Selectin Dependence of Allergic Skin Inflammation Is Diminished by Maternal Atopy.

Allergic skin inflammation requires the influx of inflammatory cells into the skin. Extravasation of leukocytes into the skin requires interactions between endothelial selectins and their glycan ligands on the surface of leukocytes. Selectin-ligand formation requires the activity of several glycosyltransferases, including Fut7 In this report, we tested the importance of Fut7 for the development of allergic skin inflammation in the Stat6VT transgenic mouse model. We observed that Fut7 deficiency was protective but did not eliminate disease. Segregation of the data by gender of the parent that transmitted the Stat6VT transgene, but not by gender of the pups, which were analyzed for disease, revealed that the protective effects of Fut7 deficiency were significantly greater when dams were Stat6VT negative. In contrast, in mice from litters of Stat6VT+ dams, Fut7 deficiency resulted in only modest protection. These findings indicate that pups from atopic dams exhibit a greater propensity for allergic disease, similar to observations in humans, and that the effect of maternal atopy is due to enhanced selectin-independent mechanisms of leukocyte recruitment in their offspring. Together, these results demonstrate that Fut7 deficiency can be protective in a model of atopic dermatitis but that maternal atopy diminishes these protective effects, suggesting alternative pathways for leukocyte recruitment in the absence of Fut7 enzyme activity. These observations have implications for understanding how the environment in utero predisposes for the development of allergic disease.

Burden of tuberculosis in Afghanistan: update on a war-stricken country.

AIM: To review Afghans Tuberculosis (TB) Control Program and assesses the impact of disruption induced by the war in Afghanistan. METHODS: National TB control program of Afghanistan was reviewed in terms of its milestones, achievement parameters, and potential barriers. Information and data were collected by review visits to the Ministry of Health and health facility survey of non-governmental organizations working for TB control in Afghanistan. Local and international literature was consulted. RESULTS: Mortality and morbidity figures due to tuberculosis remained alarmingly high in the last two decades, especially among women. Current estimates show that the incidence of active TB cases is 278 per 100,000 and mortality mounts to 15,000 cases per year. The epidemiological profile reflecting the situation of Afghans inside and outside the country is extremely deplorable. The situation has worsened due to the cessation of TB control activities during the war. Compliance of patients and access to the treatment has become very difficult in an emergency situation. Similarly, an increasing number of TB cases among Afghans refugees in Pakistan have also been observed. Overcrowded refugee camps and lack of treatment facilities increases manyfold the risk of further transmission. CONCLUSION: TB is a major public health threat inside and outside war-stricken Afghanistan. TB control activities need prompt attention of health authorities in reestablishing TB control network. World Health Organization's guidelines and nationwide Directly Observed Treatment Short Course strategy should be adopted and sufficient resources allocated. It is vital to build a peaceful environment with a viable and durable alliance of local and international donors in the fight against TB.

Urging health system research: identifying gaps and fortifying tuberculosis control in Pakistan.

AIM: To assess the significance of health system research in reducing the burden of tuberculosis and improving the performance of National Tuberculosis Control Program in Pakistan. METHOD: Qualitative and quantitative content analysis of research papers on tuberculosis and influence of the research knowledge on the efficiency of the National Tuberculosis Control Program. RESULTS: We analyzed 268 research papers on tuberculosis in Pakistan published in the 1960-2002 period, from both national and international perspectives. The majority of the studies covered epidemiology of tuberculosis (n=76) in Pakistan, whereas the rest of the papers addressed issues like pediatric tuberculosis (n=53), tuberculosis among Pakistani immigrants (n=35), tuberculosis-HIV synergism (n=24), care seeking (n=19), adherence with tuberculosis treatment (n=14), tuberculosis among women (n=12), tuberculosis prevention (n=12), directly observed treatment short-course (DOTS) strategy modification (n=5), tuberculosis drug resistance (n=7), operational research (n=5), tuberculosis case management (n=4), and research on Mycobacterium (n=2). Qualitative analysis revealed that research and spending on tuberculosis policy and nationwide tuberculosis interventions are not sufficient. Available research knowledge has not yet been translated into the tuberculosis policy and interventions. Furthermore, the lack of insight of the health system on community dynamics and tuberculosis intervention has led to failure in achieving the desired targets in tuberculosis control. CONCLUSION: Health system in Pakistan needs to improve tuberculosis control interventions by conducting extensive research on the various potential weaknesses in the field. For an effective tuberculosis eradication program in a highly endemic country such as Pakistan, health system research should be an integral part of the National Tuberculosis Control Program.