Immune phenotype is differentially affected by changing the type of bovine respiratory disease vaccine administered at revaccination in beef heifers

During preconditioning, modified-live vaccines are frequently administered to beef calves before weaning. In this study, we began to characterize the immune phenotype of calves that received a modified-live vaccination at 3-4 months of age and then either received the same modified-live or an inactivated vaccine upon arrival at the feedlot (weaning) and 28 days post-arrival (booster). Innate and adaptive immune measures were assessed before revaccination and 14 and 28 days post. Heifers that received three doses of the modified-live vaccine exhibited a relatively balanced immune response based on increases in mean cytokine concentrations (IL-17, IL-21) and total immunoglobulin-G (IgG) and subsets IgG1 and IgG2, which are related to both arms of the adaptive immune system. Conversely, heifers that received one dose of modified live and two doses of the inactivated vaccine had a more robust neutrophil chemotactic response and greater serum-neutralizing antibody titers, resulting in an enhanced innate immune and a skewed proinflammatory response. These results indicate that the revaccination protocol used after initial vaccination with a modified-live vaccine differentially influences the immune phenotype of beef calves, with three doses of modified live inducing potentially immune homeostasis and a combination of modified live and inactivated vaccines inducing a skewed immune phenotype. However, more research is needed to determine the protective efficacy of these vaccination protocols against disease.

45 Vaccine Protocol Influences Immune Phenotype of Weaned Beef Calves

Vaccination is one mechanism used as a preventative measure to decrease morbidity and mortality due to bovine respiratory disease (BRD), but vaccination efficacy is inconsistent. Therefore, the objective of this study was to compare the effect of inactivated (INA) vs. modified live (MLV) viral vaccines on the immune phenotype of weaned beef calves. Mixed-sexed pens with equal numbers of heifers and steers were randomly assigned to receive either INA (Vira Shield 6) or MLV (Titanium 5) treatments at d 0 (initial) and a booster (28 d). A subpopulation of heifers (n = 28) and steers (n = 18) were identified from these treatment pens and balanced for treatment. Samples were obtained prior to vaccination and 14 and 28 d post-initial vaccination and again at 14 and 28 d post-booster. All animals were weighed on collection days. Data were analyzed using either GLM or MIXED procedures of SAS with repeated measures. A treatment × day interaction occurred on cortisol at 14 d post-initial vaccination; the MLV calves had greater (P = 0.05) cortisol than INA calves. At 28 d post-initial and 14 d post-booster, MLV calves had greater (P < 0.05) total IgG and isotypes IgG1 and IgG2. MLV had greater (P < 0.05) cytokine concentrations associated with either humoral or cell-mediated immune responses. Conversely, serum neutralizing antibodies for antigens associated with the vaccine were significantly greater in INA calves than in MLV (P < 0.05). Calves receiving MLV were heavier (P < 0.05) at the end of the study. These data imply that vaccination protocol resulted in differential immune phenotypes. More specifically, calves receiving the MLV vaccine phenotype indicated stimulation of both the humoral and cell-mediated response. In contrast, the INA phenotype was indicative of a bias towards a humoral response. Further research should be done to determine the protective value of these phenotypes.

PSV-B-14 Bovine Luteal Cell Apoptosis Following Administration of a Commercial Inactivated or Modified-Live Virus Vaccine at Time of AI

Damage to the bovine corpus luteum (CL) has been reported following modified-live virus vaccination (MLV). The objective of this study was to investigate the degree of luteal apoptosis after MLV or inactivated vaccine (IV) administration at time of artificial insemination. Beef females were estrous synchronized and on d 0 were vaccinated with a MLV or IV after being transrectally ultrasounded to record presence and location of dominant follicles and CL. Thirteen cows (MLV, n=7; IV, n=6) were selected on d 10-13 across treatment based on dominant follicle size and estrus expression for ovariectomy. Ovaries were obtained and CL were frozen in OCT and sectioned for immunohistochemistry analysis. At the time of ovary collection, some MLV animals had two CL. These were characterized into old or new CL, relative to if ovulation had occurred in response to the synchronization protocol or afterward due to an abnormal cycle, respectively. For immunohistochemistry analysis, two nonconsecutive sections were evaluated for apoptosis using a TUNEL staining kit (ab66110) according to manufacturer’s instructions, with the modification of DAPI being used as a cell marker. Two random fields of view from each section were photographed with a Keyence BZ-X810 microscope and were evaluated for number of total and apoptotic cells. The GLIMMIX procedure of SAS was utilized to analyze percentage of apoptotic cells with image included as a random effect. Percentage of apoptotic cells were affected by treatment (P < 0.0001). MLV-new CL had the greatest percentage (35.56 ± 5.5%) of luteal cell apoptosis, while MLV-old CL (7.05 ± 4.6%) and IV (4.24 ± 4.9%) were similarly decreased. In summary, a greater degree of apoptosis in new CL which formed after an abnormal cycle following MLV administration indicates the ability of MLV to induce estrous cycle dysfunction and extend its effects to luteal cell development and function.

767 Group & Save- Are They Required for Laparoscopic Appendicectomies?

Aim

Laparoscopic appendicectomy (LA) is the gold standard surgical management of appendicitis. Serious intraoperative complications, including bleeding, are rare, however in the absence of a local established guideline, it is standard practice to send two group and save (G&S) samples prior to theatre. We aimed to review our post-operative transfusion risk for LA and to establish if routine group and save testing is required as part of the preoperative workup.

Method

All patients who underwent a laparoscopic appendicectomy in a single centre were reviewed over a 3-month period (April- June 2020). Data was retrieved from an institutional database and up to date electronic records were reviewed for operative details and transfusion history.

Results

Forty-three appendicectomies performed during audit window, twenty-one of which were laparoscopic. 100% of cases had a single group and save recorded pre-operatively, with 76.2% having a second sample sent, totalling 37 samples. Zero patients in the cohort required a post-operative transfusion. Average cost of a group and save equals £26, a total cost of £962 over a 3-month period.

Conclusion

Whilst a small study, we have illustrated LA to be a safe procedure with zero incidence of blood transfusion. There are clear benefits of producing a local guideline that G&S are not routinely required for LA, including financial and resource savings, potential reduction in theatre delays, and reduction of workload for staff.

Meta-analysis of the effects of monensin on performance of beef replacement heifers and beef cows

Although performance benefits of monensin have been extensively studied in finishing cattle, growing cattle, and dairy cows, considerably less published work is available evaluating response to monensin supplementation in cow-calf production systems. This meta-analysis investigated the impacts of monensin on performance of beef cows and developing replacement heifers. The replacement heifer analysis was conducted using data from 18 different peer-reviewed publications and experiment station reports. The mature cow analysis included 21 different publications and experiment station reports. The metaphor package (version 2.4-0; Viechtbauer, 2010) for R (version 4.0.3; www.r-project.org) was used to determine the overall effect size of monensin compared to a negative control. Each study’s n, means, and SEM or P value was used to calculate the mean difference and estimate of within study variance for responses of interest. In replacement heifers, monensin treatment increased (P < 0.01); average daily gain (+0.03 ± 0.008 kg/d), feed efficiency (+0.013 ± 0.008 gain:feed), and percentage cycling before the breeding season (+15.9 ± 5.13%); while decreasing (P < 0.01): dry matter intake (0.293 ± 0.081 kg), and age at puberty (‐8.9 ± 1.48 d). Six studies reporting ad libitum forage intake for mature cows showed decreased (P = 0.008) DMI by 0.85 ± 0.32 kg/d. Six studies reported milk yield and revealed an increase (P = 0.01) of 0.39 ± 0.15 kg/d when cows were supplemented with monensin. Monensin supplementation resulted in a reduction (P = 0.02) in days to first estrus by 18 ± 8.2 d and percentage of cows exhibiting estrus prior to the breeding season was increased by 19 ± 8% (P = 0.03). There were no differences in artificial insemination pregnancy nor total pregnancy for either the heifer or mature cow data sets. This analysis indicates potential for use of monensin in heifer development and beef cow production systems. Further research is needed to elucidate the effects on reproductive efficiency, DMI, milk production, weight, and body composition change.

Meta-analysis of the effects of monensin on growth and bloat of cattle on pasture

Monensin has been part of the beef production landscape for over 45-years. Although first approved for use in finishing cattle, it has since been approved for cattle in extensive production systems and has been an economical way to increase performance of forage fed animals. This meta-analysis investigated the impacts of monensin on performance of stocker cattle on high-forage diets. The stocker performance analysis resulted from 38 experiments with 73 mean comparisons; bloat analysis was conducted with 12 experiments with 23 mean comparisons. The metaphor package (version 2.4-0) for R (version 4.0.3; www.r-project.org) was used to determine the overall effect size of monensin compared to a negative control. Each study’s n, means, and SEM or P-value was used to calculate the mean difference and estimate of within study variance for responses of interest. Moderators of monensin response considered in the analysis were delivery method, dose, study duration, initial calf BW, diet ME and CP, and forage category. Initial BW and basal ADG averaged 236 ± 45.9 kg and 0.72 ± 0.28 kg, respectively. In the ADG analysis, the only significant moderator of those considered was length of the study (P &lt; 0.01); as duration of the study increased, the ADG response to monensin decreased by 0.0007 kg per day. For the average 112-day length of study, the average monensin response was estimated to be 0.0784 kg/day increase in ADG, approximately 10% above controls. Sufficient information was presented in 18 citations representing 40 mean comparisons for determining the effect of monensin on BW at the end of the experiment. The response model (P &lt; 0.01) for ending BW, kg = 22.3 – 0.05 (initial calf BW, kg). Thus, for the average initial BW of 235 kg the average monensin response was estimated to be 10.6 kg increase in average ending BW. The incidence (-20%) and severity (-0.7 bloat score) of bloat was found to be reduced in bloat-prone pastures. There is ample evidence that monensin increases performance of growing calves on high forage diets along with reducing the incidence and severity of bloat.

PSXIV-4 Meta-analysis of the effects of monensin on growth and bloat of growing beef calves on pasture

This meta-analysis investigated the impacts of monensin on performance of stocker cattle on high-forage diets. The stocker performance analysis resulted from 38 experiments with 73 mean comparisons; bloat analysis was conducted with 12 experiments with 23 mean comparisons. The metaphor package (version 2.4-0) for R (version 4.0.3; www.r-project.org) was used to determine the overall effect size of monensin compared to a negative control. Each study’s n, means, and SEM or P-value was used to calculate the mean difference and estimate of within study variance for responses of interest. Moderators of monensin response considered in the analysis were delivery method, dose, study duration, initial calf BW, diet ME and CP, and forage category. Initial BW and basal ADG averaged 236 ± 45.9 kg and 0.72 ± 0.28 kg/day, respectively. In the ADG analysis the only significant moderator of those considered was length of the study (P &lt; 0.01), as duration of the study increased the ADG response to monensin decreased by 0.0007 kg/day. For the average 112-day length of study, the average monensin response is estimated to be 0.0784 kg/day increase in average daily gain. Sufficient information was presented in only 18 citations representing 40 mean comparisons for determining the effect of monensin on BW at the end of the experiment, estimated by (P &lt; 0.01) monensin response (increased ending BW, kg) = 22.3 – 0.05 (initial calf BW, kg). Thus, for the average initial BW of 235 kg the average monensin response is estimated to be 10.6 kg increase in average ending BW. The incidence (-20%) and severity (-0.7 bloat scores) of bloat was found to be reduced in bloat prone pastures. There is ample evidence that monensin increases performance of growing calves on high forage diets along with reducing the incidence and severity of bloat.

270 Evaluation of Steer Implant Strategies for Long-season Grazing of Cool-season Annuals

The objective of this study was to determine the relative effects of stocker-phase implant strategies on growth and carcass characteristics of beef steers. In each of 2 locations (OK and MS), steers were grazed on cool-season annual pastures in fall 2018 through spring 2019. Steers (n = 300 in MS, n = 240 in OK) were randomly assigned to one of three implant treatments, 1) a single Synovex® One Grass implant at d 0, 2) a single Component® TE-G with Tylan implant at d 0, or 3) a reimplant treatment receiving Component® TE-G with Tylan at d 0 and again at d 82 (OK) or 85 (MS). Steers from each treatment were commingled in 2 (OK) or 3 (MS) pastures for 159 (OK) or 161 d (MS). Following grazing, steers were shipped to a commercial feedyard for finishing, sorted into 3 pens based on BW with each treatment equally represented in each pen, and were managed according to that site’s BMPs. Steers from all treatments were implanted identically in the feedyard. Steers were slaughtered when the pen was visually estimated to be at 1 cm backfat. Carcass data of individuals were collected by camera grading equipment in the packing plant. Data were analyzed as a completely random design with animal as the experimental unit, treatment as a fixed effect, and pasture within location as a random effect. Marbling score tended to be greater in the single Component® TE-G with Tylan (treatment 2) vs. the other 2 treatments (425 vs 408 and 410, P = 0.07). No other production variables, including stocker-phase ADG, approached a significant difference (P &gt; 0.39). No evidence was found to recommend stocker-phase reimplanting even in relatively long stocker phases with high ADG, and producers should consider selecting the most cost-effective implant at grazing initiation.

341 Meta-analysis of the Performance Responses of Replacement Heifers and Beef Cows to Monensin

Performance benefits of monensin have been extensively studied in finishing and stocker cattle, but considerably less published work is available evaluating response to monensin supplementation in cow-calf production systems. Feed additives are more difficult to study in cow-calf production systems due to unstable diet characteristics and cow physiological state throughout the production cycle. This meta-analysis investigated the impacts of monensin on performance of extensively raised beef cow-calf and developing replacement heifers. The replacement heifer analysis was conducted with a maximum of 48 treatment means in 18 experiments. The mature cow analysis included 21 publications and 26 mean comparisons. The metaphor package (version 2.4-0; Viechtbauer, 2010) for R (version 4.0.3; www.r-project.org) was used to determine the overall effect size of monensin compared to a negative control. Each study’s n, means, and SEM or P-value was used to calculate the mean difference and estimate of within study variance for responses of interest. For replacement heifers, average daily gain (+0.03 ± 0.008 kg/d), feed efficiency (+0.013 ± 0.008 gain:feed), and percentage cycling before the breeding season (+15.9 ± 5.13%) were increased (P &lt; 0.01), while dry matter intake (-4.3%) and age at puberty (-8.9 ± 1.48 d) were decreased (P &lt; 0.01). Six studies reporting ad libitum forage intake for mature cows showed that monensin decreased (P = 0.008) DMI by 0.85 ± 0.322 kg/day. Six studies showed monesin increased (P = 0.01) milk yield 0.39 ± 0.15 kg/day by mature cows in early lactation. There were no differences in artificial insemination pregnancy nor total pregnancy for either the heifer or mature cow data sets. This analysis also indicates potential for use of monensin in beef cow production systems, but further research is needed to elucidate the effects on DMI and milk production in beef cows.

273 Effect of Feedlot Implant Dose and Terminal Window Timing on Heifer Performance and Carcass Characteristics

Feedlot heifers (n = 3,778; initial BW = 310 kg; SD = 28 kg) were utilized in a 3 x 2 factorial arrangement (9 pens/treatment) to investigate increasing implant dose and terminal window (TW) timing on growth and carcass merit. Component with Tylan® implant dose treatments were 1. Initial TE-IH [80 mg trenbolone acetate (TBA), 8 mg estradiol (E2)] and terminal TE-H (140 mg TBA, 14 mg E2; IH/H), 2. Initial TE-IH and terminal TE-200 (200 mg TBA, 20 mg E2; IH/200), or 3. Initial TE-200 and terminal TE-200 (200/200). Heifers were fed 171 d with terminal implant administered 100 or 60 d prior to slaughter; initial implant window was inverse (71 or 111 d) to TW. Data were analyzed as a mixed model with block included as a random effect. No significant dose x TW interactions occurred for growth or carcass characteristics (P ≥ 0.06) therefore, main effects are presented. Terminal window treatments resulted in similar (P &gt; 0.25) live performance. Heifers reimplanted 60 d prior to slaughter had improved (P &lt; 0.05) marbling score and lower YG2 carcasses. Final weight, gain, HCW, yield, and LM area increased (linear; P &lt; 0.05), while marbling score and fat thickness decreased (linear; P &lt; 0.05) with increasing heifer implant dose. Heifers implanted with IH/200 had lower (P &lt; 0.05) DMI compared to IH/H. IH/200 and 200/200 had improved (+2.1%; P &lt; 0.05) efficiency compared to IH/H. HCW for 200/200 was +3.2 and 5.5 kg greater than IH/200 and IH/H, respectively. 200/200 were leaner with +7.4% YG 1&2 and -5.4% YG 4&5, but -8.5% Prime & Choice carcass compared to IH/H. Shortening TW from 100 to 60 d prior to slaughter did not alter growth performance. Increased implant dose in heifers improved gain, efficiency, HCW and yield with some quality grade considerations.

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Perioperative intravenous contrast administration and the incidence of acute kidney injury after major gastrointestinal surgery: prospective, multicentre cohort study

BACKGROUND

This study aimed to determine the impact of preoperative exposure to intravenous contrast for CT and the risk of developing postoperative acute kidney injury (AKI) in patients undergoing major gastrointestinal surgery.

METHODS

This prospective, multicentre cohort study included adults undergoing gastrointestinal resection, stoma reversal or liver resection. Both elective and emergency procedures were included. Preoperative exposure to intravenous contrast was defined as exposure to contrast administered for the purposes of CT up to 7 days before surgery. The primary endpoint was the rate of AKI within 7 days. Propensity score-matched models were adjusted for patient, disease and operative variables. In a sensitivity analysis, a propensity score-matched model explored the association between preoperative exposure to contrast and AKI in the first 48 h after surgery.

RESULTS

A total of 5378 patients were included across 173 centres. Overall, 1249 patients (23·2 per cent) received intravenous contrast. The overall rate of AKI within 7 days of surgery was 13·4 per cent (718 of 5378). In the propensity score-matched model, preoperative exposure to contrast was not associated with AKI within 7 days (odds ratio (OR) 0·95, 95 per cent c.i. 0·73 to 1·21; P = 0·669). The sensitivity analysis showed no association between preoperative contrast administration and AKI within 48 h after operation (OR 1·09, 0·84 to 1·41; P = 0·498).

CONCLUSION

There was no association between preoperative intravenous contrast administered for CT up to 7 days before surgery and postoperative AKI. Risk of contrast-induced nephropathy should not be used as a reason to avoid contrast-enhanced CT.

Harnessing Smartphone Technology to Improve Patient Engagement: Codesigning and Testing The SecondEars Consultation Audio Recording App for People With Cancer

Background: Oncology consultations can be overwhelming and information-dense. Consultation audio recordings are an effective method to promote patient participation, improve patients' recall and understanding of medical information, and can increase engagement and support through sharing with family and friends. Innovative m-health technologies such as the SecondEars consultation audio recording mobile app provide a patient-designed and controlled audio recording solution while ensuring security and legal protection for clinicians. To ensure the SecondEars app meets the needs of patients, family, clinicians and hospital administrators, the opinions of stakeholders and end users are integral to the concept and study creation, design, and testing processes. Aim: To use key elements of codesign methodology to develop and test SecondEars, a mobile app that allows patients to audio record their consultations within a clinical oncology setting. Methods: The SecondEars app concept began with consumer suggestions that consultation audio recording be used as standard practice of care using patient-driven (use is controlled/determined by patients) technologies. An app solution was conceived and the concept discussed through engagement of consumers as part of the project and research codesign team. Key health service stakeholders comprising representatives from: legal, information technology (IT), clinical service leads, digital strategy, and health information services (HIS), provided project oversight and core legal and data management requirements. The Scrum management framework was used to structure the codesign process during the development and testing phase. Six workshops were run to facilitate further user input with regard to specific app functionality and design. A wireframe version was developed and tested by the codesign team in the final workshop. Feedback was incorporated into a prototype which was circulated for acceptance testing. Results: Twenty people participated in the stakeholder engagement and workshops, comprising: oncology consumers, researchers, IT, HIS, app developers, and oncology health professionals. Key specifications necessitated that SecondEars be patient-driven, secure and confidential, have clear legal guidelines regarding audio recording sharing, be integrated with medical records, and require minimal upfront and ongoing resources. Seven people tested the prototype app during user acceptance testing and gave positive and constructive feedback. A final version of the app was then made available for clinical testing. Conclusion: The SecondEars consultation audio recording app has been successfully created by and for patients. This app gives patients permission and autonomy to audio record and share their consultations responsibly, while maintaining legal protection for clinicians. This app is currently being tested in a clinical setting prior to conducting an implementation study.

Functional characterization of the citrus canker susceptibility gene CsLOB1

Xanthomonas citri ssp. citri (Xcc) is an important plant-pathogenic bacterium that causes citrus canker disease worldwide. PthA, a transcriptional activator-like (TAL) effector, directs the expression of the canker susceptibility gene CsLOB1. Here, we report our recent progress in the functional characterization of CsLOB1. Subcellular localization analysis of CsLOB1 protein in citrus protoplast revealed that CsLOB1 is primarily localized in the nucleus. We showed that CsLOB1 expression driven by dexamethasone (DEX) in CsLOB1-GR transgenic plants is associated with pustule formation following treatment with DEX. Pustule formation was not observed in DEX-treated wild-type plants and in non-treated CsLOB1-GR transgenic plants. Water soaking is typically associated with symptoms of citrus canker. Weaker water soaking was observed with pustule formation in CsLOB1-GR transgenic plants following DEX treatment. When CsLOB1-GR-transgenic Duncan grapefruit leaves were inoculated with Xcc306ΔpthA4 and treated with DEX, typical canker symptoms, including hypertrophy, hyperplasia and water soaking symptoms, were observed on DEX-treated transgenic plant leaves, but not on mock-treated plants. Twelve citrus genes that are induced by PthA4 are also stimulated by the DEX-induced expression of CsLOB1. As CsLOB1 acts as a transcriptional factor, we identified putative targets of CsLOB1 via bioinformatic and electrophoretic mobility shift assays. Cs2g20600, which encodes a zinc finger C3HC4-type RING finger protein, has been identified to be a direct target of CsLOB1. This study advances our understanding of the function of CsLOB1 and the molecular mechanism of how Xcc causes canker symptoms via CsLOB1.

Hepatic Hilar Lymph Node Reactivity at Kasai Portoenterostomy for Biliary Atresia: Correlations With Age, Outcome, and Histology of Proximal Biliary Remnant

We hypothesized that if infection is the proximate cause of congenital biliary atresia, an appropriate response to antigen would occur in lymph nodes contiguous with the biliary remnant. We compared the number of follicular germinal centers (GC) in 79 surgically excised hilar lymph nodes (LN) and 27 incidentally discovered cystic duct LNs in 84 subjects at the time of hepatic portoenterostomy (HPE) for biliary atresia (BA) to autopsy controls from the pancreaticobiliary region of non-septic infants >3 months old at death. All 27 control LN lacked GC, a sign in infants of a primary response to antigenic stimulation. GC were found in 53% of 106 LN in 56 of 84 subjects. Visible surgically excised LN contiguous with the most proximal biliary remnants had 1 or more well-formed reactive GC in only 26/51 subjects. Presence of GC and number of GC/LN was unrelated to age at onset of jaundice or to active fibroplasia in the biliary remnant but was related to older age at HPE. Absent GC in visible and incidentally removed cystic duct LNs predicted survival with the native liver at 2 and 3 years after HPE, P = .03, but significance was lost at longer intervals. The uncommon inflammatory lesions occasionally found in remnants could be secondary either to bile-induced injury or secondary infection established as obstruction evolves. The absence of consistent evidence of antigenic stimulation in LN contiguous with the biliary remnant supports existence of at least 1 major alternative to infection in the etiology of biliary atresia.

Xanthomonas and the TAL Effectors: Nature's Molecular Biologist

Agrobacterium, due to the transfer of T-DNA to the host genome, is known as nature's genetic engineer. Once again, bacteria have led the way to newfound riches in biotechnology. Xanthomonas has emerged as nature's molecular biologist as the functional domains of the sequence-specific DNA transcription factors known as TAL effectors were characterized and associated with the cognate disease susceptibility and resistance genes of plants.

TAL effectors and the executor R genes

Transcription activator-like (TAL) effectors are bacterial type III secretion proteins that function as transcription factors in plants during Xanthomonas/plant interactions, conditioning either host susceptibility and/or host resistance. Three types of TAL effector associated resistance (R) genes have been characterized-recessive, dominant non-transcriptional, and dominant TAL effector-dependent transcriptional based resistance. Here, we discuss the last type of R genes, whose functions are dependent on direct TAL effector binding to discrete effector binding elements in the promoters. Only five of the so-called executor R genes have been cloned, and commonalities are not clear. We have placed the protein products in two groups for conceptual purposes. Group 1 consists solely of the protein from pepper, BS3, which is predicted to have catalytic function on the basis of homology to a large conserved protein family. Group 2 consists of BS4C-R, XA27, XA10, and XA23, all of which are relatively short proteins from pepper or rice with multiple potential transmembrane domains. Group 2 members have low sequence similarity to proteins of unknown function in closely related species. Firm predictions await further experimentation on these interesting new members to the R gene repertoire, which have potential broad application in new strategies for disease resistance.

Genomic and proteomic analysis of Schizaphis graminum reveals cyclophilin proteins are involved in the transmission of cereal yellow dwarf virus

Yellow dwarf viruses cause the most economically important virus diseases of cereal crops worldwide and are transmitted by aphid vectors. The identification of aphid genes and proteins mediating virus transmission is critical to develop agriculturally sustainable virus management practices and to understand viral strategies for circulative movement in all insect vectors. Two cyclophilin B proteins, S28 and S29, were identified previously in populations of Schizaphisgraminum that differed in their ability to transmit the RPV strain of Cereal yellow dwarf virus (CYDV-RPV). The presence of S29 was correlated with F2 genotypes that were efficient virus transmitters. The present study revealed the two proteins were isoforms, and a single amino acid change distinguished S28 and S29. The distribution of the two alleles was determined in 12 F2 genotypes segregating for CYDV-RPV transmission capacity and in 11 genetically independent, field-collected S. graminum biotypes. Transmission efficiency for CYDV-RPV was determined in all genotypes and biotypes. The S29 isoform was present in all genotypes or biotypes that efficiently transmit CYDV-RPV and more specifically in genotypes that efficiently transport virus across the hindgut. We confirmed a direct interaction between CYDV-RPV and both S28 and S29 using purified virus and bacterially expressed, his-tagged S28 and S29 proteins. Importantly, S29 failed to interact with a closely related virus that is transported across the aphid midgut. We tested for in vivo interactions using an aphid-virus co-immunoprecipitation strategy coupled with a bottom-up LC-MS/MS analysis using a Q Exactive mass spectrometer. This analysis enabled us to identify a third cyclophilin protein, cyclophilin A, interacting directly or in complex with purified CYDV-RPV. Taken together, these data provide evidence that both cyclophilin A and B interact with CYDV-RPV, and these interactions may be important but not sufficient to mediate virus transport from the hindgut lumen into the hemocoel.

Surface-enhanced charge-density-wave instability in underdoped Bi2Sr(2-x)La(x)CuO(6+δ)

Neutron and X-ray scattering experiments have provided mounting evidence for spin and charge ordering phenomena in underdoped cuprates. These range from early work on stripe correlations in Nd-LSCO to the latest discovery of charge-density-waves in YBa2Cu3O(6+x). Both phenomena are characterized by a pronounced dependence on doping, temperature and an externally applied magnetic field. Here, we show that these electron-lattice instabilities exhibit also a previously unrecognized bulk-surface dichotomy. Surface-sensitive electronic and structural probes uncover a temperature-dependent evolution of the CuO2 plane band dispersion and apparent Fermi pockets in underdoped Bi2 Sr(2-x) La(x) CuO(6+δ) (Bi2201), which is directly associated with an hitherto-undetected strong temperature dependence of the incommensurate superstructure periodicity below 130 K. In stark contrast, the structural modulation revealed by bulk-sensitive probes is temperature-independent. These findings point to a surface-enhanced incipient charge-density-wave instability, driven by Fermi surface nesting. This discovery is of critical importance in the interpretation of single-particle spectroscopy data, and establishes the surface of cuprates and other complex oxides as a rich playground for the study of electronically soft phases.

Cohort analysis of directly observed treatment outcomes for tuberculosis patients in urban Pakistan

BACKGROUND

This quasi-experimental cohort study aimed to evaluate World Health Organization (WHO) defined tuberculosis (TB) treatment outcomes for patients under directly observed treatment at a health facility (clinic DOT) or at home (family DOT) in urban Pakistan.

METHODS

We enrolled 582 sputum smear-positive TB patients being treated by either clinic DOT (n = 295) or family DOT (n = 287) in 11 treatment centres. Patients and/or family members were interviewed for baseline measurements. WHO-defined treatment outcomes were evaluated at the end of treatment. Proportions of 'cured' patients were computed. A log-binomial model was used to evaluate the associations of various factors with 'cured' status.

RESULTS

The proportion of 'cured' patients was respectively 66% and 34% in the clinic DOT and family DOT groups (risk difference 0.32; 95%CI 0.24-0.39). Patients on clinic DOT were more likely to achieve cure (adjusted relative risk [RR(adj)] 1.85; 95%CI 1.43-2.39) than those on family DOT, as were patients satisfied with their health care worker's attitude (RR(adj) 5.73; 95%CI 2.54-12.96).

CONCLUSION

Clinic DOT nearly doubled the proportion of cured patients compared to family DOT. Efforts to improve care-provider attitudes to enhance patient satisfaction, and effective implementation of the WHO's public-private mix approach, may enhance TB control in this and similar settings.

Rice xa13 recessive resistance to bacterial blight is defeated by induction of the disease susceptibility gene Os-11N3

The rice (Oryza sativa) gene xa13 is a recessive resistance allele of Os-8N3, a member of the NODULIN3 (N3) gene family, located on rice chromosome 8. Os-8N3 is a susceptibility (S) gene for Xanthomonas oryzae pv oryzae, the causal agent of bacterial blight, and the recessive allele is defeated by strains of the pathogen producing any one of the type III effectors AvrXa7, PthXo2, or PthXo3, which are all members of the transcription activator-like (TAL) effector family. Both AvrXa7 and PthXo3 induce the expression of a second member of the N3 gene family, here named Os-11N3. Insertional mutagenesis or RNA-mediated silencing of Os-11N3 resulted in plants with loss of susceptibility specifically to strains of X. oryzae pv oryzae dependent on AvrXa7 or PthXo3 for virulence. We further show that AvrXa7 drives expression of Os-11N3 and that AvrXa7 interacts and binds specifically to an effector binding element within the Os-11N3 promoter, lending support to the predictive models for TAL effector binding specificity. The result indicates that variations in the TAL effector repetitive domains are driven by selection to overcome both dominant and recessive forms of resistance to bacterial blight in rice. The finding that Os-8N3 and Os-11N3 encode closely related proteins also provides evidence that N3 proteins have a specific function in facilitating bacterial blight disease.

Rice xa13 recessive resistance to bacterial blight is defeated by induction of the disease susceptibility gene Os-11N3

The rice (Oryza sativa) gene xa13 is a recessive resistance allele of Os-8N3, a member of the NODULIN3 (N3) gene family, located on rice chromosome 8. Os-8N3 is a susceptibility (S) gene for Xanthomonas oryzae pv oryzae, the causal agent of bacterial blight, and the recessive allele is defeated by strains of the pathogen producing any one of the type III effectors AvrXa7, PthXo2, or PthXo3, which are all members of the transcription activator-like (TAL) effector family. Both AvrXa7 and PthXo3 induce the expression of a second member of the N3 gene family, here named Os-11N3. Insertional mutagenesis or RNA-mediated silencing of Os-11N3 resulted in plants with loss of susceptibility specifically to strains of X. oryzae pv oryzae dependent on AvrXa7 or PthXo3 for virulence. We further show that AvrXa7 drives expression of Os-11N3 and that AvrXa7 interacts and binds specifically to an effector binding element within the Os-11N3 promoter, lending support to the predictive models for TAL effector binding specificity. The result indicates that variations in the TAL effector repetitive domains are driven by selection to overcome both dominant and recessive forms of resistance to bacterial blight in rice. The finding that Os-8N3 and Os-11N3 encode closely related proteins also provides evidence that N3 proteins have a specific function in facilitating bacterial blight disease.

A systematic approach for screening glass containers and elastomeric closures for use with parenteral solutions

The purpose of this study is to systematically screen different packaging options for a particular pharmaceutical application using a multi-stage strategy. This approach includes initial screening of packaging options with the pharmaceutical formulation testing for critical chemical attributes (Stage 1), assessing compendial compliance of the sterile pharmaceutical product contained within the packaging options identified (Stage 2), testing of the experimental product under accelerated storage conditions (Stage 3), and subsequent confirmation testing through long-term studies designed to evaluate the stability characteristics of the product (Stage 4). Water for injection was evaluated in 19 different Type I glass vial and elastomeric closure configurations. Based on the results for Stage 1, 13 configurations were eliminated for the reason that pH data were at or exceed the United States Pharmacopeia (USP) limits after a single sterilization cycle, or that pH data had markedly variable results. Additional configurations--newly available European Pharmacopoeia (EP) stoppers--were introduced in Stage 2 based on the data available from Stage 1 in regard-to the effect of the glass vials. During Stage 2, four configurations were eliminated because pH data was at the USP limits or failed EP acidity or alkalinity tests. For Stage 3, one configuration was eliminated because pH results exceeded the USP limits after 3 months at 40 degrees C. It was concluded during Stage 4 that a SiO2-coated Type I glass vial configured with a fluropolymer-coated elastomeric closure successfully met USP pH and all EP and Japanese Pharmacopoeia compendia specifications after 12 months at 5- degrees C, 25- degrees C, 30- degrees C, and 40- degrees C storage.

Myelodysplastic syndrome after autologous peripheral blood stem cell transplantation for multiple myeloma

Long-term survivors after autologous peripheral blood stem cell transplantation (APBSCT) for lymphoma or Hodgkin's disease are known to have a high risk of developing myelodysplastic syndrome (MDS), but the risk of MDS is not clear for patients transplanted for myeloma. We reviewed the outcomes for 82 myeloma patients who underwent APBSCT at our center. The group included 47 men and 35 women of median age 56 years (range: 37-74 years). Median time from diagnosis to APBSCT was 8.2 months (range: 2.6-86.1 months). Before coming to transplantation, 28% had received oral melphalan (MEL), 98% received other chemotherapy and 34% received radiation. A single APBSCT was provided for 68, and 32% underwent APBSCT more than once. High-dose MEL alone was used as the preparative regimen for 83%, and the remainder received at least one APBSCT with a more intensive preparative regimen. Ten patients (12%) developed MDS. The 5-year cumulative incidence is 18% (95% confidence interval, 9-30%). There were no demographic factors associated with an increased risk of developing MDS. Median survival after the diagnosis of MDS was 18 months. There is a relatively high risk of MDS after APBSCT for myeloma, and optimal therapy has not been established for these patients.

Review of specialist dietitian services in patients with inherited metabolic disease in the United Kingdom

INTRODUCTION

Dietary management forms the mainstay of treatment for many inherited metabolic diseases (IMDs) and specialist dietitians play a crucial role in the multi-disciplinary core team for these patients. Professional concerns have been expressed that the current clinical workforce is inadequate for meeting current and future service demands. The aim of this work was to describe the provision of specialist dietetics to patients with IMD as part of a national needs assessment and review.

MATERIALS AND METHODS

The 24 main specialist providers and 27 specialist dietitians were surveyed by a questionnaire. A focus group of three specialist dietitians was also held to explore the roles of specialist dietitians in greater depth.

RESULTS

Responses were received from all 24 specialist service providers and 63% of 27 specialist dietitians. The majority of service providers (92%) have specialist dietitians, but only eight services had more than one whole time equivalent (33%). Key roles were management of complex dietary regimens, prevention and management of metabolic crises, education, co-ordination of care, clinical audit and research. Although highly qualified, there is currently no clear formal career structure or training pathway for dietitians in IMDs.

CONCLUSION

Specialist dietitians have important clinical and leadership roles in managing IMD but specialist services are thinly spread. There is a need for access to formal education, training and support programmes. The clinical workforce needs expansion to provide more comprehensive and equitable services.

Diabetes knowledge, beliefs and practices among people with diabetes attending a university hospital in Karachi, Pakistan

A structured questionnaire on knowledge, beliefs and practices regarding diabetes was administered to 199 persons with diabetes (92.5% type 2) attending the Aga Khan University Hospital, Karachi. Mean age [standard deviation (SD)] was 53 (11) years. Mean duration of diabetes (SD) was 8 (7) years in men and 9 (6) years in women. Men had a significantly better knowledge score than women (P = 0.02); there was no significant difference in the beliefs and practices scores. Scores were classed as good (> 60%) in only 13.6% of participants for knowledge, 17.6% for beliefs and 11.2% for practices. About 38% of the participants had received education on diabetes care.

Identification of the growth arrest and DNA damage protein GADD34 in the normal human heart and demonstration of alterations in expression following myocardial ischaemia

Growth arrest and DNA damage protein 34 (GADD34) is a multifunctional protein upregulated in response to cellular stress and is believed to mediate DNA repair and restore protein synthesis. In the present study we have examined GADD34 immunoreactivity in human myocardial tissue at defined survival times following cardiac arrest and determined alterations in expression following ischaemia. In the normal human heart, GADD34 immunoreactivity was generally intense and present within most cells. GADD34 immunoreactivity was downregulated in tissue displaying ischaemic damage and remained intense in adjacent non-infarcted tissue. Unlike brain, GADD34 was not found to be upregulated in the peri-infarct zone. Cells displaying apoptotic changes were located in regions displaying reduced GADD34 immunoreactivity. In the brain, it is thought that GADD34 supports re-initiation of protein synthesis following ischaemia. Similarly, GADD34 may perform important functions in cardiac tissue in response to ischaemia.

Inhibition of resistance gene-mediated defense in rice by Xanthomonas oryzae pv. oryzicola

Xanthomonas oryzae pv. oryzae and the closely related X. oryzae pv. oryzicola cause bacterial blight and bacterial leaf streak of rice, respectively. Although many rice resistance (R) genes and some corresponding avirulence (avr) genes have been characterized for bacterial blight, no endogenous avr/R gene interactions have been identified for leaf streak. Genes avrXa7 and avrXa10 from X. oryzae pv. oryzae failed to elicit the plant defense-associated hypersensitive reaction (HR) and failed to prevent development of leaf streak in rice cultivars with the corresponding R genes after introduction into X. oryzae pv. oryzicola despite the ability of this pathovar to deliver an AvrXa10:Cya fusion protein into rice cells. Furthermore, coinoculation of X. oryzae pv. oryzicola inhibited the HR of rice cultivar IRBB10 to X. oryzae pv. oryzae carrying avrXa10. Inhibition was quantitative and dependent on the type III secretion system of X. oryzae pv. oryzicola. The results suggest that one or more X. oryzae pv. oryzicola type III effectors interfere with avr/R gene-mediated recognition or signaling and subsequent defense response in the host. Inhibition of R gene-mediated defense by X. oryzae pv. oryzicola may explain, in part, the apparent lack of major gene resistance to leaf streak.

Fat intakes of children with PKU on low phenylalanine diets

BACKGROUND

As part of a study on the effects of a fat-supplemented phenylalanine (phe)-free protein substitute on the fatty acid status of children with phenylketonuria (PKU), the adequacy of the diets of children aged 1-10 years for fat and essential fatty acids (EFA) was assessed.

METHODS

Subjects randomized in a 1 : 1 ratio to a phe-free protein substitute supplemented with EFA (test-treatment group) or a phe-free, fat-free protein substitute (control group) for 20 weeks. 3-day semi-weighed records of food intakes collected at the end of the study period.

RESULTS

Total fat and alpha-linolenic acid (alpha-LA) intakes were found to be poor in the control group (n = 19). Those in the test-treatment group (n = 24) had higher fat and EFA intakes (P < 0.05), bringing intakes closer to population norms. The youngest children (<5 years of age) in the control group appeared to be especially vulnerable to poor fat intakes because of the restricted diversity of their diets and, regardless of age, alpha-LA intakes by this group were poor compared with the non-PKU population.

CONCLUSIONS

The quantity and quality of fat in the diets of children with PKU, in particular young children, should be given careful consideration in trying to optimize the ratio of linoleic acid: alpha-LA in their diets and in satisfying the requirements of this group for fat and alpha-LA.

Health and social impacts of improved stoves on rural women: a pilot intervention in Sindh, Pakistan

To assess the acceptability, social and health impacts of improved stoves among women. A cross-sectional study was conducted from April to May 2002 among households using improved stoves in the two villages of District Thatta and Hyderabad, Sindh, Pakistan. A questionnaire was administered to 45 women using improved stoves named Smoke Free Stoves (SFS). The same questionnaire was administered to a sample of 114 women, using Traditional Stoves (TS). Carbon monoxide (CO) levels were measured in a sample of both groups. Multivariate analysis was carried out to adjust for confounders. In addition, focus group discussions (FGDs) were conducted to evaluate the perception of women regarding acceptability and impact of SFS on women. A majority of women reported that SFS produce less smoke and have a beneficial impact on their health. In the multivariate analysis, symptoms of dry cough (AOR=0.61; 95% CI 0.26-1.41), sneezing (AOR=0.54; 95% CI 0.22-1.30) and tears while cooking (TWC) (AOR=0.51; 95% CI 0.21-1.21) are less likely to occur in women using SFS compared to TS. However, the results were not statistically significant possibly due to the small sample. The mean (+/-s.e.) CO levels were 15.4+/-3.4 ppm in SFS and 28.5+/-5.7 ppm in TS kitchens with a mean difference of -13.1 (95% CI -29.5 and 3.2). The results indicate a trend favorable for SFS and suggest that a larger scale project should be undertaken to reach to a definitive conclusion, ideally using a longitudinal design.

PRACTICAL IMPLICATIONS

In order to enhance IAQ in kitchens in developing regions of the world stoves for burning of biomass should be constructed in a way that the emission of fuel gases are low. In this way the risk of negative health effects will be reduced.

Identification and characterization of IS1112 and IS1113 insertion element sequences in Xanthomonas oryzae pv. oryzae

Two new insertion sequences (IS1112 and IS1113) were identified in the genome of Xanthomonas oryzae pv. oryzae, the causal agent of bacterial blight of rice. Three copies of IS1112 were trapped, one containing 1052-bp and the other two with 1055-bp. They all have 25-bp imperfect inverted repeats with a 3-bp duplication at the site of insertion. They contain an open reading frame (ORF) of 317 and 318 amino acid residues, respectively. IS1113 is 1306-bp, contains 25-bp imperfect terminal inverted repeats, and is flanked by a 9-bp direct repeat at the site of insertion. It contains an ORF of 395 amino acid residues.

Quality of pharmacies in Pakistan: a cross-sectional survey

OBJECTIVE

To estimate the proportion of pharmacies meeting licensing requirements and to identify factors associated with these pharmacies in urban Rawalpindi, Pakistan.

DESIGN

Cross-sectional questionnaire survey conducted during July-September 2001, of 311 pharmacies selected from a drug company list of 506.

SETTING

Free-standing licensed and unlicensed pharmacies in urban Rawalpindi.

STUDY PARTICIPANTS

A pharmacist or (if unavailable) the most experienced drug seller.

RESULTS

The proportion of pharmacies meeting licensing requirements was 19.3% [95% C.I (confidence interval): 15.1, 24.2], with few qualified persons (22%). Only 10% had a temperature-monitoring device and 4% an alternative power supply for refrigerators (present in 76% of pharmacies). Associated with pharmacies meeting licensing requirements was the knowledge of not giving co-trimoxazole, a prescription drug, without prescription [OR (odds ratio) = 2.0; 95% CI: 1.1, 3.6], knowledge of the temperature range for vaccines (OR = 2.6; 95% CI: 1.4, 4.8), availability of vaccines (OR = 2.8; 95% CI: 2.8, 18.4), and alternative power supply for the refrigerator (OR = 6.0; 95% CI: 1.5, 23.7). The practice of selling drugs without prescription was not found to have a significant association (OR = 1.1; 95% CI: 0.5, 2.3); however, it did show a trend indicating discrepancy between knowledge and practice.

CONCLUSIONS

Most drug sellers had fragmentary knowledge regarding drug dispensing and storage, and improper dispensing practices. There is a need to enforce existing legislation with training programmes directed towards drug sellers and to involve the pharmaceutical industry, which plays an important role in influencing pharmacy knowledge and practices.

Up-regulation of a growth arrest and DNA damage protein (GADD34) in the ischaemic human brain: implications for protein synthesis regulation and DNA repair

GADD34 is a growth arrest and DNA damage inducible gene up-regulated in response to DNA damage, cell cycle arrest and apoptosis. It is thought that GADD34 may play a crucial role in cell survival in ischaemia. GADD34 expression was assessed immunohistochemically in post-mortem human hippocampal tissue obtained from patients surviving for defined periods (0-24 h; 24 h-7 days) after a cardiac arrest and in age-matched control subjects. In control brain, cytoplasm staining in GADD34 immunopositive cells was faint but present throughout the hippocampus and cortex. There was minimal change in GADD34 expression in the group surviving 0-24 h after cardiac arrest. However GADD34 immunostaining was markedly increased in selectively vulnerable regions in the 24 h-7 day survival group. Increased GADD34 staining was present in ischaemic neurones and in some morphologically normal neurones after cardiac arrest. Extensive ischaemic damage was found to correlate with elevated GADD34 immunostaining in the CA1 layer of the hippocampus (**P < 0.0016). In addition, GADD34 was found to colocalize with proliferating cell nuclear antigen in some neurones. The up-regulation of GADD34 in response to global ischaemia in the human brain plus its influence on protein synthesis and DNA repair suggests that this protein may have the potential to influence cell survival.

Risk factors for non-fatal myocardial infarction in young South Asian adults

OBJECTIVE

To determine the risk factors for premature myocardial infarction among young South Asians.

DESIGN AND SETTING

Case-control study in a hospital admitting unselected patients with non-fatal acute myocardial infarction.

METHODS AND SUBJECTS

Risk factor assessment was done in 193 subjects aged 15-45 years with a first acute myocardial infarct, and in 193 age, sex, and neighbourhood matched population based controls.

RESULTS

The mean (SD) age of the subjects was 39 (4.9) years and 326 (84.5%) were male. Current smoking (odds ratio (OR) 3.82, 95% confidence interval (CI) 1.47 to 9.94), use of ghee (hydrogenated vegetable oil) in cooking (OR 3.91, 95% CI 1.52 to 10.03), raised fasting blood glucose (OR 3.32, 95% CI 1.21 to 8.62), raised serum cholesterol (OR 1.67, 95% CI 1.14 to 2.45 for each 1.0 mmol/l increase), low income (OR 5.05, 95% CI 1.71 to 14.96), paternal history of cardiovascular disease (OR 4.84, 95% CI 1.42 to 16.53), and parental consanguinity (OR 3.80, 95% CI 1.13 to 1.75) were all independent risk factors for acute myocardial infarction in young adults. Formal education versus no education had an independently protective effect on acute myocardial infarction (OR 0.04, 95% CI 0.01 to 0.35).

CONCLUSIONS

Tobacco use, ghee intake, raised fasting glucose, high cholesterol, paternal history of cardiovascular disease, low income, and low level of education are associated with premature acute myocardial infarction in South Asians. The association of parental consanguinity with acute myocardial infarction is reported for the first time and deserves further study.

Macrovascular complications and their associated factors among persons with type 2 diabetes in Karachi, Pakistan--a multi-center study

OBJECTIVE

To assess the prevalence of macrovascular complications and factors associated with these complications among persons with Type 2 diabetes.

METHODS

A multi-center, cross-sectional survey was conducted in three diabetes clinics of Karachi from November 2000 to April 2001. Six hundred and seventy-two persons were interviewed to determine the prevalence of ischemic heart disease (IHD), cerebrovascular disease (CVA) and diabetic foot (DF). Demographic data and co-variables obtained include age, sex, duration of diabetes, body mass index (BMI), smoking status, exercise habits and history of hypertension (HTN).

RESULTS

Overall, 26.4%, 6.8% and 3.9% of individuals had IHD, CVA and DF respectively. Multiple logistic regression analysis showed that subjects having IHD were more likely to have HTN (AOR=1.88, 95% CI 1.31-2.69), not performing regular exercise (AOR = 2.09, 95% CI 1.39-3.17) and be current smokers (AOR = 1.85, 95% CI 1.10-3.10) Subjects having CVA were more likely to have diabetes for more than 5 years (AOR = 1.94, 95% CI 0.97-3.87). Males were more prone than females to have DF (AOR = 3.48, 95% CI 1.46-8.31). Those who had DF were more likely to have diabetes for more than 5 years (AOR = 3.29, 95% CI 1.09-9.89) and of reporting current smoking (AOR = 4.01, 95% CI 1.49-10.71).

CONCLUSION

Large proportions of persons with Type 2 diabetes were suffering from preventable macrovascular complications in Karachi, Pakistan. There is a need to develop risk factor modification interventions to reduce the impact of long-term complications.

Animal disease surveillance: prospects for development in Pakistan

Surveillance is a continuous and systematic process of collection, consolidation, analysis, interpretation and dissemination of relevant information on the occurrence of health problems. Data from surveillance can be used to calculate the incidence and prevalence of events, to categorise disease distribution by relevant characteristics, to guide investigations into the occurrence of epidemic and endemic disease, and to contribute essential information for the design and evaluation of effective disease prevention and control programmes. Disease surveillance systems should also respond to the information needs of government agencies, agribusiness, academia, producers and consumers. However, in most developing countries, including Pakistan, animal disease surveillance systems are not well developed, and do not produce a desirable quality of information on disease status and trends. In this paper, the authors describe various facets of a generic surveillance system and propose a structure for a surveillance system at district level. Such systems have been designed and implemented for public health surveillance in a number of countries, and may be developed to meet the needs of veterinary public health.

Proliferation and neuronal differentiation of mitotically active cells following traumatic brain injury

Recent studies have identified endogenous neural stem cells in adult rodent brains. The present study characterizes the early response of mitotically active cells in the brain to traumatic brain injury. Animals were subjected to lateral fluid percussion injury and sacrificed at various times after injury. To examine increases in cell proliferation animals were injected with the mitotic marker bromodeoxyuridine (BrdU) 24 h before sacrifice. Increased numbers of mitotically active cells were observed at 2 days in the subgranular zone (SGZ) and the subependymal zone (SEZ) under the injury site. To characterize the differentiation potential of these cells, animals were injected with BrdU 18 and 20 h after injury, then sacrificed at multiple time points after injury. Histologically, co-localization with betaIII-tubulin (neuronal marker) and BrdU was evident at 10 and 15 days postinjury in the SGZ. Flow cytometry analysis was used to quantitatively assess neurogenesis in the SEZ. Animals were sacrificed 1, 5, or 10 days after injury and tissue sections extracted, grown in tissue culture for 24 h, fixed, and stained for nestin and betaIII-tubulin to identify newly formed neurons. The percentage of cells expressing both markers was determined using flow cytometry analysis. There was a significant increase in newly differentiated neurons by 10 days postinjury in the SEZ. Thus, we conclude that traumatic brain injury stimulates an increase in proliferation of endogenous neural stem/progenitor cells and that a significant number of these express a neuronal marker. This response may be the brain's way of trying to heal itself after injury.

Clinical decision making Part I: errors of commission and omission

Clinical decision making refers to any act of diagnosis that leads to a decision regarding prognosis, treatment, referral or counseling. It has long been recognized that diagnostic probabilities influence perceptions and judgements in medical practice. However, so do ethical values affect clinical judgements, even if these lead to adverse consequences: for example, to judge a well person sick is considered "more ethical" than to judge a sick person well. This dilemma confronts us also when having to choose between what are called Type 1 and Type 2 errors, and the consequences of either may be serious. Other factors that should be taken into account, as they can affect the "pretest likelihood" or "prior probability" of disease and the error rates obtained, include the individual circumstances of the patient (e.g. socioeconomic background), the organizational setting (e.g. patient volume, cultural practices and norms), and system differences (e.g. fee for service versus salaried service). In Part II of this two-part series,we explore in greater depth the mathematical basis for why various diagnostic procedures perform differently in different settings.

Factors affecting utilization of antenatal care among reproductive age group women (15-49 years) in an urban squatter settlement of Karachi

OBJECTIVES

To describe the socio-demographic characteristics and utilization pattern of antenatal care of reproductive age group women (15-49 years) in an urban squatter settlement of Karachi and to assess and compare the knowledge on antenatal care between women who received and those who did not receive antenatal care.

METHODS

A community-based cross sectional survey was conducted and a sample of 323 women was taken through systematic sampling. Two hundred ninety five (295) women were interviewed and 28 were excluded, as they never experienced a pregnancy. Socio-demographic characteristics and knowledge about antenatal care were compared on the basis of having received and not having received antenatal care, utilizing bivariate and multivariate analysis.

RESULTS

Multivariate logistic regression analysis showed that higher income women were twice likely to use antenatal care services (AOR = 2.11 95% CI 1.14-3.89) than those of lower income. Women receiving antenatal care were more knowledgeable about the importance of dietary protein (AOR = 1.97 95% CI 1.16-3.33), intake of green leafy vegetables for the prevention of anemia (AOR = 2.34 95% CI 1.33-4.11), and reporting danger signs (AOR = 2.25 95% CI 1.07-4.74).

CONCLUSION

Women of reproductive age need to recognize the importance of receiving antenatal care in the community. Uplifting the socio-economic status and literacy rate of women is required to provide community based education. There is a potential need to increase nutrition education, highlighting the importance of iron supplementation, appropriate food during pregnancy and recognition of signs and symptoms and danger signs in pregnancy.

Evaluation of a water, sanitation, and hygiene education intervention on diarrhoea in northern Pakistan

OBJECTIVE

Inadequate water and sanitation services adversely affect the health and socioeconomic development of communities. The Water and Sanitation Extension Programme (WASEP) project, undertaken in selected villages in northern Pakistan between 1997 and 2001, was designed to deliver an integrated package of activities to improve potable water supply at village and household levels, sanitation facilities and their use, and awareness and practices about hygiene behaviour.

METHODS

A case-control study was conducted during July-September 2001 to evaluate whether, after selected confounders were controlled for, children aged <6 years with diarrhoea were more or less likely to reside in villages that participated in the project than in villages that did not participate. Descriptive and logistic regression analyses were performed.

FINDINGS

Children not living in WASEP villages had a 33% higher adjusted odds ratio for having diarrhoea than children living in WASEP villages (adjusted odds ratio, 1.331; P<0.049). Boys had 25% lower odds of having diarrhoea than girls (adjusted odds ratio, 0.748; P<0.049). A 2.6% decrease was found in the odds of diarrhoea for every yearly increase in the mother's age (adjusted odds ratio, 0.974; P<0.044) and a 1.4% decrease for every monthly increase in the child's age (adjusted odds ratio, 0.986; P<0.001).

CONCLUSIONS

The findings in this study may help refine the approach to future water, sanitation, and hygiene initiatives in northern Pakistan. The integrated approach taken by WASEP, which incorporates engineering solutions with appropriate education to maximize facility usage and improve hygiene practices, is a useful example of how desired health benefits can be obtained from projects of this type.

Effect of ibuprofen and acetaminophen on postexercise muscle protein synthesis

We examined the effect of two commonly consumed over-the-counter analgesics, ibuprofen and acetaminophen, on muscle protein synthesis and soreness after high-intensity eccentric resistance exercise. Twenty-four males (25 +/- 3 yr, 180 +/- 6 cm, 81 +/- 6 kg, and 17 +/- 8% body fat) were assigned to one of three groups that received either the maximal over-the-counter dose of ibuprofen (IBU; 1,200 mg/day), acetaminophen (ACET; 4,000 mg/day), or a placebo (PLA) after 10-14 sets of 10 eccentric repetitions at 120% of concentric one-repetition maximum with the knee extensors. Postexercise (24 h) skeletal muscle fractional synthesis rate (FSR) was increased 76 +/- 19% (P < 0.05) in PLA (0.058 +/- 0.012%/h) and was unchanged (P > 0.05) in IBU (35 +/- 21%; 0.021 +/- 0.014%/h) and ACET (22 +/- 23%; 0.010 +/- 0.019%/h). Neither drug had any influence on whole body protein breakdown, as measured by rate of phenylalanine appearance, on serum creatine kinase, or on rating of perceived muscle soreness compared with PLA. These results suggest that over-the-counter doses of both ibuprofen and acetaminophen suppress the protein synthesis response in skeletal muscle after eccentric resistance exercise. Thus these two analgesics may work through a common mechanism to influence protein metabolism in skeletal muscle.