The purpose of this study was to assess the feasibility and compliance of second dose self-administration when the second dose was provided in a plastic bag to first dose vaccine recipients as OCV is stable for up to 42?days at ambient temperatures. We aimed to deploy vaccines (N?=?112,000) left over from other studies to 56,000 people aged?≥?one year living in Mirpur, Dhaka to see the feasibility of self-administration strategy. During vaccination, the first OCV dose (OCV1) was given from fixed sites and the second dose (OCV2) was provided in a plastic zip-lock bag for the participant to take the vaccine two weeks later at home. Participants were instructed to keep the vaccine away from light and in a dry cool place. Empty vials were collected following the end date of the scheduled second vaccination. Of the targeted population, 41,694 (74%) received the first OCV dose whereas an estimated 38,852 (93% of those receiving the first dose) received the second dose which represents a 7% drop out rate from OCV1 to OCV2. However the average two dose coverage was 69%. A survey of a subsample 2990 (from 8551) randomly selected households revealed that almost all respondents (98.75%) appreciated this new self-administration strategy and considered the strategy to be more practical and convenient than the usual method. This simplified, self-administered delivery strategy provides an ideal alternative for second-dose OCV delivery in hard-to-reach populations and resource-poor settings.     

Production of a highly potent epoxide through the microbial metabolism of 3β-acetoxyurs-11-en-13β,28-olide by Aspergillus niger culture

Context 3β-Acetoxyurs-11-en-13β,28-olide (I), a triterpenoid, is found in most plant species. Pharmacologically triterpenes are very effective compounds with potent anticancer, anti-HIV and antimicrobial activities.

Objectives Microbial transformation of 3β-acetoxyurs-11-en-13β,28-olide (I) was performed in order to obtain derivatives with improved pharmacological potential.

Materials and methods Compound (I, 100?mg) was incubated with Aspergillus niger culture for 12 d. The metabolite formed was purified through column chromatography. Structure elucidation was performed through extensive spectroscopy (IR, MS and NMR). In vitro α- and β-glucosidase inhibitory, and antiglycation potentials of both substrate and metabolite were evaluated.

Results Structure of metabolite II was characterized as 3β-acetoxyurs-11,12-epoxy-13β,28-olide (II). Metabolite II was found to be an oxidized product of compound I. In vitro α- and β-glucosidases revealed that metabolite II was a potent and selective inhibitor of α-glucosidase (IC₅₀ value?=?3.56?±?0.38?μM), showing that the inhibitory effect of metabolite II was far better than compound I (IC₅₀ value?=?14.7?±?1.3?μM) as well as acarbose (IC₅₀ value?=?545?±?7.9?μM). Antiglycation potential of compound II was also high with 82.51?±?1.2% inhibition. Thus, through oxidation, the biological potential of the substrate molecule can be enhanced.

Conclusion Biotransformation can be used as a potential tool for the production of biologically potent molecules.     

Acute Renal Infarction: An Unusual Cause of Abdominal Pain

Acute renal infarction is an uncommon and under-diagnosed disease. Its clinical presentation is nonspecific and often mimics other more common disease entities. The diagnosis is usually missed or delayed, which frequently results in irreversible renal parenchyma damage. High index of suspicion is required for early diagnosis, as timely intervention may prevent loss of kidney function. We report a case of acute renal infarction following coronary angiography in a patient with paroxysmal atrial fibrillation who initially presented with acute abdominal pain mimicking appendicitis.     

Vulvar ulcer as a presentation of systemic Langerhans cell histiocytosis

We report a 38-year-old housewife with systemic Langerhans cell histiocytosis (LCH) presenting as a chronic vulvar and peri-anal ulcer. She had systemic involvement in the form of diabetes insipidus and bone "hot-spots". She responded favorably to etoposide, 6-mercaptopurine, and systemic steroids, and has been in remission since 10 years. Chronic vulvar ulcers not responding to routine therapy should not be neglected and need to be biopsied repeatedly to come to a specific diagnosis. The vulvar ulcer in our case provided a vital clue to a systemic LCH, with a successful outcome.     

Endogenous animal models of intracranial aneurysm development: a review

Neurosurgical Review - The pathogenesis and natural history of intracranial aneurysm (IA) remains poorly understood. To this end, animal models with induced cerebral vessel lesions mimicking human...     

Monitoring of Acute Allograft Rejection by Cytological, Immunocytochemical, and Immunohistochemical Studies Following Rat Small-Bowel Transplantation

u ) to Lewis recipients and syngeneic transplantation using Lewis (RTl^l) rats were carried out. Twenty centimeters of the proximal jejunum was transplanted as a Thiry-Vella loop. The luminal fluid on days 0, 3, and 6 was examined cytologically using Papanicolaou, periodic acid-Schiff, and Giemsa staining, and immunocytochemically with monoclonal antibodies for macrophages (ED1 and ED2). Full thickness biopsies of graft tissue were evaluated by both immunofluorescence (ED1 and ED2) and by standard histological methods. The cytological examination on day 6 revealed an increase in the number of enterocytes, lymphocytes, and neutrophils, the presence of bacteria, and the depletion of goblet cells in the allografts. Histologically, significant morphological changes of acute rejection were first seen on day 6. Immunofluorescence predicted the acute rejection of the allografts earlier than a histological examination by showing an increase in the number of ED1- and Ed2-positive cells on day 3. Graft luminal fluid cytology and immunofluorescence analysis of ED1 and ED2 cells could thus be used to recognize early acute allograft rejection following small-bowel transplantation. (Received for publication on Sept. 18, 1997; accepted on Nov. 6, 1997)     

Job stress among Muslim immigrants in North America: Moderating effects of religiosity

This study examined the relationship of job stress with psychosomatic health problems, happiness in life, job satisfaction, job motivation, organizational commitment and turnover motivation in a sample of Muslims living in Canada and the USA. Data were collected by means of a structured questionnaire (N = 325). Results generally supported the prediction that job stress will be positively related to psychosomatic health problems and turnover motivation, and negatively related to happiness in life, job satisfaction, job motivation and organizational commitment. Degree of religiosity was proposed as a moderator of job stress-outcome relationships. Results from moderated multiple regression indicated that for this sample of Muslims religiosity was an important moderator of the stress-outcome relationships. Implications of the findings for stress management and for future research in the racioethnic area are highlighted.