Knowledge and management of diarrhea among underserved minority parents/caregivers.

OBJECTIVE: Dehydration resulting from diarrhea continues to be a cause of morbidity, mortality, and increased health care costs in the United States. This study assesses parental knowledge of the causes and signs of diarrhea and dehydration. It also examines parental-care practices during an episode of diarrhea. METHODS: A survey was given to 219 parents/caregivers of children less than 5 years of age who presented to a pediatric continuity clinic. A bilingual interviewer was used to administer the surveys to participants for assessing knowledge of causes, signs, and treatment of diarrhea; signs of dehydration; and care practices during an episode of diarrhea. RESULTS: A wide variation in the level of awareness of signs, causes, and treatment of diarrhea was detected. General knowledge of diarrhea was related positively to accessibility of health information, level of education, ethnicity, and experience with dehydration. General knowledge of diarrhea, adjusted for level of education, was higher in African Americans than in Hispanics. CONCLUSIONS: In children, dehydration from diarrhea may be prevented by increasing parents'/caregivers' general knowledge of diarrhea and dehydration and the appropriate usage of oral rehydration solutions. Intervention programs designed to increase parents'/caregivers' knowledge must be culturally sensitive and appropriate for diverse educational backgrounds and must assist in improving access to health-related information.     

Social and Economic Burden of Human Leishmaniasis

Leishmaniasis continues to pose a major public health problem worldwide. With new epidemics occurring in endemic areas and the spread of the disease to previously free areas because of migration, tourism, and military activities, there is a great need for the development of an effective vaccine. Leishmaniasis is a disease of the poor, occurring mostly in remote rural villages with poor housing and little or no access to modern health-care facilities. In endemic areas, diagnosis of any form of leishmaniasis puts a huge financial strain on an already meagre financial resource at both the individual and community levels. Most often families need to sell their assets (land and livestock) or take loans from informal financial outfits with heavy interest rates to pay for the diagnosis and treatment of leishmaniasis. Here, we discuss the disease with special emphasis on its socioeconomic impact on the affected individual and community. In addition, we highlight the reasons why continued research aimed at developing an effective Leishmania vaccine is necessary.     

Qualitative differences in the early immune response to live and killed Leishmania major: Implications for vaccination strategies against Leishmaniasis

Recovery from natural or deliberate infection with Leishmania major leads to the development of lifelong immunity against rechallenge infections. In contrast, vaccination with killed parasites or defined leishmanial antigens generally induces only short-term protection. The reasons for this difference are currently not known but may be related to differences in the quality of the early immune responses to live and killed parasites. Here, we report that live and killed L. major parasites elicit comparable early inflammatory response as evidenced by influx and/or proliferation of cells in the draining lymph nodes (dLNs). In contrast, the early cytokine responses were qualitatively different. Cells from mice inoculated with killed parasites produced significantly more antigen-specific IL-4 and less IFN-γ than those from mice injected with live parasites. Inclusion of CpG ODN into killed parasite preparations changed the early response to killed parasites from IL-4 to a predominantly IFN-γ response, resulting in better protection following secondary high dose virulent L. major challenge. Interestingly, CpG-mediated enhancement of killed parasites-induced protection was short-lived and waned after 12 weeks. Taken together, these results suggest that the nature of primary immunity induced by killed and live parasites are qualitatively different and that these differences may account for the differential protection seen in mice following vaccination with live and killed parasites. They further suggest that modulating the early response with an appropriate adjuvant could enhance efficacy of killed parasite vaccines.     

An unusual presentation of Castleman's Disease:a case report

Background

Castleman's disease (CD), a rare condition of uncertain etiology, involves a massive proliferation of lymphoid tissues and typically presents as mediastinal masses. We describe a patient with CD who presented with diffuse adenopathy involving the inguinal, paratracheal, retroperitoneal, axillary, and pelvic regions.

Case presentation

Case report describing presentation, work-up, management and clinical course of a patient with Castleman's disease in the setting of a county hospital in metropolitan area. Patient was treated with chemotherapeutic agents.

Conclusions

To our knowledge, this represents the first case of CD involving an HIV-positive patient with a negative Human Herpes Virus (HHV-8) viral panel. Because patients with similar clinical histories are at high risk for the development of non-Hodgkin's lymphoma and Kaposi sarcoma, regular medical surveillance is recommended.     

Plasma vitamin A and C status of in-school adolescents and associated factors in Enugu State,Nigeria

The study was undertaken to determine the intake of vitamin A and C and plasma concentrations of these vitamins among in-school adolescents. The factors affecting the vitamin status of these adolescents were also determined. Data for this report were obtained from a cross-sectional survey of 600 in-school adolescents in Nsukka local government area (LGA) of Enugu State, Nigeria. Ninety and 45 of the adolescents were randomly selected for determining plasma concentrations of vitamin A and C and intake of these vitamins respectively. Dietary assessment was done using a three-day weighed food intake method. Venous blood samples were collected and used for determining plasma vitamin A using the trifluoroacetic acid (TFA) method, while plasma vitamin C was determined by the thiourea method. Values obtained were matched against standards. The intake of vitamin A by all the adolescents was adequate (126-137% of recommended intake), while the intake of vitamin C was inadequate (51-91% of recommended intake). The mean intake of vitamin C was higher among males (23.7 +/- 0.71-27.3 +/- 8.0) than among females (15.3 +/- 2.8-19.5 +/- 5.1). Despite the adequate intake of vitamin A, 40% of the male and 32% of the female adolescents had low plasma concentrations of the vitamin (< 20 microg/dL). On the other hand, concentrations of plasma vitamin C were low among about 47% of these adolescents. Using multiple regression analysis, the two most important variables influencing vitamin A status were household size (b = -0.629; p < 0.0 1) and nutrition knowledge (b = -1.372; p < 0.01), while for vitamin C status, these were household size (b = -0.110; p = 0.05) and age (b = 0.226; p < 0.05). The daytime students had a significantly (p < 0.05) better vitamin A and C status than the boarders. The prevalence of vitamin A and C deficiencies among the adolescents may be more than estimated due to inadequate intake and/or poor bioavailability. This may pose a serious health risk for adolescents. There is, therefore, a need for adequate nutrition education and awareness about healthy lifestyles among Nigerian adolescents.     

An overview of management of pterygium in Nigeria

To review the management of pterygiumin Nigeria. ·METHODS: The medical records of patients who had pterygium excisions over a four year period (January 1999-December 2002) were reviewed. These patients were seen at University of Nigeria Teaching Hospital and Ebrans Clinic both in Enugu, Nigeria. The analysis of patients' bio-data, clinical presentation, surgical management and post-operative complications were carried out using EPI-INFO version 6.1. Three surgical techniques were employed: bare sclera procedure only (60 eyes); bare sclera with adjuvant 5-fluorouracil (42 eyes) and bare sclera with mitomycin-C, MMC, (22 eyes). · RESULTS: One hundred and twenty-four eyes of 72 patients had pterygium excisions and were followed up for a least one year post-operatively. There were 41 males (56.9%) and 31 females (43.1%) giving a male to female ratio of 1:0.8. The mean age was 42.8 years while the range was 20-69 years. Recurrence was highest in stage III (55.6%) and lowest in stage I (22.2%). Concerning the 3 surgical techniques, the recurrence rates were 65.0%, 52% and 13.6%respectively. ·CONCLUSION: In the management of pterygiumin a developing country, early excision with use of intraoperative MMC is advocated. It is safe, affordable, technically easier and less invasive.     

Delivery of oligodeoxynucleotides into human saphenous veins and the adjunct effect of ultrasound and microbubbles

Therapy with naked oligodeoxynucleotides (ODNs, molecular weight: 3000 to 7500) provides an elegant means of modulating gene expression without the problems associated with conventional gene therapy, but the relatively low transfer efficiency on intravascular administration is a limitation to clinical application. Ultrasound, which can be potentiated by microbubbles, shows promise as a method of delivering macromolecules such as plasmid DNA and other transgenes into cells. Since uptake of molecules into cells depends on their molecular weight, it might be expected that the delivery of ODNs, which are relatively small, will be facilitated by ultrasound and microbubbles. In the present study, we delivered ODNs into veins using ultrasound and microbubbles. First, we quantified the uptake of fluorescent-labeled ODNs into intact ex vivo human saphenous veins and isolated smooth muscle cells from the veins, evaluating the effect of ultrasound and microbubbles on uptake. Ultrasound potentiated the delivery of ODN in cells, except at high concentrations. When intact veins were studied, we achieved nuclear localization of fluorescent-labeled ODNs in cells. This increased with increasing concentration and incubation time and was not potentiated by ultrasound, even when microbubbles were used. We then applied a therapeutic ODN (antisense to intercellular adhesion molecule 1, ICAM-1) to vein samples and documented a functional inhibition of gene expression in a sequence-specific manner at the protein level with immunohistochemistry and western blot analysis. Again, no significant difference was seen with adjunct ultrasound. These observations suggest high diffusion of ODNs into human saphenous veins in this ex vivo model, indicating potential applications to inhibition of vascular bypass graft occlusion and other vasculopathies. Although microbubble-ultrasound was of value with cells in culture, it was not beneficial with intact veins.     

Serum intestinal fatty-acid binding protein: predictor of bowel necrosis in pediatric intussusception

Background/purpose

Serum Intestinal Fatty-Acid Binding Protein (I-FABP) is a useful marker of bowel necrosis in pediatric intussusception. The aim of this study is to determine the sensitivity of this marker and correlate it with length of necrosed small bowel.

Managing job stress among teachers of children with autism spectrum disorders: A randomized controlled trial of cognitive behavioral therapy with yoga

Background:Job-related stress undermines occupational, personal, and organizational outcomes. Stress symptoms are common among teachers of children with autism spectrum disorders and affect the academic progress of the children. This study investigated the effectiveness of yoga-based cognitive behavioral therapy in reducing occupational stress among teachers of children with autism in Lagos states, Nigeria.Methods:The current study adopted a group-randomized waitlist control (WLC) trial design with pre-test, posttest, and follow-up assessments. Participants included 58 teachers of children with autism in public and private special schools in Lagos state. Participants were randomly assigned to combined cognitive behavioral therapy and yoga (Y-CBT) (N = 29) and WLC (N = 29) groups. The Y-CBT group participated in a 2 hours Y-CBT program weekly for 12 weeks. Three instruments – Demographic Questionnaire, Single-Item Stress Questionnaire, and Teachers’ Stress Inventory (TSI) were used to collect data. Data were collected at baseline; posttest and follow-up evaluations. Data were analyzed using means, standard deviations, t test statistics, repeated measures analysis of variance, and bar charts.Results:Results revealed that all dimensions of job stress (perception of stress sources, stress manifestation, and total TSI scores) reduced significantly at posttest and follow up assessments among the Y-CBT group, compared to the WLC.Conclusion:It was concluded that Y-CBT modalities could help to minimize the perception of stress sources and stress manifestation as well as total TSI scores among teachers of children with autism spectrum disorders.