Prevalence of Trachoma in Jigawa State,Northwestern Nigeria

ABSTRACT

Purpose: To determine the magnitude of trachoma and the prevalent forms of the disease, and to provide baseline data for the establishment of a trachoma control program in Jigawa State, northwestern Nigeria.

Methods: A population-based cross-sectional survey was conducted in Jigawa State in May 2007 using a 2-stage cluster random sampling technique to select 4598 persons from 40 villages based on probability proportional to size. All participants were examined using a penlight and a 2.5?×?binocular loupe for signs of trachoma, and graded using the World Health Organization (WHO) simplified grading system.

Results: A total of 4598 people were seen with 99.96% coverage. Of these, 2460 (53.5%) were female and 2138 (46.5%) were male. Mean age was 21.6 years (?±?19.8 years). The prevalence of follicular trachoma in children aged ≤9 years was 20.5% (95% confidence interval, CI, 18.7–22.4%) with no difference between the sexes. The prevalence of trichiasis in adults aged ≥15 years was 5%, and the prevalence was higher in females than males (odds ratio 2.60, 95% CI 2.06–3.28; p?<?0.001).

Conclusion: Trachoma is a major problem in Jigawa State; there is a need to train trichiasis surgeons and empower them to carry out community-based surgery. District-level prevalence of trachoma needs to be determined to know which aspects of the WHO SAFE strategy (surgery, antibiotics, facial cleanliness and environmental improvements) need to be emphasized in each district.     

Comparative Evaluation of the Binding Properties of Two Species of Khaya Gum Polymer in a Paracetamol Tablet Formulation

A study was made of the comparative effects of polymers obtained from two species of khaya tree – Khaya senegalensis and Khaya grandifoliola – as binding agents in a paracetamol tablet formulation. The mechanical properties of the tablets were assessed using the tensile strength (T), brittle fracture index (BFI) and friability (F) of the tablets while the drug release properties of the tablets were assessed using disintegration and dissolution times. The tensile strength, disintegration and the dissolution times of tablets increased with the increase in binder concentration while F and BFI decreased. K. senegalensis gum produced tablets with stronger mechanical properties with less tendency to laminate, and longer disintegration and dissolution times than K. grandifoliola gum. The results suggest that the polymer gum from K. senegalensis will be more appropriate as a binding agent than the gum from K. grandifoliola when higher mechanical strength and slower release profiles of tablets are desired.     

Genetic ablation of NADPH oxidase enhances susceptibility to cigarette smoke-induced lung inflammation and emphysema in mice

Cigarette smoke (CS) induces recruitment of inflammatory cells in the lungs leading to the generation of reactive oxygen species (ROS), which are involved in lung inflammation and injury. Nicotinamide adenine dinucleotide phosphate (NADPH) oxidase is a multimeric system that is responsible for ROS production in mammalian cells. We hypothesized that NADPH oxidase-derived ROS play an important role in lung inflammation and injury and that targeted ablation of components of NADPH oxidase (p47(phox) and gp91(phox)) would protect lungs against the detrimental effects of CS. To test this hypothesis, we exposed p47(phox-/-) and gp91(phox-/-) mice to CS and examined inflammatory response and injury in the lung. Surprisingly, although CS-induced ROS production was decreased in the lungs of p47(phox-/-) and gp91(phox-/-) mice compared with wild-type mice, the inflammatory response was significantly increased and was accompanied by development of distal airspace enlargement and alveolar destruction. This pathological abnormality was associated with enhanced activation of the TLR4-nuclear factor-kappaB pathway in response to CS exposure in p47(phox-/-) and gp91(phox-/-) mice. This phenomenon was confirmed by in vitro studies in which treatment of peritoneal macrophages with a nuclear factor-kappaB inhibitor reversed the CS-induced release of proinflammatory mediators. Thus, these data suggest that genetic ablation of components of NADPH oxidase enhances susceptibility to the proinflammatory effects of CS leading to airspace enlargement and alveolar damage.     

Evaluating the MoA/human relevance framework for F-344 rat liver epithelioid granulomas with mineral oil hydrocarbons

Toxicology feeding studies of mineral oil hydrocarbons (MOHs), within the carbon number range C₂₂–C₂₈, results in species-specific epithelioid granulomas in the liver of F-344 rats but not in other rat strains, or species. While MOH has been detected, and some pathological effects have been shown to occur in other organs/tissues of F-344 rats and other rat strains/species, it is generally accepted that the effect of toxicological concern is species-specific inflammatory liver granuloma. As oil retention and other MOH-related nontoxic pathological changes in the liver are observed in humans, some have hypothesized that the potential for oil accumulation over a lifetime, through dietary sources, may predispose humans to similar liver effects as observed in F-344 rats. To address this concern, a mode of action/human relevance framework (MoA/HRF) analysis for MOH-induced epithelioid granuloma in the F-344 rat model was developed. The key events for the development of liver epithelioid granulomas were identified as increased MOH intestinal absorption, preferential tissue retention and ultimately formation of necrotic granulomas encased by infiltrating inflammatory lymphocytes. The hypothesized MoA was evaluated using the modified Bradford Hill considerations for causality and was considered to be established in the F-344 rodent model. However, key strain/species differences in the rate of intestinal absorption, tissue retention of MOH and inflammatory response to MOH in the liver were identified. Overall, the F-344 rat MoA was not considered to be relevant to humans, consistent with data showing no evidence for the formation of epithelioid granulomas with humans even in cases of massive ingestion of MOHs.     

Screening,Brief Intervention,and Referral to Treatment: Public Health Training for Primary Care

Objectives. The purpose of this study was to elucidate changes in attitudes, experiences, readiness, and confidence levels of medical residents to perform screening, brief intervention, and referral to treatment (SBIRT) and factors that moderate these changes.Methods. A cohort of 121 medical residents received an educational intervention. Self-reported experience, readiness, attitude, and confidence toward SBIRT-related skills were measured at baseline and at follow-up. Analyses were conducted to evaluate the effects of medical specialization.Results. The intervention significantly increased experience (P < .001), attitude (P < .05), readiness (P < .001), and confidence (P < .001). Residents were more likely to report that their involvement influenced patients’ substance use. However, experience applying SBIRT skills varied by country of birth, specialty, and baseline scores.Conclusions. This study suggested that SBIRT training was an effective educational tool that increased residents’ sense of responsibility. However, application of skills might differ by specialization and other variables. Future studies are needed to explore and evaluate SBIRT knowledge obtained, within the context of cultural awareness and clinical skills.Substance use disorders are a major public health problem, contributing substantially to the nation''s morbidity and mortality. Substance abuse is estimated to cost more than $484 billion per year in the United States.1 Health care providers exert time and resources treating patients with substance abuse related injuries and illnesses. This suggests that health care providers have a vital role in the prevention and intervention of substance use disorders.Despite the US Preventive Services Task Force recommendation to provide screening and counseling for alcohol, tobacco, and illicit drug use among adults, pregnant women, and adolescents, many medical health care professionals face barriers and challenges providing early intervention, motivating change of behavior, facilitating access to treatment when appropriate, and improving quality of care with at-risk users.2 Barriers to providing optimal care may include deficient clinical skills and knowledge,3 negative attitudes,4 and discomfort with patient discussions about substance use.5 Studies suggest physicians report low confidence in their skills and poor satisfaction in treating substance use disorders,6,7 and often overlook the opportunity to diagnose alcohol problems in primary care settings.4,8–11 When health care professionals confront the consequences of substance abuse during patient care, they often lack the expertise to facilitate behavior change.12 Overall training in substance use related diagnosis, treatment, and prevention with chronic disease management has been inadequate for physicians.13 To address the demand for prevention and intervention in the health care setting, health care professionals must have the education and training to effectively identify substance use problems, provide behavioral counseling, and coordinate treatment. Increased education, cultural awareness, and clinical skills training of health care professionals on substance use disorders is imperative in providing quality and competent care for patients. According to the Substance Abuse and Mental Health Administration and the Office of National Drug Control Policy, screening, brief, intervention, and referral to treatment (SBIRT) is a comprehensive and integrated public health approach to the delivery of early intervention and treatment services for substance use disorders.14,15 The SBIRT approach reduces substance use consumption, improves population health, and promotes health equity through the effective integration of primary care with public health.16 Alcohol screening and brief intervention offers an evidence-based and cost-effective approach.17,18 There is strong evidence documenting the efficacy and effectiveness of screening brief intervention in reducing alcohol consumption for at-risk individuals in meta-analyses of randomized control trials and systematic reviews.19–21 In addition, the efficacy and cost effectiveness of SBIRT has been demonstrated in primary care, emergency departments, and trauma centers.22 Thus, the integration of SBIRT training for primary care residency programs lays the foundation for physician practices that may ultimately reduce substance abuse among at-risk users and dependent patients.Research suggests that medical specialization influences screening and brief interventions among physicians. Freidmann et al. 23 found that physicians practicing internal medicine and psychiatry were more likely to screen patients than family medicine or obstetrics/gynecology physicians. Also within this study, psychiatrists were most likely to attempt a brief intervention.23 However, little is known about the influence of SBIRT training on the health care providers’ attitudes, experiences, readiness, and confidence in performing SBIRT-related skills. In an evaluation of an SBIRT curriculum for emergency department providers, significant improvements in the providers’ self-reported confidence in ability and responsibility to intervene were noted.22The purpose of this study was to examine changes in residents’ attitude, experience, confidence, and readiness to implement SBIRT with patients. The study also elucidated the moderating effects on changes in attitudes, experiences, readiness, and confidence level of medical residents.     

The relevance of occupational medicine to primary care in the 21st century

The relatively infrequent incidence of dramatic outbreaks of occupational disease, as occurred in the past, along with economic downturns, have lowered the medical altitude of the workplace as a risk factor for or determinant of disease and disability. However, in 2007 alone, there were more than 4 million nonfatal occupational illnesses in the United States. Equally relevant is the explosion in 2010 at a coal mine in West Virginia that left 29 workers dead. Not to be overlooked are the ongoing challenges to medical practitioners of managing workers' compensation cases. At the same time, the convergence of demographic changes, changes in the workplace structure, and emerging technologies are reinforcing the views of occupational medicine clinicians and other practitioners that occupational health must be integrated into primary care systems and that total separation of work-caused and nonwork-caused care is counterproductive and arbitrary. Therefore, basic principles, concepts, and procedures of occupational medicine must be integrated into the substrate of information and experience upon which students must depend on entering a medical career.     

Curcumin restores corticosteroid function in monocytes exposed to oxidants by maintaining HDAC2

Oxidative stress as a result of cigarette smoking is an important etiologic factor in the pathogenesis of chronic obstructive pulmonary disease (COPD), a chronic steroid-insensitive inflammatory disease of the airways. Histone deacetylase-2 (HDAC2), a critical component of the corticosteroid anti-inflammatory action, is impaired in lungs of patients with COPD and correlates with disease severity. We demonstrate here that curcumin (diferuloylmethane), a dietary polyphenol, at nanomolar concentrations specifically restores cigarette smoke extract (CSE)- or oxidative stress-impaired HDAC2 activity and corticosteroid efficacy in vitro with an EC(50) of approximately 30 nM and 200 nM, respectively. CSE caused a reduction in HDAC2 protein expression that was restored by curcumin. This decrease in HDAC2 protein expression was reversed by curcumin even in the presence of cycloheximide, a protein synthesis inhibitor. The proteasomal inhibitor, MG132, also blocked CSE-induced HDAC2 degradation, increasing the levels of ubiquitinated HDAC2. Biochemical and gene chip analysis indicated that curcumin at concentrations up to 1 muM propagates its effect via antioxidant-independent mechanisms associated with the phosphorylation-ubiquitin-proteasome pathway. Thus curcumin acts at a post-translational level by maintaining both HDAC2 activity and expression, thereby reversing steroid insensitivity induced by either CSE or oxidative stress in monocytes. Curcumin may therefore have potential to reverse steroid resistance, which is common in patients with COPD and asthma.