Incentivized recruitment of a population sample to a mobile HIV testing service increases the yield of newly diagnosed cases, including those in need of antiretroviral therapy

Objective

The aim of the study was to compare the yields of newly diagnosed cases of HIV infection and advanced immunodeficiency between individuals attending a mobile HIV counselling and testing (HCT) service as participants in a population‐based HIV seroprevalence survey and those accessing the same service as volunteers for routine testing.

Methods

The study was conducted in a peri‐urban township within the Cape Metropolitan Region, South Africa. Survey participants (recruited testers) were randomly selected, visited at home and invited to attend the mobile HCT service. They received 70 South African Rand food vouchers for participating in the survey, but could choose to test anonymously. The yield of HIV diagnoses was compared with that detected in members of the community who voluntarily attended the same HIV testing facility prior to the survey and did not receive incentives (voluntary testers).

Results

A total of 1813 individuals were included in the analysis (936 recruited and 877 voluntary testers). The prevalence of newly diagnosed HIV infection was 10.9% [95% confidence interval (CI) 9.0–13.1%] among recruited testers and 5.0% (3.7–6.7%) among voluntary testers. The prevalence of severe immune deficiency (CD4 count ≤200 cells/μL) among recruited and voluntary testers was 17.8% (10.9–26.7%) and 4.6% (0.0–15.4%), respectively. Linkage to HIV care in recruited testers with CD4 counts ≤350 cells/μL was 78.8%.

Conclusion

Compared with routine voluntary HCT, selection and invitation in combination with incentives doubled the yield of newly diagnosed HIV infections and increased the yield almost fourfold of individuals needing antiretroviral therapy. This may be an important strategy to increase community‐based HIV diagnosis and access to care.     

A comparison of participants and non-participants in the Chennai Glaucoma Study-rural population

PURPOSE: To study whether the difference in the demographic characteristics of participants and non participants could result in biased prevalence estimates and associations. AIM: To compare the non-participant and participant characteristics, and to ascertain if non-response bias is present in the rural population of the Chennai Glaucoma Study (CGS). METHODS: Rural participants and non-participants were compared with regard to socio-demographic variables (age, gender, religion, mother tongue, literacy and employment). RESULTS: 4800 subjects aged 40 years or over were enumerated, 82% (3934: 45% male and 55% female) responded. Gender did not influence participation (adjusted OR-1.11, CI: .91-1.36). Subjects in the 70-79 year age group were more likely to respond (OR-1.76; CI-1.31-2.38). Hindus had a higher participation rate than Christians or Muslims (adjusted OR-2.63, CI: 1.80-3.84). The other predictors of participation were illiteracy (adjusted OR-1.44, CI: 1.22-1.70), unemployment (OR-1.28, CI: 1.04-1.58), place of residence (main villages) (OR-6.66, 95% CI: 4.6-9.64). CONCLUSION: Based on our study findings, it does not seem likely that participation bias will affect the study results.     

Biochemical evaluation of antitumor effect of muthu marunthu (a herbal formulation) on experimental fibrosarcoma in rats.

Natural products from plants are rich sources used for treating a number of diseases. Many of the pharmacological principles of the currently used anticancer agents have been initially isolated from plants. Most of the herbal drugs are a mixture of a number of plant ingredients. Their cumulative effect increases the efficacy of the drug in curing the diseases. Muthu Marunthu is a herbal formulation comprising of eight various plant ingredients, and has been claimed to possess antitumor effect. Therefore, attention has been focused on studying the various plant ingredients in the drug as a whole for its antitumor effects. It was observed that the growth rate in rats was normal and there was no change in blood parameters such as glucose, urea, proteins, cholesterol and also in the activities of pathophysiological enzymes such as lactate dehydrogenase (LDH), glutamate oxaloacetate transaminase (GOT), glutamate pyruvate transaminase (GPT), alkaline and acid phosphatase after Muthu Marunthu administration. The tumor weight was found to be reduced in methylcholanthrene induced fibrosarcoma rats after Muthu Marunthu treatment. Elevated levels of glycocomponents of glycoproteins such as hexose, hexosamine, sialic acid and fucose in plasma of fibrosarcoma rats decreased significantly after Muthu Marunthu treatment. The DNA and RNA levels of liver and kidney, which were increased in fibrosarcoma rats, returned to near normal levels after Muthu Marunthu treatment. The vitamins such as A, C and E in plasma were decreased in fibrosarcoma rats but increased significantly after Muthu Marunthu treatment. The altered levels of copper, zinc and selenium in plasma have also been corrected after Muthu Marunthu treatment. These observations clearly suggested the antitumor potency of Muthu Marunthu in experimentally induced fibrosarcoma in rats.     

Duplication of the urethra

Accessory urethra or duplication of the urethra is a rare anomaly. The vast majority occur in the sagittal plane; however, collateral or side-by-side duplications in the absence of bladder duplication also exist. We report six cases of urethral duplications. The mode of presentation and the importance of complete examination are discussed. Accepted: 13 July 1998     

Downregulation of Aurora-A overrides estrogen-mediated growth and chemoresistance in breast cancer cells

Estrogen is known to play a causative role in the development of sporadic breast cancers and chemoresistance. However, studies on the mechanism and proteins involved in mediating the oncogenic effects of estrogen are very limited. Recently, Aurora-A, a centrosomal protein kinase, which induces centrosome amplification and genomic instability, has been shown to be upregulated during long-term treatment of rats with estrogen and was implicated in estrogen-induced oncogenesis. Herein, we present results of the studies carried out in short-term in vitro cultures to understand the regulation of Aurora-A by estrogen and the effect of downregulation of Aurora-A on estrogen-induced breast tumorigenesis and chemoresistance. Treatment of breast cancer cells with 10 nM 17beta-estradiol (E(2)) resulted in the upregulation of Aurora-A levels in an estrogen receptor-dependent manner. However, the upregulation by E(2) was not restricted to Aurora-A alone. Following release from the tamoxifen-induced arrest, the appearance of Aurora-A in the presence of estradiol in MCF7 cells coincided with the appearance of other mitotic markers suggesting that the spike in Aurora-A levels is an indirect consequence of estrogen-mediated cell proliferation. Thus, at least in short-term in vitro studies, Aurora-A is not a specific direct target of estrogen. However, downregulation of Aurora-A by RNA interference led to a significant decrease in estrogen-induced, anchorage-dependent, and independent growth of MCF7 cells. Moreover, knockdown of Aurora-A could overcome estrogen-induced decrease in docetaxel sensitivity of MCF7 cells. Cumulatively, we propose that the upregulation of Aurora-A by estrogen in short-term in vitro cultures is an indirect consequence of estrogen-induced cell proliferation. Nevertheless, Aurora-A inhibitors could be exploited to override the effects of estrogen on breast tumorigenesis and chemoresistance.     

How High is the Non-Response Rate of Patients Referred for Eye Examination from Diabetic Screening Camps?

Aim: To elucidate the rate of non-response among diabetics (recently diagnosed in rural diabetic screening camps) who were referred for eye examination to detect diabetic retinopathy. Methods: At diabetic retinopathy screening camps, all patients underwent dilated fundus examination using binocular indirect ophthalmoscopy. Results: Of the 4,111 known diabetics, only 2231(55%) patients attended the diabetic retinopathy screening camps. Likewise, of the 1076 newly detected diabetics, only 125 (11.6%) attended the diabetic retinopathy screening camps. Conclusions: Non-response of such a magnitude calls for creating greater awareness among masses on diabetes and its microvascular complications. Second, conducting simultaneous diabetes screening and diabetic retinopathy screening camps could minimize the dropout rate.     

Z–2 aldose reductase allele and diabetic retinopathy in India

Genetic factors have been identified that regulate the severity and the rapidity of onset of retinopathy in diabetic patients. Polymorphisms in (CA) n present upstream of the promoter of the aldose reductase ( ALR2 ) gene have been shown to be associated with retinopathy in different ethnic populations. We aimed to study the association between the (CA) n polymorphism and type 2 diabetic patients with and without retinopathy in the Asian Indian population. We screened 105 diabetic patients with retinopathy (DR) and 109 diabetic patients without retinopathy (DNR) for the (CA) n polymorphism and compared the results with those of an unrelated healthy control group (CT). We identified 13 alleles in our diabetic population. The Z–2 allele (136bp) showed an association with the DR group (13.81%) with a significant p value (p = 0.029) when compared with the DNR group (7.34%). The Z–2 allele also showed a significant association with those DR patients who had proliferative retinopathy (PDR) and maculopathy (MAC) (p = 0.004). The Z–2 allele is, therefore, a high-risk allele for diabetic retinopathy in the Asian Indian patients.     

Acaricidal, pediculocidal and larvicidal activity of synthesized ZnO nanoparticles using wet chemical route against blood feeding parasites

The present study was based on assessments of the anti-parasitic activities to determine the efficacies of synthesized zinc oxide nanoparticles (ZnO NPs) prepared by wet chemical method using zinc nitrate and sodium hydroxide as precursors and soluble starch as stabilizing agent against the larvae of cattle tick Rhipicephalus (Boophilus) microplus, Canestrini (Acari: Ixodidae); head louse Pediculus humanus capitis, De Geer (Phthiraptera: Pediculidae); larvae of malaria vector, Anopheles subpictus, Grassi; and filariasis vector, Culex quinquefasciatus, Say (Diptera: Culicidae). R. microplus larvae were exposed to filter paper envelopes impregnated with different ZnO NP concentrations. Direct contact method was conducted to determine the potential of pediculocidal activity. Parasite larvae were exposed to varying concentrations of synthesized ZnO NPs for 24 h. The results suggested that the mortality effects of synthesized ZnO NPs were 43% at 1 h, 64% at 3 h, 78% at 6 h, and 100% after 12 h against R. microplus activity. In pediculocidal activity, the results showed that the optimal times for measuring mortality effects of synthesized ZnO NPs were 38% at 10 min, 71% at 30 min, 83% at 1 h, and 100% after 6 h against P. humanus capitis. One hundred percent lice mortality was observed at 10 mg/L treated for 6 h. The mortality was confirmed after 24 h of observation period. The larval mortality effects of synthesized ZnO NPs were 37%, 72%, 100% and 43%, 78% and 100% at 6, 12, and 24 h against A. subpictus and C. quinquefasciatus, respectively. It is apparent that the small size and corresponding large specific surface area of small nanometer-scale ZnO particles impose several effects that govern its parasitic action, which are size dependent. ZnO NPs were synthesized by wet chemical process, and it was characterized with the UV showing peak at 361 nm. X-ray diffraction (XRD) spectra clearly shows that the diffraction peaks in the pattern indexed as the zinc oxide with lattice constants a = 3.249 and c = 5.206 ?. The FTIR spectrum showed the range of 400–4,000 cm⁻¹. The band at 899.56 cm⁻¹; 1,151.87 cm⁻¹; 1,396 cm⁻¹; and these bands showed the complete composition of ZnO NPs. SEM micrograph showed 60–120-nm size and aggregates of spherical shape nanoparticles. EDX showed the complete chemical composition of the synthesized nanoparticles of zinc oxide. The maximum efficacy was observed in zinc oxide against the R. microplus, P. humanus capitis, and the larvae of A. subpictus, C. quinquefasciatus with LC₅₀ values of 29.14, 11.80, 11.14, and 12.39 mg/L; r ² = 0.805, 0.876, 0.894, and 0.904, respectively. The synthesized ZnO NPs showed the LC₅₀ and r ² values against the R. microplus (13.41 mg/L; 0.982), P. humanus capitis (11.80 mg/L; 0.966), and the larvae of A. subpictus (3.19; 0.945 mg/L), against C. quinquefasciatus (4.87 mg/L; 0.970), respectively. The control (distilled water) showed nil mortality in the concurrent assay. This is the first report on anti-parasitic activity of the synthesized ZnO NPs.