Changes in the geographical distribution of tuberculosis patients in Veracruz, Mexico, after reinforcement of a tuberculosis control programme

OBJECTIVE: Geographical information systems are valuable tools for studying tuberculosis (TB) epidemiology, but have been underused for the evaluation of TB control programs. We aimed to compare the geographical distribution of TB before and after the five elements of directly observed therapy, short course (DOTS) were strengthened in a Health Jurisdiction in Mexico in response to recommendations made by the WHO Global Tuberculosis Program. METHODS: All consenting persons detected by passive case finding between March 1995 and February 2000 who were confirmed to have acid-fast bacilli (AFB) in sputum underwent clinical and laboratory evaluation. A TB 'episode' was defined as the period of time between bacteriological diagnosis and treatment discharge by the local control programme. Distances of TB episodes from the nearest urban centre were determined according to recent transmission and multidrug resistance (MDR). RESULTS: During the first half of the study period, MDR episodes were located a median distance of 1.24 km from urban centres, which did not differ significantly from non-MDR episodes (1.14 km, P=0.56). In contrast, the median distance of MDR episodes increased 55% to 1.92 km during the second half, which placed them significantly further away out than non-MDR episodes (1.08 km, P=0.01). No changes in location were detected for recent transmission. CONCLUSION: While reinforcing the TB control programme reduced the incidence of MDR, the remaining episodes were located in poorer and more remote areas.     

Impacts of the 10 Steps to Healthy Feeding in Infants: a randomized field trial

This study assesses the impact of an intervention known as the Ten Steps to Healthy Feeding: A Nutritional Guide for Children under Two on nutritional conditions and infant health in low-income families. Two hundred newborns were randomized to the intervention group and three hundred to the control group. Parents of the intervention group received nutritional orientation during the child's first year of life. Both groups received visits at 6 and 12 months and routine follow-up by their pediatricians. The results (n = 397) showed that the intervention was associated with a higher proportion of exclusive breastfeeding at 4 months (RR = 1.58; 95%CI: 1.21-2.06) and 6 months (RR = 2.34; 95%CI: 1.37-3.99) and breastfeeding at 12 months (RR = 1.26; 95%CI: 1.02-1.55) and a lower proportion of children with diarrhea (RR = 0.68; 95%CI: 0.51-0.90), respiratory problems (RR = 0.63; 95%CI: 0.46-0.85), use of medication (RR = 0.56; 95%CI: 0.34-0.91), and dental caries (RR = 0.56; 95%CI: 0.32-0.96) in the 12-16 month bracket. The intervention had no effect on the occurrence of anemia, hospitalization, or nutritional status. The results suggest that the nutritional orientation program led to positive changes in infant feeding practices and health conditions, but that it was insufficient to prevent iron deficiency anemia.     

West Nile Virus isolation in human and mosquitoes, Mexico

West Nile virus has been isolated for the first time in Mexico, from a sick person and from mosquitoes (Culex quinquefasciatus). Partial sequencing and analysis of the 2 isolates indicate that they are genetically similar to other recent isolates from northern Mexico and the western United States.     

Effect of D-003, a mixture of very-long-chain aliphatic acids purified from sugarcane wax, on cerebral ischemia in Mongolian gerbils

D-003 is a mixture of very-high-molecular-weight aliphatic acids purified from sugar cane wax (Saccharum officinarum), which inhibits platelet aggregation and lipid peroxidation. The objective of the present study was to evaluate the effect of D-003 on cerebral ischemia induced by ischemia-reperfusion (I-R) in Mongolian gerbils. Two experimental series were conducted. The first series investigated the effects of D-003 on cerebral edema, neurological symptoms, and mortality in Mongolian gerbils with cerebral ischemia induced by I-R, while the second series investigated the effects on histological markers of cerebral injury, such as edema intensity (vacuolization) and cerebral necrosis. Animals were randomly distributed in five experimental groups: a sham-operated group experiencing surgical handling except the clamping and orally treated with Tween/water vehicle and four groups subjected to the I-R surgical procedure. One of these groups was treated with the same vehicle, and the other three groups received D-003 at 25, 100, and 200 mg/kg, respectively. All treatments were administered for 14 days. D-003 (200 mg/kg) significantly reduced the cerebral edema and clinical symptoms provoked by I-R compared with the positive control group, whereas lower doses (25 and 100 mg/kg) were not effective. Positive control animals showed an injury profile characterized by swelling (tissue vacuolization) and necrosis of neurons in all areas of the brain studied (frontal cortex, hippocampus, and striatum). The results of the histological study were consistent with those observed by determining cerebral edema and symptoms observation. Thus, D-003 at 200 mg/kg significantly reduced histological markers of brain injury (swelling and necrosis) compared with the control group. It is concluded that D-003 administered orally at 200 mg/kg for 14 days protected against cerebral damage caused by bilateral cerebral ischemia in Mongolian gerbils.     

Maximizing participation of Hispanic community-based/non-governmental organizations (NGOs) in emergency preparedness

To better understand social and structural changes needed to maximize community-based participation in emergency preparedness, 27 organizations, representing 12 states, participated in a study of the National Alliance for Hispanic Health. The study assessed social change needs (social will, community readiness, assets, and barriers) and structural needs (organizational capacity to integrate services into emergency management efforts locally). Results show high social will but little community readiness. Most non-governmental organizations (NGOs; 96%) were willing, but ill-prepared (65%) to face large-scale emergencies. Assets include bilingual/bicultural personnel, cultural competency, local knowledge, and public trust. Barriers include lack of culturally appropriate training and resources. Structurally, most NGOs want to link with voluntary organizations (79%) and public health departments (74%), but lack integration and coordination. Maximizing timely participation of these underutilized stakeholders in emergency planning can ensure culturally-proficient, community-tailored emergency plans, increased public confidence, and timely compliance with evacuation orders, thus helping to save lives.     

Bioequivalence of two recombinant granulocyte colony-stimulating factor formulations in healthy male volunteers

To evaluate the equivalence of the pharmacokinetic, pharmacodynamic and safety properties of two recombinant G-CSF formulations in healthy male volunteers, a standard 2-way randomized crossover double-blind study, with a 3 week washout period, was conducted. A single 300 microg G-CSF dose was administered subcutaneously. Hebervital (Heber Biotec, Havana, formulation A) and Neupogen (Hoffmann-La Roche S.A, formulation B) were compared. Twenty-four healthy male volunteers were included. The serum G-CSF level was measured by enzyme immunoassay (EIA) during the first 36 h after administration. Absolute neutrophils (ANC), white blood cells (WBC) and CD34+ cells counts were the pharmacodynamic variables measured up to 120 h. Other clinical and laboratory determinations were used as safety criteria. The pharmacokinetic parameters for formulation A and B were very close to each other (i.e. AUC, 235.9 vs 270.0 ng.h/ml; C(max), 29.2 vs 33.4 ng/ml; T(max), 4.2 vs 4.7 h; half-life, 3.2 vs 2.8 h; CL, 260.9 vs 277.2 ml/h; V(d), 1.2 vs 1.1 l; and MRT, 7.58 vs 7.38 h). The confidence intervals for the means ratio of all these parameters were within or very close to the 0.8-1.25 acceptance range. The pharmacodynamics showed high similarity since ANC and WBC had the same profiles for both products and no differences were detected for the estimated parameters. The CD34+ cells count increments were evident for both formulations in a similar way as well. The treatments were well tolerated. Registered adverse events were similar; back/spine pain was the most frequent. According to the overall results these formulations could be considered as clinically comparable.     

Metabolic pathways of 4-bromo-2,5-dimethoxyphenethylamine (2C-B): analysis of phase I metabolism with hepatocytes of six species including human

4-Bromo-2,5-dimethoxyphenethylamine (2C-B) is a psychoactive designer drug of abuse that is sold under the street names "Venus", "Bromo", "Erox", "XTC" or "Nexus". Concern has been raised because only little is known about its toxicity and metabolism in humans. In the present study we incubated 2C-B with human, monkey, dog, rabbit, rat and mouse hepatocytes to identify the metabolites formed and to determine possible toxic effects as evidenced by an ATP assay. Our data allow construction of the main metabolic pathways of 2C-B. Oxidative deamination results in the 2-(4-bromo-2,5-dimethoxyphenyl)-ethanol (BDMPE) and 4-bromo-2,5-dimethoxyphenylacetic acid (BDMPAA) metabolites. Additionally, 4-bromo-2,5-dimethoxybenzoic acid (BDMBA) can be produced also by oxidative deamination. Further metabolism of BDMPE and BDMPAA may occur by demethylation. Alternatively, the later metabolites can be generated by demethylation of 2C-B followed by oxidative deamination. Two remarkable interspecies differences in metabolism of 2C-B were observed (i) a hitherto unknown metabolite, 4-bromo-2,5-dimethoxy-phenol (BDMP), was identified after incubation only with mouse hepatocytes; (ii) 2-(4-bromo-2-hydroxy-5-methoxyphenyl)-ethanol (B-2-HMPE) was produced by hepatocytes from human, monkey and rabbit but not by dog, rat and mouse. Comparing the toxic effects of 2C-B between hepatocytes of the six examined species we observed only minor interspecies differences. However, large inter-individual differences in susceptibility of hepatocytes from three human donors were observed.     

Pentalogy of Cantrell: A Case Report with Pathologic Findings

We present the case of a 28-h-old female infant born at 37 weeks of gestation with a rare congenital malformation consisting of a pentad of findings: ectopia cordis, a midline supraumbilical wall defect, a defect of the lower sternum, absent pericardium, and an anterior diaphragmatic defect. This constellation of defects is known as the pentalogy of Cantrell. Additional autopsy findings included a bilateral cleft lip and palate, bilateral pulmonary hypoplasia, an atrial septal defect, and a patent ductus arteriosus. We present this case because of its rarity and discuss the pathologic findings. published online December 6, 2004.