Safety assessment of nebulized xylitol in beagle dogs.

Xylitol, a potential cystic fibrosis treatment, lowers the salt concentration of airway surface liquid and enhances innate immunity of human airways. The study objective was to evaluate the potential toxicity/recovery from a 14-consecutive day (7 days/week), facemask inhalation administration of nebulized xylitol solution in Beagle dogs. Aerosolized xylitol was generated through three Aerotech II nebulizers operating at approximately 40 psi driving pressure. Test article groups were exposed to the same concentration of aerosolized xylitol for 1, 0.5, or 0.25 h for the high, mid, and low exposures, respectively. A control group was exposed for 1 h to a nebulized normal saline solution. Animals were sacrificed the day following the last exposure or subsequently after 14 non-exposure days. Study endpoints included clinical observations, body weights, ophthalmology, and physical examinations, food consumption, clinical pathology, urinalyses, organ weights, and histopathology. Mean xylitol aerosol concentrations for all groups were approximately 3.5 mg/l. Mean total deposited doses to the pulmonary region were estimated as 21, 11, and 5 mg/kg, for the high-, mid-, and low-exposure groups, respectively. All dogs survived to the scheduled necropsy. No treatment-related findings were observed due to xylitol exposure in any end point examined. Lung findings (mild interstitial infiltration, macrophage hyperplasia, alveolitis, and bronchitis) were consistent among exposed and control groups. No exposure-related effect of xylitol in any parameter assessed was seen during or after the 14-day exposure in Beagle dogs. The No Observed Effect Level was the high-exposure level and suggests that inhaled xylitol is safe for clinical administration.

Integrating HIV clinical services into primary health care in Rwanda: a measure of quantitative effects.

BACKGROUND: With the intensive scale-up of care and treatment for HIV/AIDS in developing countries, some fear that intensified attention to HIV programs may overwhelm health care systems and lead to declines in delivery of other primary health care. Few data exist that confirm negative or positive synergies on health care provision generally resulting from HIV-dedicated programs. METHODS: Using a retrospective observational design we compare aggregate service data in Rwandan health facilities before and after the introduction of HIV care on selected measures of primary health care. The study tests the hypothesis that non-HIV care does not decrease after the introduction of basic HIV care. FINDINGS: Overall, no declines were observed in reproductive health services, services for children, laboratory tests, and curative care. Statistically significant increases were found in utilization and provision of some preventive services. Multivariate regression, including introduction of HIV care and two important health care financing initiatives in Rwanda, revealed positive associations of all with observed increases. Introduction of HIV services was especially associated with increases in reproductive health. While hospitalization rates increased for the whole sample, declines were observed at health facilities that offered basic HIV care plus highly active antiretroviral therapy. INTERPRETATION: Our results partially counter fears that HIV programs are producing adverse effects in non-HIV service delivery. Rather than leading to declines in other primary health care delivery, our findings suggest that the integration of HIV clinical services may contribute to increases.

Access to modern contraception.

Access to modern contraception has become a recognized human right, improving the health and well-being of women, families and societies worldwide. However, contraceptive access remains uneven. Irregular contraceptive supply, limited numbers of service delivery points and specific geographic, economic, informational, psychosocial and administrative barriers (including medical barriers) undermine access in many settings. Widening the range of providers enabled to offer contraception can improve contraceptive access, particularly where resources are most scarce. International efforts to remove medical barriers include the World Health Organization's Medical Eligibility Criteria. Based on the best available evidence, these criteria provide guidance for weighing the risks and benefits of contraceptive choice among women with specific clinical conditions. Clinical job aids can also improve access. More research is needed to further elucidate the pathways for expanding contraceptive access. Further progress in removing medical barriers will depend on systems for improving provider education and promoting evidence-based contraceptive service delivery.

Discovery of five conserved beta -defensin gene clusters using a computational search strategy.

The innate immune system includes antimicrobial peptides that protect multicellular organisms from a diverse spectrum of microorganisms. beta-Defensins comprise one important family of mammalian antimicrobial peptides. The annotation of the human genome fails to reveal the expected diversity, and a recent query of the draft sequence with the blast search engine found only one new beta-defensin gene (DEFB3). To define better the beta-defensin gene family, we adopted a genomics approach that uses hmmer, a computational search tool based on hidden Markov models, in combination with blast. This strategy identified 28 new human and 43 new mouse beta-defensin genes in five syntenic chromosomal regions. Within each syntenic cluster, the gene sequences and organization were similar, suggesting each cluster pair arose from a common ancestor and was retained because of conserved functions. Preliminary analysis indicates that at least 26 of the predicted genes are transcribed. These results demonstrate the value of a genomewide search strategy to identify genes with conserved structural motifs. Discovery of these genes represents a new starting point for exploring the role of beta-defensins in innate immunity.

Estudio hospitalario del aborto ilegal en Bolivia / A hospital study of illegal abortion in Bolivia

A causa del carácter ilegal del aborto provocado, es difícil determinar el grado en que este se practica en América Latina. En el caso de Bolivia, a la fecha no existen datos sobre el problema. Por este motivo, se decidió estudiar las características sociodemográficas y obstétricas de una muestra de 4.371 mujeres bolivianas internadas por complicaciones del aborto en 11 hospitales urbanos en un período de un año (1 de julio de 1983 a 30 de junio de 1984). Los datos se recogieron con ayuda de un calendario rellenado por los médicos tratantes y se interpretaron desde el punto de vista de la planificación familiar. Una cuarta parte (22,7 por ciento) de los abortos fueron ilegalmente provocados. Las mujeres que deliberadamente pusieron fin a su embarazo se caracterizaron por ser en general jóvenes, nulíparas y solteras. En total, 65,0 por ciento de los abortos fueron provocados por personas con adiestramiento médico, la mayor parte de las veces mediante raspado uterino; en 30 por ciento fue provocado por personas sin adiestramiento médico y en 5 por ciento por la propia mujer, y en estos casos el medio más común fue la introducción de un cuerpo extraño en el útero. Las mujeres con mayor escolaridad tendieron a recurrir a personas con adiestramiento médico. Además, cuando el aborto fue provocado por raspado uterino hubo menos probabilidades de sufrir fiebre y lesiones genitales, pero fue más prolongada la estadía hospitalaria promedio... (AU)

Estudio hospitalario del aborto ilegal en Bolivia / A hospital study of illegal abortion in Bolivia

A causa del caracter ilegal del aborto provocado, es dificil determinar el grado en que este se practica en América Latina. En el caso de Bolivia, a la fecha no existen datos sobre el problema. Por este motivo, se decidio estudiar las caracteristicas sociodemograficas y obstétricas de una muestra de 4.371 mujeres bolivianas internadas por complicaciones del aborto en 11 hospitales urbanos en un período de un ano (1 de julio de 1983 a 30 de junio de 1984). Los datos se recogieron con ayuda de un calendario rellenado por los medicos tratantes y se interpretaron desde el punto de vista de la planificacion familiar. Una cuarta parte (22,7 por ciento) de los abortos fueron ilegalmente provocados. Las mujeres que deliberadamente pusieron fin a su embarazo se caracterizaron por ser en general jóvenes, nuliparas y solteras. En total, 65,0 por ciento de los abortos fueron provocados por personas con adiestramiento medico, la mayor parte de las veces mediante raspado uterino; en 30 por ciento fue provocado por personas sin adiestramiento medico y en 5 por ciento por la propia mujer, y en estos casos el medio mas comun fue la introduccion de un cuerpo extrano en el utero. Las mujeres con mayor escolaridad tendieron a recurrir a personas con adiestramiento medico. Ademas, cuando el aborto fue provocado por raspado uterino hubo menos probabilidades de sufrir fiebre y lesiones genitales, pero fue mas prolongada la estadia hospitalaria promedio...