Using ethnographic film in tackling podoconiosis

Background

Ethiopia has one of the worst podoconiosis rates in the world, affecting >1.5 million patients. We present our ethnographic film ‘Tigist, the story of a girl with podoconiosis’ and its potential use in tackling podoconiosis.

Methods

We conducted visual ethnography, consisting of video-recorded participant observations and interviews with seven patients, three healthcare workers and two podoconiosis experts.

Results

We acquired video recordings of social moments, the state of podoconiosis patients’ bodies and minds, their emotions and the impact of poverty.

Conclusions

Our film allows for an intensified understanding of patients’ daily experiences with podoconiosis, potentially impacting care, awareness and medical teaching programs.

[How does a new medicine reach the patient?]

The Medicines Evaluation Board (MEB) grants market authorisation for medicinal products in the Netherlands. The European Medicines Agency (EMA) coordinates the evaluation and safeguarding of medicinal products in the European Union. The core task of the MEB is to evaluate the quality of every medicinal product for which marketing authorisation is applied for by the manufacturer, and to assess the risk - efficacy balance of the product concerned. There are three different procedures that a manufacturer can follow: (a) the national procedure; (b) the decentralised procedure or mutual recognition procedure; (c) the centralised procedure. After marketing authorisation has been granted, the MEB ensures pharmacovigilance in cooperation with partners such as the Netherlands Pharmacovigilance Centre (Lareb). The MEB determines the text of the package leaflet, the packaging and the Summary of Product Characteristics (SmPC). The MEB checks the warnings that are sent out by manufacturers if important new information about a medicinal product becomes available.

Reporting of medical research costs. Improving transparency and reproducibility of medical research

Increasing numbers of research reporting guidelines are being published. These guidelines facilitate rigorous and complete reporting, and presentation of published studies. However, current reporting guidelines do not address issues related to costs of research methods. We propose to publish costs of research in order to increase transparency, efficiency, quality and ultimately reproducibility of scientific studies.

Podoconiosis, a neglected tropical disease

Podoconiosis or 'endemic non-filarial elephantiasis' is a tropical disease caused by exposure of bare feet to irritant alkaline clay soils. This causes an asymmetrical swelling of the feet and lower limbs due to lymphoedema. Podoconiosis has a curable pre-elephantiasic phase. However, once elephantiasis is established, podoconiosis persists and may cause lifelong disability. The disease is associated with living in low-income countries in the tropics in regions with high altitude and high seasonal rainfall. It is found in areas of tropical Africa, Central and South America and north-west India. In endemic areas, podoconiosis is a considerable public health problem. Social stigmatisation of patients is widespread and economic losses are enormous since it mainly affects the most productive people, sustaining the disease-poverty-disease cycle. Podoconiosis is unique in being an entirely preventable, non-communicable tropical disease with the potential for eradication. Low-cost preventive measures are a simple but effective solution. However, so far it has received little attention from health care policy makers and, until recently, research into the disease has been scarce and the pathogenesis and genetic basis are partly unclear. A better understanding of these aspects may lead to new prevention and treatment opportunities. In the past few years, several projects fighting podoconiosis have been started by non-governmental organisations. In February 2011, the World Health Organisation designated podoconiosis as one of the 20 neglected tropical diseases, marking an important step in the fight against the disease.

Characterization of two paralysing protein toxins (A-MTX and B-MTX), isolated from a homogenate of the wasp Microbracon hebetor (Say)

Two paralysing toxins (A-MTX and B-MTX) from extracts of Microbracon hebetor (Say) wasps were isolated and purified by gel chromatography, ion exchange chromatography and gel electrophoresis. Both toxins are labile proteins with molecular weights of 43,700 and 56,700, respectively, as estimated by gel chromatography, and with isoelectric pH of 6.85 and 6.62, respectively. Both toxins are inactivated by proteolytic enzymes and by dithiothreitol, but A-MTX appears to be more resistant than B-MTX. The relative amino acid compositions of both toxins show great similarity. The biological effects of the two toxins were identical to those previously found for crude toxin preparations.

Further studies on the structure-activity relationships of bradykinin-potentiating peptides

Several pentapeptides were synthesized and tested for bradykinin-potentiating activity. From these and previous data it appeared that an (L)-aromatic amino acid residue (preferably Trp) in position 3 is essential for high activity. Position 3 represents a stereospecific pillar function, whereas the other positions and the lipophilicity/hydrophilicity balance are important for additional activity. So far, BPP5a seems to have the optimal structure for a bradykinin-potentiating pentapeptide.

Structure-activity relationships of bradykinin potentiating peptides

A number of A-VI-5 (Val-Glu-Ser-Ser-Lys) analogues and fragments were synthetized and tested on bradykinin potentiating activity so as to establish the nature of the active group(s) or structural characteristics of some bradykinin potentiating pentapeptides. It could be concluded that (1) the polar groups of the side-chains, such as the two hydroxyl groups of the serine residues, the omega-carboxyl group of the glutamic acid residue and the omega-amino group of the C-terminal lysine, are not essential for the bradykinin potentiating activity; (2) the chain length (at least 5 amino acids) and the lipophilicity of the N-terminal amino acid as well as the whole peptide are of much more importance; (3) the free N-terminal NH2-group is not essential; (4) aromatic amino acids in position 3 of the peptide chain result in highly active bradykinin potentiating peptides.

An analysis of an apparent sex difference in the desoxyribonucleic acid content of rat liver

Using the extraction procedure of Schmidt & Thannhauser (1945) and the indole reaction for DNA according to Ceriotti (1952), the DNA content of female rat liver was about one and a half times that of male liver. Castration of male rats, with or without administration of testosterone propionate, had no effect on the liver DNA content. Spaying of female rats (5-6 weeks of age) caused a decrease of the liver DNA content. Substitution with oestradiol benzoate restored the amount of DNA. No significant sex difference was observed in the DNA content of either rat brain, kidney, spleen and thymus, or mouse liver. Dische's diphenylamine reaction showed no significant sex difference in the rat liver DNA content. It was concluded that rat liver may contain a substance which is controlled by oestrogens and which interferes with the indole reaction. The interfering factor is present in the protein fraction of the liver extract. The possible nature of this interfering substance is discussed.