Diphtheria remains a threat to health in the developing world: an overview

Changes in the epidemiology of diphtheria are occurring worldwide. A large proportion of adults in many industrialized and developing countries are now susceptible to diphtheria. Vaccine-induced immunity wanes over time unless periodic booster is given or exposure to toxigenic Corynebacterium diphtheriae occurs. Immunity gap in adults coupled with large numbers of susceptible children creates the potential for new extensive epidemics. Epidemic emergencies may not be long in coming in countries experiencing rapid industrialization or undergoing sociopolitical instability where many of the factors thought to be important in producing epidemic such as mass population movements and difficult hygienic and economic conditions are present. The continuous circulation of toxigenic C. diphtheriae emphasizes the need to be aware of epidemiological features, clinical signs, and symptoms of diphtheria in vaccine era so that cases can be promptly diagnosed and treated, and further public health measures can be taken to contain this serious disease. This overview focused on worldwide data obtained from diphtheria with particular emphasis to main factors leading to recent epidemics, new clinical forms of C. diphtheriae infections, expression of virulence factors, other than toxin production, control strategies, and laboratory diagnosis procedures.

Obesity increases your risk of developing diabetes

There are an estimated 69,000 adults and 1092 children living with diabetes in Northern Ireland in 2010. The number of adults with diabetes in Northern Ireland has increased by 34% since 2004. Many of these cases are preventable and related to obesity. With this in mind, during Diabetes Week (12 - 18 June 2011) the Public Health Agency is encouraging everyone across Northern Ireland to be aware of how diabetes can be prevented and what the signs and symptoms of diabetes are to ensure early diagnosis and good diabetic care.Type 1 diabetes cannot be prevented. It usually occurs in children and young adults. Type 2 diabetes typically occurs after the age of 40, but may occur at a younger age, and can often be prevented - mainly by keeping your weight within the normal range for your height. Dr Brid Farrell, Consultant in Public Health Medicine, PHA, said: "The increase of diabetes occurring in the population can be explained by rising levels of obesity, people living longer and improved detection and diagnosis of diabetes in primary care."The symptoms of diabetes can include increased thirst, passing urine more frequently (bedwetting in children), extreme tiredness, slow healing infections, blurred vision and significant or unexplained weight loss. Symptoms of diabetes can develop quickly over days or weeks, and sometimes with Type 2 diabetes, a person may have no symptoms. Early diagnosis is important. If you think you have diabetes speak to your GP or pharmacist.Dr Farrell continued: "Diabetes is a lifelong condition, but complications can be prevented or delayed by controlling your blood sugar, and treating high blood pressure and high cholesterol. If you have diabetes, a healthy diet and regular exercise is very important."Health Minister Edwin Poots said:"Diabetes is a serious condition, which affects many thousands of people across Northern Ireland. While not all diabetes is preventable, we all have a responsibility to look after our own health. "By making healthier lifestyle choices such as eating a healthy, well-balanced diet and taking regular exercise, we can reduce our risk of developing potentially life threatening conditions such as type 2 diabetes. I would urge everyone to take every possible step to improve their health and avoid developing preventable illnesses."Ends

PHA advises 'breast is best'!

The Public Health Agency is using National Breastfeeding Awareness Week (NBAW) to emphasise the message that breastfeeding is the healthiest option for both you and your baby and that by deciding to breastfeed, you will be giving your child the best possible start in life. NBAW runs from 19-25 June and highlights the fact that any period of breastfeeding, however short, will benefit your baby.Breast milk is different to formula milk as it contains antibodies that cannot be manufactured in formula. Antibodies help protect babies from infection and stimulate their immune system.Northern Ireland has the lowest breastfeeding rate in the UK, with an average of 63% of women breastfeeding their baby at birth. Janet Calvert, Regional Breastfeeding Coordinator at the PHA, said: "This is an issue that clearly needs addressed, as breastfeeding has many important health benefits for both mother and baby. These include a reduced risk of ear, chest, kidney and stomach infections and less risk of childhood diabetes and obesity."Breastfeeding can also significantly reduce the risk of hospital admission of children for gastroenteritis and chest infections. The health benefits for mothers who choose to breastfeed include a reduced risk of developing illnesses such as breast cancer, ovarian cancer and osteoporosis."There are other benefits as well as those to your health. Breastfeeding is free - you don't have to buy formula, bottles, teats, sterilising equipment etc. Breast milk is always available, with the right ingredients, at the right temperature, so it's easier to feed at night or on the go.The PHA recognises the importance of breastfeeding to health and the need to ensure that mothers get off to a good start with breastfeeding. It is vital that mothers get the right support and encouragement from their family and friends should they decide to breastfeed. Breastfeeding can be difficult at the start and mothers need reassurance while they learn."There are many local initiatives in the community to improve breastfeeding support. These include improving support in the health service and through Sure Start programmes, which work in areas of need to help ensure children get the best start in life," Janet added."Mother to mother peer support programmes are in place in many areas and are working with expectant and new mothers to help them breastfeed for longer. There are also 70 breastfeeding support groups, which provide ongoing support for breastfeeding mothers throughout Northern Ireland. "The PHA is also working to improve attitudes to breastfeeding in public through the Breastfeeding Welcome Here scheme, which began in 2005 and now has over 200 businesses and public facilities signed up to support and welcome breastfeeding families. All these initiatives, along with support from partners and family, are vital to help expectant and new mothers stay with breastfeeding."Health Minister Edwin Poots said: "There is clear evidence that breastfeeding offers health benefits for both babies and mothers. We know that breast milk gives baby the best start in life by providing all the nutrients and protection a baby needs for the first six months of life. That is why my Department is committed to promoting and supporting breastfeeding".For further information on breastfeeding visit www.breastfedbabies.org.uk

Prevent type 2 diabetes by preventing obesity

In 2011 nearly 73,000 adults in Northern Ireland are registered as having diabetes. Many cases of diabetes are preventable and are the result of obesity. With this in mind, on World Diabetes Day, 14 November 2011, the Public Health Agency is encouraging everyone across Northern Ireland to be aware of how Type 2 diabetes can be prevented, the dangers it can cause to your health and what the signs and symptoms of diabetes are to ensure early diagnosis.The links between type 2 diabetes and obesity are firmly established. Without the intervention of a healthy diet and appropriate exercise, obesity may develop into diabetes over a relatively short period of time. According to the International Diabetes Federation (IDF), worldwide 80 per cent of people with Type 2 diabetes are overweight or obese at the time of diagnosis.If you are overweight, or obese the key step to preventing or delaying the onset of Type 2 diabetes is to lose a small amount of weight by making healthy food choices and being physically active 30 minutes a day, 5 days a week.Diabetes, if left untreated can cause serious long term health complications such as heart disease, kidney damage, eye problems, which can affect vision, and foot problems leading to amputation.Dr Brid Farrell, Consultant in Public Health Medicine, PHA, said: "The increase of diabetes occurring in the population can be explained by rising levels of obesity, people living longer and improved detection and diagnosis of diabetes in primary care."Having a family history of Type 2 diabetes increases your chances of developing diabetes. Take the first step today toward lowering your risk for Type 2 diabetes and improving your health and the health of future generations." The symptoms of diabetes can include increased thirst, passing urine more, frequently (bedwetting in children), extreme tiredness, slow healing infections, blurred vision and significant or unexplained weight loss. Symptoms of diabetes can develop quickly over days or weeks, and sometimes with Type 2 diabetes, a person may have no symptoms. Early diagnosis is important. If you think you have diabetes speak to your GP or pharmacist.Dr Farrell continued: "Diabetes is a lifelong condition, but complications can be prevented or delayed by controlling your blood sugar, and treating high blood pressure and high cholesterol. If you have diabetes, a healthy diet and regular exercise is very important."Health Minister Edwin Poots said:"Diabetes is a serious condition, which affects many thousands of people across Northern Ireland. While not all diabetes is preventable, we all have a responsibility to look after our own health. "By making healthier lifestyle choices such as eating a healthy, well-balanced diet and taking regular exercise, we can reduce our risk of developing potentially life threatening conditions such as type 2 diabetes. I would urge everyone to take every possible step to improve their health and avoid developing preventable illnesses

Inducible malondialdehyde pools in zones of cell proliferation and developing tissues in Arabidopsis.

Malondialdehyde (MDA) is a natural and widespread genotoxin. Given its potentially deleterious effects, it is of interest to establish the identities of the cell types containing this aldehyde. We used in situ chemical trapping with 2-thiobarbituric acid and mass spectrometry with a deuterated standard to characterize MDA pools in the vegetative phase in Arabidopsis thaliana. In leaves, MDA occurred predominantly in the intracellular compartment of mesophyll cells and was enriched in chloroplasts where it was derived primarily from triunsaturated fatty acids (TFAs). High levels of MDA (most of which was unbound) were found within dividing cells in the root tip cell proliferation zone. The bulk of this MDA did not originate from TFAs. We confirmed the localization of MDA in transversal root sections. In addition to MDA in proliferating cells near the root tip we found evidence for the presence of MDA in pericyle cells. Remodeling of non-TFA-derived MDA pools occurred when seedlings were infected with the fungus Botrytis cinerea. Treatment of uninfected seedlings with mediators of plant stress responses (jasmonic acid or salicylic acid) increased seedling MDA levels over 20-fold. In summary, major pools of MDA are associated with cell division foci containing stem cells. The aldehyde is pathogen-inducible in these regions and its levels are increased by cellular mediators that impact defense and growth.

Biotechnology to improve health in developing countries: a review

The growing health disparities between the developing and the developed world call for urgent action from the scientific community. Science and technology have in the past played a vital role in improving public health. Today, with the tremendous potential of genomics and other advances in the life sciences, the contribution of science to improve public health and reduce global health disparities is more pertinent than ever before. Yet the benefits of modern medicine still have not reached millions of people in developing countries. It is crucial to recognize that science and technology can be used very effectively in partnership with public health practices in developing countries and can enhance their efficacy. The fight to improve global health needs, in addition to effective public health measures, requires rapid and efficient diagnostic tools; new vaccines and drugs, efficient delivery methods and novel approaches to therapeutics; and low-cost restoration of water, soil and other natural resources. In 2002, the University of Toronto published a report on the "Top 10 Biotechnologies for Improving Health in Developing Countries". Here we review these new and emerging biotechnologies and explore how they can be used to support the goals of developing countries in improving health.

GB virus C/hepatitis G virus infection in dialysis patients and kidney transplant recipients in central Brazil

In order to investigate the prevalence of GB virus C (GBV-C)/hepatitis G virus (HGV) infection in dialysis patients and kidney transplant recipients in Central Brazil and also to analyze the virus genotypes distribution, a total of 123 patients including 98 on hemodialysis, 13 on continuous ambulatory peritoneal dialysis treatment, and 12 who received kidney transplantation were interviewed in one unit of dialysis treatment in Goiânia city. Blood samples were collected and serum samples tested for GBV-C/HGV RNA by polymerase chain reaction. Genotypes were determined by restriction fragment length polymorphism (RFLP) analysis. Eighteen samples were GBV-C/HGV RNA-positive, resulting in an overall prevalence of 14.6% (95% CI: 9.2-21.7). A high positivity for GBV-C/HGV RNA was observed in patients who had received kidney transplant (16.7%), followed by those on hemodialysis (15.3%), and peritoneal dialysis (7.7%). RFLP analysis revealed the presence of genotypes 1, 2, and 3 of GBV-C/HGV; more precisely, 9 (50%) samples were found belonging to the 2b subtype, 4 (22%) to the 2a subtype, 3 (17%) to genotype 1, and 2 (11%) to genotype 3. The present data indicate an intermediate prevalence of GBV-C/HGV infection among dialysis patients and kidney transplant recipients in Central Brazil. Genotype 2 (subtype 2b) seems to be the most prevalent GBV-C/HGV genotype in our region.

Neurochemical profile of the developing mouse cortex determined by in vivo 1H NMR spectroscopy at 14.1 T and the effect of recurrent anaesthesia.

The neurochemical profile of the cortex develops in a region and time specific manner, which can be distorted by psychiatric and other neurological pathologies. Pre-clinical studies often involve experimental mouse models. In this study, we determined the neurochemical profile of C57BL/6 mice in a longitudinal study design to provide a reference frame for the normal developing mouse cortex. Using in vivo proton NMR spectroscopy at 14 T, we measured the concentrations of 18 metabolites in the anterior and posterior cortex on postnatal days (P) 10, 20, 30, 60 and 90. Cortical development was marked by alterations of highly concentrated metabolites, such as N-acetylaspartate, glutamate, taurine and creatine. Regional specificity was represented by early variations in the concentration of glutamine, aspartate and choline. In adult animals, regional concentration differences were found for N-acetylaspartate, creatine and myo-inositol. In this study, animals were exposed to recurrent isoflurane anaesthesia. Additional experiments showed that the latter was devoid of major effects on behaviour or cortical neurochemical profile. In conclusion, the high sensitivity and reproducibility of the measurements achieved at 14 T allowed us to identify developmental variations of cortical areas within the mouse cortex.

Arrhythmogenesis in the developing heart during anoxia-reoxygenation and hypothermia-rewarming: an in vitro model.

INTRODUCTION: The spatio-temporal pattern of arrhythmias in the embryonic/fetal heart subjected to a transient hypoxic or hypothermic stress remains to be established. METHODS AND RESULTS: Spontaneously beating hearts or isolated atria, ventricles, and conotruncus from 4-day-old chick embryos were subjected in vitro to 30-minute anoxia and 60-minute reoxygenation. Hearts were also submitted to 30-minute hypothermia (0-4 degrees C) and 60-minute rewarming. ECG disturbances and alterations of atrial and ventricular electromechanical delay (EMD) were systematically investigated. Baseline functional parameters were stable during at least 2 hours. Anoxia induced tachycardia, followed by bradycardia, atrial ectopy, first-, second-, and third-degree atrio-ventricular blocks and, finally, transient electromechanical arrest after 6.8 minutes, interquartile ranges (IQR) 3.1-16.2 (n = 8). Reoxygenation triggered also Wenckebach phenomenon and ventricular escape beats. At the onset of reoxygenation QT, PR, and ventricular EMD increased by 68%, 70%, and 250%, respectively, whereas atrial EMD was not altered. No fibrillations, no ventricular ectopic beats, and no electromechanical dissociation were observed. Arrhythmic activity of the isolated atria persisted throughout anoxia and upon reoxygenation, whereas activity of the isolated ventricles abruptly ceased after 5 minutes of anoxia and resumed after 5 minutes of reoxygenation. During hypothermia-rewarming, cardiac activity stopped at 17.9 degrees C, IQR 16.2-20.6 (n = 4) and resumed at the same temperature with no arrhythmias. All preparations fully recovered after 40 minutes of reoxygenation or rewarming. CONCLUSION: In the embryonic heart, arrhythmias mainly originated in the sinoatrial tissue and resembled those observed in the adult heart. Furthermore, oxygen readmission was by far more arrhythmogenic than rewarming and the chronotropic, dromotropic, and inotropic effects were fully reversible.

Pathology and first occurrence of the kidney trematode Paratanaisia bragai (Santos, 1934) Freitas, 1959 (Digenea: Eucotylidae) in Phasianus colchicus L., 1758, from Brazil

The kidney trematode Paratanaisia bragai is reported for the first time parasitizing the ring-necked pheasant (Phasianus colchicus L., 1758) and the pathological alterations associated to the parasitism are referred on the basis of 50 specimens of this bird from backyard flocks in 11 counties of the state of Rio de Janeiro, Brazil after clinical examination, necropsies, and histopathological analysis. The counting of the kidney flukes was based on worms recovered from one of the kidneys, since the other was fixed in 10% formalin and then routinely processed for histopathological procedures. The prevalence of P. bragai was of 22%, with a mean intensity of 44.3, mean abundance of 9.7, and range of infection of 3-153. Parasitized birds did not present with clinical signs and kidney gross lesions. Microscopic lesions were mild and characterized by dilatation of the renal medullary collecting ducts, occasional flattening of the lining epithelium of the ducts and inflammatory reaction of variable intensity with granulocytes around the ureter branches and medullary collecting ducts. The severity and pattern of the microscopic lesions seem not to be associated to the size of the worm burden and could be related to the mechanic action of the parasites, without traumatism, in despite of the presence of the tegumentar spines in specimens of P. bragai.

Insulin Resistance as a Therapeutic Target for Chronic Kidney Disease.

Insulin resistance (IR) is a prevalent metabolic feature in chronic kidney disease (CKD). Postreceptor insulin-signaling defects have been observed in uremia. A decrease in the activity of phosphatidylinositol 3-kinase appears critical in the pathophysiology of CKD-associated IR. Lipotoxicity due to ectopic accumulation of lipid moieties has recently emerged as another mechanism by which CKD and/or associated metabolic disorders may lead to IR through impairment of various insulin-signaling molecules. Metabolic acidosis, anemia, excess of fat mass, inflammation, vitamin D deficiency, adipokine imbalance, physical inactivity, and the accumulation of nitrogenous compounds of uremia all contribute to CKD-associated IR. The clinical impacts of IR in this setting are numerous, including endothelial dysfunction, increased cardiovascular mortality, muscle wasting, and possibly initiation and progression of CKD. This is why IR may be a therapeutic target in the attempt to improve outcomes in CKD. General measures to improve IR are directed to counteract causal factors. The use of pharmaceutical agents such as inhibitors of the renin-angiotensin system may improve IR in hypertensive and CKD patients. Pioglitazone appears a safe and promising therapeutic agent to reduce IR and uremic-associated abnormalities. However, interventional studies are needed to test if the reduction and/or normalization of IR may actually improve outcomes in these patients.

Cardiovascular disease, chronic kidney disease, and diabetes mortality burden of cardiometabolic risk factors from 1980 to 2010: a comparative risk assessment.

BACKGROUND: High blood pressure, blood glucose, serum cholesterol, and BMI are risk factors for cardiovascular diseases and some of these factors also increase the risk of chronic kidney disease and diabetes. We estimated mortality from cardiovascular diseases, chronic kidney disease, and diabetes that was attributable to these four cardiometabolic risk factors for all countries and regions from 1980 to 2010. METHODS: We used data for exposure to risk factors by country, age group, and sex from pooled analyses of population-based health surveys. We obtained relative risks for the effects of risk factors on cause-specific mortality from meta-analyses of large prospective studies. We calculated the population attributable fractions for each risk factor alone, and for the combination of all risk factors, accounting for multicausality and for mediation of the effects of BMI by the other three risks. We calculated attributable deaths by multiplying the cause-specific population attributable fractions by the number of disease-specific deaths. We obtained cause-specific mortality from the Global Burden of Diseases, Injuries, and Risk Factors 2010 Study. We propagated the uncertainties of all the inputs to the final estimates. FINDINGS: In 2010, high blood pressure was the leading risk factor for deaths due to cardiovascular diseases, chronic kidney disease, and diabetes in every region, causing more than 40% of worldwide deaths from these diseases; high BMI and glucose were each responsible for about 15% of deaths, and high cholesterol for more than 10%. After accounting for multicausality, 63% (10·8 million deaths, 95% CI 10·1-11·5) of deaths from these diseases in 2010 were attributable to the combined effect of these four metabolic risk factors, compared with 67% (7·1 million deaths, 6·6-7·6) in 1980. The mortality burden of high BMI and glucose nearly doubled from 1980 to 2010. At the country level, age-standardised death rates from these diseases attributable to the combined effects of these four risk factors surpassed 925 deaths per 100 000 for men in Belarus, Kazakhstan, and Mongolia, but were less than 130 deaths per 100 000 for women and less than 200 for men in some high-income countries including Australia, Canada, France, Japan, the Netherlands, Singapore, South Korea, and Spain. INTERPRETATION: The salient features of the cardiometabolic disease and risk factor epidemic at the beginning of the 21st century are high blood pressure and an increasing effect of obesity and diabetes. The mortality burden of cardiometabolic risk factors has shifted from high-income to low-income and middle-income countries. Lowering cardiometabolic risks through dietary, behavioural, and pharmacological interventions should be a part of the global response to non-communicable diseases. FUNDING: UK Medical Research Council, US National Institutes of Health.