Levels of metals in hair of young children as an indicator of environmental pollution

In 1982 the levels of lead (Pb), cadmium (Cd), vanadium (V), copper (Cu), and selenium (Se) were determined in hair of 231 four- to five-year-old children. The objective was to explore the feasibility of using metal-in-hair levels in groups of children as an indicator of environmental pollution. The study was carried out in four areas, which were assumed to differ in ambient pollution by metals. A questionnaire on personal data, socioeconomic status, intake of beverages, and life-style was completed by the parents. The metal-in-hair levels covered a large range. The variables pertaining to location together with sex, presence of a garden, and drinking of coffee and/or tea explained 32% of the variance of Pb, 24% of the variance of Cd, and 21% of the variance of V. The total variance explained by all measured questionnaire items was at best 38%. The location was the most important factor. Cu and Se levels did not differ between the locations.     

Occupational exposure to lead and blood pressure: a study in 105 workers

A group of workers, occupationally exposed to lead and cadmium compounds (n = 53), was compared to a group of workers not exposed to these metals (n = 52). The average values of systolic, diastolic, and mean blood pressure were found to be higher in the exposed group (p less than 0.05). In contrast with the correlation between CdU and blood pressure, the correlation between PbB and systolic and mean blood pressure remained statistically significant after controlling for age and pulse rate (r = 0.22, p less than 0.05). The prevalence of potential hypertension (defined as systolic blood pressure greater than or equal to 160 mm Hg and/or diastolic blood pressure greater than or equal to 95 mm Hg and/or under treatment for hypertension) was higher in the exposed group, but the observed relative risk was not statistically significant: relative risk = 1.91 (95% confidence limits, 0.90-4.05). Furthermore, a significant correlation between PbB and Hgb (r = -0.28, p = 0.004) was observed. Differences in kidney function, as assessed in this study, were not detected.     

Malignant large cell calcifying Sertoli cell tumor of the testis

A 45-year old man presented with a slow-growing, unilateral beige testicular mass, with a diameter of 4 cm. The testosterone, FSH, LH, estradiol and betahCG serum levels were within normal limits, and there were no associated hormonal syndromes. The patient was treated with inguinal orchidectomy. Microscopically, the tumor was composed of nests of cells with large eosinophilic, slightly granular cytoplasm. There was only a mild degree of atypia and no mitotic activity. The tumor extended into the rete testis. There were intratumoral calcifications, and in the vicinity of the tumor, there was intratubular growth. Although this case is histologically similar to the three previously reported cases of clinically benign large cell calcifying Sertoli cell tumor of the testis with rete testis involvement, the current patient developed right sided para-aortic lymph node metastases 18 months after the initial diagnosis.     

A pilot study of cadre training to promote responsible self-medication in Indonesia: Which is better specific or general modules?

In 2015, the Indonesian Government initiated ‘Smart Use of Medications Movement’ (‘GeMa CerMat’) which included cadre training to promote responsible self-medication. Evaluation of a pilot training conducted across Indonesia suggested the need to improve those training modules. This study aimed to assess cadre’ knowledge gained following training with newly developed general or specific training modules. Five types of modules were developed and used to train cadres at five Community Health Centres (CHCs) in Surabaya, Indonesia: 1) Sidosermo CHC (general-drugs module), 2) Tenggilis CHC (common cold drugs module), 3) Gunung Anyar CHC (analgesic drugs module), 4) Kalirungkut CHC (anti-diarrhoeal drugs module), and 5) Jagir CHC (indigestion drugs module). Cadres’ knowledge improvements were evaluated using pre-/post-test scores and the difference scores depending on the module being tested. Multifactorial ANOVA explored the effects of the type of module on difference scores. A total of 279 cadres across five CHCs were involved in the training, giving response rates from 65% to 93%. There was an increase in the post-test scores after the training with all modules. However, significant differences were reported only for the specific-drugs module groups (all p < .001). Furthermore, the general module group had the lowest difference score (1.12; 95% CI [−0.45, 2.92]) while the common cold module group had the highest gain (5.02; 95% CI [1.95, 5.17]). Multifactorial ANOVA revealed that there was a significant main effect of the type of modules on difference scores [F (4, 263) = 8.37, p <.001]. In conclusion, this preliminary study indicated that the development of modules for specific minor illnesses could be beneficial in facilitating effective community-based training to promote responsible self-medication in Indonesia. The priority for therapeutic areas chosen for the module should be based on the local needs. Further research is required to confirm the findings in broader community members.     

Ageing in the South-East Asian region

The increasing trend in the aging population of countries in the South-East Asia Region (SEAR) transforms these countries from "mature societies" to "aging societies.? The elderly population in this region would be increasing from 18.1% in 1995 to 21.4% of the world elderly population in 2025. Since women have a longer life expectancy than men, the proportion of elderly women in the region would increase to 13.2% by 2025, while the proportion of elderly men would be 11.6%. In SEAR, 11.8 million people reportedly suffered from blindness in 1998; 50-80% of these cases are caused by cataract, which is most common in those aged 60 years and above. Although the aged is one of the most vulnerable population groups, little attention is given to geriatric care. Health services in many countries still focus largely on communicable diseases, maternal care, and child care, rather than on the enormous needs of the elderly population. Care of the elderly should be a priority of the primary health care system, focusing on the promotion of a healthy old-age lifestyle and prevention of behaviors that are hazardous to health.     

Lower rate of preeclampsia after antioxidant supplementation in pregnant women with low antioxidant status.

OBJECTIVE: To investigate maternal and neonatal outcomes after antioxidant supplementation relatively early in pregnancy (8 to 12 weeks) for pregnant women with low antioxidant status. METHODS: A randomized, double-blind, placebo-controlled trial of daily antioxidant supplementation was performed on pregnant women screening positive for low antioxidant status at 8 to 12 weeks of gestation. Low antioxidant status was defined as a superoxidedismutase (SOD) level below 1102 U/g Hb or 164 U/mL. The supplementation group received the following antioxidants daily: vitamins A (1000 IU), B6 (2.2 mg), B12 (2.2 microg), C (200 mg), and E (400 IU), folic acid (400 microg), N-acetylcysteine (200 mg), Cu (2 mg), Zn (15 mg), Mn (0.5 mg), Fe (30 mg), calcium (800 mg), and selenium (100 microg). The control group received Fe (30 mg) and folic acid (400 microg). Maternal (preeclampsia, abortion, and hypertension) and perinatal outcomes were assessed. RESULTS: In the supplementation group (29 subjects), we observed 2 cases of preeclampsia (6.8%, 1 mild and 1 severe), 1 of IUGR (birth weight 2300 g at 38 weeks), and 1 preterm delivery. In the control group (31 subjects), there were 8 abortions, 9 cases of preeclampsia (29%, 6 mild and 3 severe) with perinatal outcome: 3 preterm delivery cases and 1 IUGR (birth weight 2030 g at 39 weeks). Preeclampsia was significantly less frequent in the supplementation group when compared to the control group (2 vs. 9 cases, p = 0.043, OR = 0.18 [95% CI: 0.03, 0.92]). Finally we focused on the prediction of preeclampsia at 8 to 12 weeks. Combined sensitivity of markers of antioxidant status (SOD slutathione peroxidase, [GPx], and total anti-oxidant status [TAS]) was 33% (false-positive rate of 4.5%). CONCLUSION: Antioxidant supplementation was associated with better maternal and perinatal outcome in pregnant women with low antioxidant status than control supplementation with iron and folate alone. In a selected population already screened positive for low SOD, preeclampsia can be detected in 33% of asymptomatic cases in the first trimester using SOD, GPx, and TAS. It seems feasible that panels of both biochemical and molecular markers may be clinically useful in the prediction of this disease.     

Relationship between intra-household food distribution and coexistence of dual forms of malnutrition

BACKGROUND/OBJECTIVES

The relationship between food intake and nutritional status has been clearly established. Yet, there are only limited studies on food intake among family members and their nutritional status. The study examined the relationship between intra-household food distribution and coexistence of dual forms of malnutrition (DFM) in the same household.

SUBJECTS/METHODS

Households with a malnourished child and overweight mother were categorized as DFM. Intra-household food distribution among family members was reported using ratios, which are a measure of individual intakes as compared to all household member intakes adjusted to RDA.

RESULTS

A 1,899 families were included in the study. The prevalence of DFM was 29.8% (95%CI 26.5-31.2). Children consumed lower amounts of energy (OR 1.34; 95%CI 1.06-1.69, P = 0.011), carbohydrates (OR 1.2; 95%CI1.03-1.61, P = 0.022), protein (OR 1.3; 95%CI 1.03-1.64, P = 0.026), and fat (OR 1.3; 95%CI 1.05-1.66, P = 0.016) than their mothers and other family members. In contrast, mothers consumed more carbohydrates than children and other family members (OR1.24; 95%CI 1.02-1.51, P = 0.03).

CONCLUSIONS

This study is the first to report on the food distribution among family members and its relationship with occurrence of DFM in Indonesia. The results confirm the occurrence of an unequal food distribution between children and mothers, which increases risk of DFM in the household. The results also demonstrate that nutritional education at the household level is important to increase awareness of the impact of DFM.     

High tuberculosis notification and treatment success rates through community participation in central Sulawesi, Republic of Indonesia.

SETTING: Central Sulawesi Province, Republic of Indonesia. OBJECTIVE: To increase tuberculosis case notification and maintain high treatment success rates through community participation in a tuberculosis field programme. DESIGN: Comparison of tuberculosis case notification and treatment results in a community based tuberculosis programme (CBTP), before and after introduction of the programme and between areas where the programme was and was not introduced. RESULTS: During 1998, the CBTP was introduced in two of the four rural districts of the Central Sulawesi province, covering 224 (29%) of the 772 villages and 362,700 (33%) of the 1,109,100 population in these districts. In the CBTP villages the notification rate of new smear-positive patients per 100,000 population increased from SI in 1996 and 48 in 1997 to 166 in 1998. In the 548 non-CBTP villages the rates were 62, 60 and 70, respectively. The sputum conversion rate at the end of the first 2 months of the treatment was over 85% in both the CBTP and the non-CBTP villages. In the CBTP villages the treatment success rate (cure and treatment completion) was 90.4%, 89.5% and 93.7% in 1996, 1997, and 1998. For the non-CBTP villages these rates were respectively 85.4%, 86.8% and 85.9%. In 1998 the sputum conversion and treatment success rates were significantly higher in the CBTP villages than in the non-CBTP villages. CONCLUSION: Through community participation, the notification of new smear-smear positive patients increased substantially, while sputum conversion and treatment success rates remained high.     

Canagliflozin Prevents Diabetes-Induced Vascular Dysfunction in ApoE-Deficient Mice

Aim: Recent studies have demonstrated that selective sodium–glucose cotransporter 2 inhibitors (SGLT2is) reduce cardiovascular events, although their mechanism remains obscure. We examined the effect of canagliflozin, an SGLT2i, on atherogenesis and investigated its underlying mechanism.Method: Canagliflozin (30 mg/kg/day) was administered by gavage to streptozotocin-induced diabetic apolipoprotein E-deficient (ApoE^−/−) mice. Sudan IV staining was performed at the aortic arch. Immunostaining, quantitative RT-PCR, and vascular reactivity assay were performed using the aorta. In vitro experiments using human umbilical vein endothelial cells (HUVECs) were also performed.Result: Canagliflozin decreased blood glucose (P < 0.001) and total cholesterol (P < 0.05) levels. Sudan IV staining showed that 12-week canagliflozin treatment decreased atherosclerotic lesions (P < 0.05). Further, 8-week canagliflozin treatment ameliorated endothelial dysfunction, as determined by acetylcholine-induced vasodilation (P < 0.05), and significantly reduced the expressions of inflammatory molecules such as ICAM-1 and VCAM-1 in the aorta at the RNA and protein levels. Canagliflozin also reduced the expressions of NADPH oxidase subunits such as NOX2 and p22phox in the aorta and reduced urinary excretion of 8-OHdG, suggesting a reduction in oxidative stress. Methylglyoxal, a precursor of advanced glycation end products, increased the expressions of ICAM-1 and p22phox in HUVECs (P < 0.05, both). Methylglyoxal also decreased the phosphorylation of eNOS^Ser1177 and Akt but increased the phosphorylation of eNOS^Thr495 and p38 MAPK in HUVECs.Conclusion: Canagliflozin prevents endothelial dysfunction and atherogenesis in diabetic ApoE^−/− mice. Anti-inflammatory and antioxidative potential due to reduced glucose toxicity to endothelial cells might be its underlying mechanisms.