Turcinoemacheilus ekmekciae, a new dwarf loach from upper Tigris and Euphrates (Teleostei: Nemacheilidae).

Turcinoemacheilus ekmekciae, new species, from upper Euphrates and Tigris drainages is distinguished from other species of Turcinoemacheilus in Western Asia by having a dark stripe broader than the eye diameter along the lateral line, rarely possessing roundish blotches, 5-6 mandibular pores in mandibular canal, a comperatvely smaller head, a deeper body, and a greater pre-pelvic distance. Our specimens collected from the upper Great Zab, near the type locality of Turcinoemacheilus kosswigi, showed notable genetic divergence (a minimum K2P of 3.3%) from sequences reported as T. kosswigi in previous studies. Despite morphological similarities, this molecular difference suggests that the populations analysed in previous studies may represent a potential new species of Turcinoemacheilus, which we tentatively named as Turcinoemacheius cf. kosswigi. Molecular data also suggest that T. ekmekciae is characterized by a minimum K2P distance of 3.5% from Turcinoemacheilus minimus and T. cf. kosswigi. The three methods for species delimitation (assemble species by automatic partitioning [ASAP], Poisson tree processes [PTP], and multi-rate PTP [mPTP]) that were utilized for testing species assignments consistently identified our test group as a distinct species.

Higher body mass index in 16-19 year-old Jewish Adolescents of North African, Middle Eastern and European Origins is a Predictor of Acute Myeloid Leukemia: a cohort of 2.3 million Israelis.

PURPOSE: Studies evaluating adolescent risk factors for developing acute myeloid leukemia (AML) are virtually nonexistent. We assessed adolescent predictors of AML in adults, with a main focus on adolescent BMI. METHODS: The study included 2,310,922 16-19-year-old Jewish Israeli adolescents (mean age 17.3 ± 0.4, 59.5% male), called up for an obligatory health examination. Sociodemographic and health data, including measured weight and height, were gathered. Body mass index (BMI) was examined both as a continuous variable and grouped according to the World Health Organization (WHO) classification and US-CDC percentiles. Bone-marrow-biopsy-verified AML cases diagnosed up to 31 December 2012 were identified by linkage to the Israel national cancer registry. Multivariable-adjusted Cox proportional-hazards models were used to model time to diagnosis. RESULTS: During 47 million person years of follow-up, 568 AML cases were identified (crude incidence rate 1.21/100,000 person years). There was a multivariable-adjusted hazard ratio (HR) of 1.041 (95% CI 1.015-1.068, p = 0.002) per unit BMI. The association was evident in those of Middle Eastern, North African, and European origin. A graded association was evident across the overweight and obese WHO grouping. With the US-CDC grouping, excess risk was evident in overweight but not in obese adolescents, although a test for trend in percentiles was significant (p = 0.004). Borderline associations were noted for origin (p = 0.065) (higher in the predominantly Ashkenazi European origin), sex (higher in women: HR = 1.24 (95% CI 0.99-1.55), and stature (HR = 1.013, 95% CI 1.000-1.026, per cm). CONCLUSIONS: Higher BMI in adolescence was associated with increased AML incidence in adulthood in this multiethnic population.

Life history and biogeography of the enigmatic mantid Nilomantisfloweri (Mantodea, Nanomantidae).

The biology and distribution patterns of the Sahelian mantid species Nilomantisfloweri are still insufficiently known. For the first time, records are confirmed of this species from Iran and the distribution map of its native range is updated. Records are compiled from the Sahel zone of North Africa, the Arabian Peninsula, and Iran. Detailed information on its biology, oothecal characteristics, male genitalia variation, and intraspecific molecular diversity in the mitochondrial gene cytochrome c oxidase are provided, and ecological niche modelling was used to gain insight into the overall species distribution and understand its climatic niche limits. Genetic analysis revealed only one haplotype shared between Iran and Oman. The Iranian populations likely represent two distinct clusters, both more related to the diverse Oman haplotypes than to each other. Based on new data, N.floweri appears to be mostly associated with coastal areas in southwestern Asia, with the vast majority of records found along the Red Sea, Persian Gulf, and Oman Gulf coasts. This distribution contrasts markedly with N.floweri records in the Sahel, where most collections have been reported in the transitional zone between the southern Sahara and arid thorn savannah, far off the coast. This study contributes to a comprehensive understanding of this still enigmatic mantid species.

The rise of coastal Middle Bronze Age Levant - A multidisciplinary approach for investigating in Sidon, Lebanon.

OBJECTIVES: The Levantine Middle Bronze Age (MBA, circa 2000-1500 BCE) marks a period of increased trade and regional interaction, spurred on by technological developments. In light of previous research exhibiting limited mobility in Sidon, further investigation was conducted using biodistance analysis to understand local population history and site development. MATERIALS AND METHODS: Dental nonmetric traits, a proxy for genetic information, were explored using ASUDAS on a sub-sample of primary inhumations (n = 35). The biodistance matrix was generated using Gower distance measures, and further tested using PERMDISP, PERMANOVA, Mantel test and hierarchical cluster analysis. The data was also contrasted to 87 Sr/86 Sr and δ18 O as well as δ13 C and δ15 N values. RESULTS: There were no significant diachronic differences in isotopes values, and there was biological continuity (n = 35, Mantel test r = 0.11, p = 0.02, comparing local phases and biodistance). The analysis also suggested of a sub-group of individuals with biological proximity shared a more limited range of mobility and dietary habits. CONCLUSIONS: The isotopes (87 Sr/86 Sr, δ18 O, δ13 C, δ15 N) and biodistance analysis conducted on the Sidon College site skeletal assemblage exhibits stability and continuity of the people, despite the site's increasing role in the maritime network. This continuity may have been a key factor in Sidon's success, allowing it to accumulate wealth and resources for centuries to come.

DNA barcoding and morphology reveal European and western Asian Arctiavillica (Linnaeus, 1758) as a complex of species (Lepidoptera, Erebidae, Arctiinae).

Currently, the genus Arctia Schrank, 1802 includes approximately 16 species in the Palaearctic region, depending on the taxonomic interpretation. Here, populations of the Arctiavillica (Linnaeus, 1758) morphospecies complex were studied from Europe to the Middle East (Turkey, northern Iran) by molecular methods. Morphological treatment has traditionally revealed the presence of five nominal taxa: A.villica (Linnaeus, 1758), A.angelica (Boisduval, 1829), A.konewkaii (Freyer, 1831), A.marchandi de Freina, 1983, and A.confluens Romanoff, 1884. The molecular approach tests whether they represent well-delimited species. Subsequently, this study corroborates the suitability of the mitochondrial cytochrome c oxidase subunit 1 (COI) marker sequence for species delimitation. In total, 55 barcodes of the Arctiavillica complex were compared, and two molecular species delimitation algorithms were applied to reveal the potential Molecular Operational Taxonomic Units (MOTUs), namely the distance-based Barcode Index Number (BIN) System, and the hierarchical clustering algorithm based on a pairwise genetic distances approach using the Assemble Species by Automatic Partitioning (ASAP). The applied ASAP distance-based species delimitation method for the analysed dataset revealed an interspecific threshold of 2.0-3.5% K2P distance as suitable for species identification purposes of the Iberian A.angelica and the Sicilian A.konewkaii and less than 2% for the three taxa of the A.villica clade: A.villica, A.confluens, and A.marchandi. This study contributes to a better understanding of the taxonomy of the genus Arctia and challenges future revision of this genus in Turkey, the Caucasus, Transcaucasia as well as northern Iran using standard molecular markers.

Defining the burden of febrile illness in rural South and Southeast Asia: an open letter to announce the launch of the Rural Febrile Illness project.

In rural areas of South and Southeast Asia malaria is declining but febrile illnesses still account for substantial morbidity and mortality. Village health workers (VHWs) are often the first point of contact with the formal health system, and for patients with febrile illnesses they can provide early diagnosis and treatment of malaria. However, for the majority of febrile patients, VHWs lack the training, support and resources to provide further care. Consequently, treatable bacterial illnesses are missed, antibiotics are overused and poorly targeted, and patient attendance wanes along with declining malaria. This Open Letter announces the start of a new initiative, the Rural Febrile Illness (RFI) project, the first in a series of projects to be implemented as part of the South and Southeast Asian Community-based Trials Network (SEACTN) research programme. This multi-country, multi-site project will run in Bangladesh, Cambodia, Lao PDR, Thailand, and Myanmar. It will define the epidemiological baseline of febrile illness in nine remote and underserved areas of Asia where malaria endemicity is declining and access to health services is limited. The RFI project aims to determine the incidence, causes and outcomes of febrile illness; understand the opportunities, barriers and appetite for adjustment of the role of VHWs to include management of non-malarial febrile illnesses; and establish a network of community healthcare providers and facilities capable of implementing interventions designed to triage, diagnose and treat patients presenting with febrile illnesses within these communities in the future.

Contributions to the fauna of chigger mites (Acariformes: Trombiculidae) of Iran.

Chigger mites of northern Iran were studied on the basis of field collections from rodent hosts. Thirty-five species were recorded. Two new species, Cheladonta afshari Stekolnikov and Shamsi sp. nov., collected on Apodemus sp. in Guilan and Mazandaran Provinces, and Neotrombicula tehranensis Stekolnikov and Shamsi sp. nov., collected on Cricetulus migratorius and Chionomys sp. in Tehran Province, are described. One new synonym is established: Neotrombicula vernalis (Willmann, 1942) (= Neotrombicula kermani Kudryashova, 1977 syn. nov.). Seventeen species were recorded in Iran for the first time; thus, the number of known Iranian chiggers constitutes 104. The record of Neotrombicula autumnalis (Shaw, 1790) in Iran is important from the veterinarian and medical points of view, as this species attacks humans and domestic animals.

Molecular phylogeny and intraspecific differentiation of the Trapelus agilis species complex in Iran (Squamata: Agamidae) inferred from mitochondrial DNA sequences.

BACKGROUND: Trapelus agilis consists of different morphotypes with restricted distributions in the Iranian Plateau. The phylogeny of the species complex has not been resolved so far, but recently Trapelus sanguinolentus were elevated from this complex into a full species. Other populations of the species complex need to be evaluated taxonomically. METHODS: In the present study, several populations of this species complex along with specimens of its closely related taxa in Iran, T. sanguinolentus, T. ruderatus and T. persicus, were examined using partial nucleotide sequences of two mitochondrial genes (cytb and ND2) (total length 1,322 bp). RESULT: Populations of T. sanguinolentus clustered within the T. agilis species complex, thus indicating its paraphyly, but T. sanguinolentus was previously determined to be a species based on morphological features. The T. agilis species complex forms two distinct major clades, each of which is represented by several local populations on the Iranian Plateau. At least five distinct taxa can be identified within this traditional group. Our biogeographic evaluation of the molecular dataset suggested that the Trapelus complex originated in the Late Oligocene (30 mya) and subsequently diversified during the early to middle Miocene (22-13 mya). At first, the predominantly western clade of Trapelus ruderatus diverged from the other clades (22 mya). Afterward, Trapelus persicus diverged around 18 mya ago. The broader T. agilis complex started to diverge about 16 mya, forming several clades on the Iranian Plateau and in Central Asia. The different lineages within this species complex appear to be the result of vicariance events and dispersal waives. The corresponding vicariance events are the formation of the Zagros and Kopet Dagh basins (16-14 mya), and consequently, the aridification of the Iranian Plateau in the late Miocene (11-6 Mya).

Chigger mites (Acariformes: Trombiculidae) of Iran.

Chigger mites of Iran have been revised based on examination of type materials in the collection of Zoological Museum of Moscow University and reference data. Hitherto, 85 species of trombiculids were recorded in Iran; synonymy, diagnoses, data on depositories of type specimens, lists of hosts and collection localities are given for each species. Original measurements of holotypes or paratypes are provided for 46 species. Four new combinations are proposed: Ornithogastia merops (Vercammen-Grandjean, Rohde and Mesghali, 1970) comb. nov., transferred from Guntherana; O. oenanthe (Vercammen-Grandjean, Rohde and Mesghali, 1970) comb. nov., transferred from Guntherana; Microtrombicula galerida (Vercammen-Grandjean, Rohde and Mesghali, 1970), comb. nov., transferred from Eltonella; and M. meriones (Vercammen-Grandjean, Rohde and Mesghali, 1970), comb. nov., transferred from Eltonella. Comparison of our measurements of holotypes with those given in the original species descriptions published by Kudryashova was carried out using statistical methods to establish probable systematic bias between metric data obtained by different researchers. A key to species of Iranian trombiculid larvae is compiled. With the use of public geoinformation online resources, actual names and coordinates were established for all 48 sites of Iran where chigger mites were collected.

Burden of Clostridium (Clostridioides) difficile Infection among Patients in Western Asia: A Systematic Review and Meta-Analysis.

BACKGROUND: Clostridium difficile is the most common causes of hospital-acquired diarrhea affecting particularly hospitalized patients globally. This organism has re-emerged in recent years with significant morbidity and mortality. The present study aimed to estimate the burden of C. difficile infection (CDI) and to acquire information on the overall rates of community- and hospital-acquired CDI in western Asia. METHODS: A systematic literature search was performed to identify articles published from the eight Persian Gulf countries in western Asia including Iran, Iraq, Bahrain, Kuwait, Oman, Qatar, Saudi Arabia, and the United Arab Emirates in the electronic databases within Jan of 2000 to Dec of 2017. Then, 20 publications which met our inclusion criteria were selected for data extraction and analysis by Comprehensive Meta-Analysis Software. RESULTS: Twenty studies reported the prevalence of toxigenic strains of C. difficile among patients from Persian Gulf countries, of these the pooled prevalence of CDI was 9% (95% CI: 6.5%-12.5%). Totally, 8 studies showed the prevalence of hospital-acquired CDI, from those studies the prevalence of CDI was estimated 8.4% (95% CI: 4.9%-14.1%). Moreover, 7 studies reported the prevalence of community-acquired CDI, from those studies the prevalence of CDI was estimated 1.8% (95% CI: 1.2%-2.9%). CONCLUSION: The prevalence of CDI in western Asia is lower than southern and eastern region. Moreover, the lower prevalence of community-acquired CDI compared to hospital-acquired CDI, indicate that the source of infection in western Asia is more likely in the hospitals.

Medicine Shortages: Gaps Between Countries and Global Perspectives.

Introduction: Over the last decade, global health policies and different research areas have focused on the relevance and impact of medicine shortages. Published studies suggest there have been difficulties with access to medicines since the beginning of the 20th century, and there have been advances in our understanding and management of the problem since then. However, in view of global and regional health care concerns with shortages, we believe this phenomenon needs to be characterized and described more fully regarding the types of medicines affected, possible causes, and potential strategies to address these. The aim of this scoping review was to identify, compare if possible, and characterize the recent literature regarding the situation of medicines shortages between countries, and provide different perspectives, including a global context and national approaches. Methodology: A scoping study presented as a narrative review of the situation and findings principally based on published articles. Results: Based on the reported cases in the literature, a typology of medicines shortage and supply interruption episodes and their causes were proposed; national approaches to notify and manage the medicines shortages cases were described and classified by update frequency; principal differences between market and supply chain management perspectives of the situation were identified and global and countries' perspectives were described. Conclusion: Policy makers require solutions that prevent those cases in which the population's health is affected by episodes of medicine shortages and/or interruption in the supply chain. There is also a need to generate a glossary related to logistics management and the availability of medicines which will be useful to understand and overcome shortages. In addition, recognize that potential solutions are not only related with actions linked to research, development and innovation, but much wider. Overall, we believe this article can act as a basis for future discussions in this important area.

Cutaneous Leishmaniasis among Syrian Refugees in Jordan: a Retrospective Study.

The aim of this study is to investigate cutaneous leishmaniasis (CL) among Syrian refugees residing in Jordan. A total of 558 Syrian refugee patients were clinically diagnosed with cutaneous leishmaniasis during 2010-2016. For each patient, sex, age, location, and number of lesions were recorded. Of the total 558 CL cases among Syrian refugees, 514 (92.1%) were classified as imported, 14 (2.5%) as locally acquired infection, and 30 (3.4%) of cases unclassified due to lack of information. By gender, 306 (55%) were males and 252 (45%) were females. Ages ranged between 1 and 78 years (17.3 ± 16.3), with the age group 1-10 years (48.2%) being the most affected group. The face was the most affected (171 cases, 30.6%), followed by the hands and arms in 95 cases (17%), while lesions on the legs were observed in 69 cases (12.4%), and 65 cases (11.6%) on the trunk. The number of lesions ranged from 1 to 5 (1.39 ± 0.985) on the face, 1 to 3 (1.32 ± 0.898) on the trunk, 1 to 17 (1.5 ± 41.39) on the arms, and 1 to 5 (1.5 ± 1.473) on the legs. Extensive efforts should be undertaken by the health officials in Jordan to confine the spread of this disease by strengthening surveillance, diagnosis of new cases, proper treatment of all cases, and entomological surveys for the presence of the vector sandflies as well as the reservoir hosts within the refugee camps. Most cases were considered as imported (92.1%) and require immediate attention at the port of entry.

L'objectif de ce travail est l'étude de la leishmaniose cutanée (LC) chez des réfugiés syriens résidant en Jordanie. La LC a été cliniquement diagnostiquée chez 558 réfugiés syriens entre 2010 et 2016. Les données suivantes ont été enregistrées pour chaque patient : le sexe, l'âge, le nombre et l'emplacement des lésions. Sur ce total de 558 cas de LC, 514 (92,1 %) sont classés comme importés, 14 (2,5 %) comme localement contractés et 30 (3,4 %) n'ont pas été classifiés en raison d'un manque d'information ; 306 patients (55 %) sont des hommes et 252 (45 %) des femmes. Les âges vont de 1 à 78 ans (17,3 ± 16,3), le groupe de 1­10 ans (48,2 %) est le plus touché. Les lésions sont les plus nombreuses sur le visage (171 cas, 30,6 %), suivi par les mains et les bras dans 95 cas (17 %), les jambes dans 69 cas (12,4 %) et le tronc dans 65 cas (11,6 %). Le nombre de lésions varie de 1­5 (1,39 ± 0,985) sur le visage, de 1­3 (1,32 ± 0,898) sur le tronc, de 1­17 (1,5 ± 41,39) sur les bras et de 1­5 (1,5 ± 1,473) sur les jambes. Les agents de santé en Jordanie doivent mettre en œuvre les mesures nécessaires pour circonscrire la propagation de cette maladie en renforçant le suivi, le diagnostic des nouveaux cas, le traitement approprié de tous les cas et la surveillance entomologique des phlébotomes vecteurs et des hôtes réservoirs dans les camps de réfugiés. La plupart des cas sont considérés comme importés (92,1 %) et nécessitent des soins immédiats à la porte d'entrée.

Urinary Myiasis Caused by Clogmia albipunctata from the Palestinian Territories.

This is the first record of a case of urinary myiasis in the Palestinian Territories caused by Clogmia albipunctata. Larvae were discharged through urine by a 28-year-old pregnant female whom complained of mild abdominal pain associated with burning sensation while urinating over the past 3 months. Detailed description of the larva was provided.

Il s'agit du premier cas de myiase urinaire dans les Territoires palestiniens due à Clogmia albipunctata. Les larves ont été excrétées dans les urines d'une patiente de 28 ans, enceinte, qui se plaignait de douleurs abdominales légères associées, les trois derniers mois, à une sensation de brûlure lors des mictions. Cet article présente également la description des larves.

Exploring the Causes of the Low Incidence of Cervical Cancer in Western Asia

Anecdotal epidemiologic observations can provide valuable tools to study various biologic elements in complex diseases such as cancer. Although cervical cancer is one of the most frequent malignancy affecting women in the world, it displays wide geographical variations remnant of socioeconomic, ethnic and genetic predisposing factors. The observed low incidence of cervical cancer in western Asia has triggered scientists to try to delineate the causes of this reduced occurrence. Although this region including Saudi Arabia is known for being conservative societies with low incidence of sexually transmitted infections including human papillomavirus (HPV) and associated cervical cancer, scientific research points out multifaceted biological explanations including host genetic variations. Researchers observed that a protective genetic variant TP53 codon 72 proline allele was more commonly found in this population and appear to be over-transmitted compared to others known for their high rate of cervical cancer. Thus, the combination of relative low rate of HPV infection, over-transmission of protective genetic variant along with societal variables are the rationale behind the low incidence of cervical cancer in women in the region of western Asia. The influence of the genetic makeup of the patients has impact on personalized preventive medicine to gauge the risk of developing cervical cancer.

Systemic Measures and Legislative and Organizational Frameworks Aimed at Preventing or Mitigating Drug Shortages in 28 European and Western Asian Countries.

Drug shortages have been identified as a public health problem in an increasing number of countries. This can negatively impact on the quality and efficiency of patient care, as well as contribute to increases in the cost of treatment and the workload of health care providers. Shortages also raise ethical and political issues. The scientific evidence on drug shortages is still scarce, but many lessons can be drawn from cross-country analyses. The objective of this study was to characterize, compare, and evaluate the current systemic measures and legislative and organizational frameworks aimed at preventing or mitigating drug shortages within health care systems across a range of European and Western Asian countries. The study design was retrospective, cross-sectional, descriptive, and observational. Information was gathered through a survey distributed among senior personnel from ministries of health, state medicines agencies, local health authorities, other health or pharmaceutical pricing and reimbursement authorities, health insurance companies and academic institutions, with knowledge of the pharmaceutical markets in the 28 countries studied. Our study found that formal definitions of drug shortages currently exist in only a few countries. The characteristics of drug shortages, including their assortment, duration, frequency, and dynamics, were found to be variable and sometimes difficult to assess. Numerous information hubs were identified. Providing public access to information on drug shortages to the maximum possible extent is a prerequisite for performing more advanced studies on the problem and identifying solutions. Imposing public service obligations, providing the formal possibility to prescribe unlicensed medicines, and temporary bans on parallel exports are widespread measures. A positive finding of our study was the identification of numerous bottom-up initiatives and organizational frameworks aimed at preventing or mitigating drug shortages. The experiences and lessons drawn from these initiatives should be carefully evaluated, monitored, and presented to a wider international audience for careful appraisal. To be able to find solutions to the problem of drug shortages, there is an urgent need to develop a set of agreed definitions for drug shortages, as well as methodologies for their evaluation and monitoring. This is being progressed.

Simultaneous introduction of distinct HIV-1 subtypes into different risk groups in Russia, Byelorussia and Lithuania.

OBJECTIVE: To investigate genotypes and serotypes of HIV-1 variants in Russia, Byelorussia and Lithuania. PATIENTS AND METHODS: Sera from 20 HIV-1-infected individuals were tested in an enzyme-linked immunosorbent assay (ELISA) with 19 V3 synthetic peptides, and serum HIV-1 V3 RNA was amplified and sequenced. RESULTS: Sequence comparison of the envelope V3 region among specimens tested revealed a 2-29% range nucleotide divergence, with a mean of 19%. Phylogenetic analysis from the homosexual men were shown to belong to subtype B, and all of the heterosexually infected individuals to subtype C. Sequences from the parenterally infected individuals were more heterogeneous. IOn the peptide ELISA three reactivity patterns were found. Serum samples from six out of seven homosexual men showed reactivity to peptides p108 or p110 representing V3 amino-acid sequences found in US/West European HIV-1 isolates. Serum samples from six of seven individuals who had acquired HIV-1 through heterosexual contacts were reactive to peptide p169. Four out of six parenterally infected patients had peak reactivity to p168. CONCLUSION: Distinct HIV-1 variants were found in Russia, Byelorussia and Lithuania, which were introduced simultaneously in the mid-1980s. This diversity was shown to be associated with the route of transmission. Homosexual men appeared to be infected with subtype B and heterosexually infected individuals with subtype C HIV-1 variants. HIV-1 subtypes A, C, D and G were found among parenterally infected individuals.

PIP: HIV-1 variants show a relatively high level of genomic and antigenic diversity. This heterogeneity is particularly high in the V3 domain of envelope glycoprotein gp120, which is implicated in a number of biological properties of HIV-1, including cell tropism, infectivity, and cytopathogenicity; it is also a target for both humoral and cellular immune response. At least nine subtypes of HIV-1 have been identified. Subtypes A-H are phylogenetically equidistant and shown to be geographically associated with different subcontinents. Subtype B is most prevalent in North and South America and western Europe. Subtypes A, C, D, G, and H are found frequently in sub-Saharan countries, while subtype C is also found in India. Subtype E sequences have been found in patients from Thailand and Central Africa, and subtype F has been described in Romania and Brazil. This study reports findings from an investigation of genotypes and serotypes of HIV-1 variants in Russia, Byelorussia, and Lithuania. Sera from 15 HIV-1-infected men and 5 HIV-1-infected females were tested by ELISA with 19 V3 synthetic peptides with amplified and sequenced serum HIV-1 V3 RNA. Sequence comparison of the envelope V3 region among specimens tested revealed a 2-29% range of nucleotide divergence, with a mean of 19%. Distinct variants of HIV-1 were found in Russia, Byelorussia, and Lithuania, which were introduced simultaneously in the mid-1980s. The diversity was shown to be associated with the route of transmission. Homosexual men appeared to be infected with subtype B compared to heterosexually infected individuals with subtype C HIV-1 variants. HIV-1 subtypes A, C, D, and G were found among parenterally-infected individuals. These findings are based upon the three peptide reactivity patterns identified by ELISA. Serum samples from six out of seven homosexual men showed reactivity to peptides p108 or p110 representing V3 amino-acid sequences found in US/West European HIV-1 isolates. Serum samples from six out of seven individuals who had acquired HIV-1 through heterosexual contacts were reactive to peptide p169, and four out of six parenterally infected patients had peak reactivity to p168.

Molecular epidemiology of HIV-1 in the former Soviet Union: analysis of env V3 sequences and their correlation with epidemiologic data.

OBJECTIVE: To investigate the HIV-1 V3 sequence diversity in the former Soviet Union in 30 subjects infected with HIV-1 via different modes of transmission. PATIENTS: A cohort of children infected after exposure to nonsterile needles during the epidemic in 1988-1989 in southern Russia (Elista, n = 12 and Rostov-on-Don, n = 10), and eight HIV-seropositive subjects from Belarus (Minsk), infected via sexual (n = 7) and parenteral (n = 1) infection. METHODS: The HIV-1 V3 encoding region was amplified by nested polymerase chain reaction on DNA of primary peripheral blood mononuclear cells collected from the study subjects and then cloned and sequenced. RESULTS: The alignment of 127 V3 sequences from 22 patients in the cohort group demonstrated common consensus sequences in both the Elista and Rostov samples. The average means of interperson variation were 5.9 and 6.6% in Elista and Rostov subjects, respectively, and comparable to the mean intraperson variation. The average mean interperson variation between nucleotide sequences of HIV patients infected through sexual transmission was considerably higher (14.9%). CONCLUSION: V3 sequence analysis confirms the epidemiologic data which support the transmission of HIV-1 in children from a single source, and suggests the infection of a mother from her parenterally infected child. Furthermore, the genetic variability of HIV-1 V3 in the noncohort group was particularly divergent indicating the heterogeneity of the virus circulating in the former Soviet Union.

PIP: In 1988, an HIV-1 epidemic occurred in Elista, Kalmyk Republic, Russia, among 90 children in two hospitals after exposure to blood contaminated needles from an HIV infected infant. A few months later, a similar HIV-1 outbreak in children occurred in Rostov-on-Don, Russia, probably a result of transporting children from Elista to Rostov-on-Don hospitals. In Rostov-on-Don, it appears that seven HIV infected infants transmitted HIV to their mothers during breast feeding. Health workers collected blood samples from 22 HIV-1 infected subjects in Elista (n = 12) and Rostov-on-Don (n = 10 including 1 mother-child pair) and from 8 control subjects who became infected with HIV-1 via sexual (7) and parenteral (1) transmission from Minsk, Belarus. Researchers wanted to determine the extent of the diversity of proviral DNA encoding the V3 loop from different patients in the children cohort. They used nested polymerase chain reaction on DNA of primary peripheral blood mononuclear cells and then cloned and sequenced them to detail the HIV-1 V3 encoding region. The Elista and Rostov-on-Don samples shared common consensus sequences (127 nucleotide sequences) in the V3 region. The average mean interperson variation between the nucleotide sequences of HIV patients infected through sexual transmission from Minsk was 14.9%, which was much higher than those for Elista and Rostov HIV patients infected through parenteral transmission (5.9% and 6.6%, respectively). The major nucleotide sequence in the mother in the Rostov group, who was presumably infected with HIV by her HIV infected infant during breast feeding, matched that of her daughter. The mother had no history of blood transfusion or any other risk factors except breast feeding. These findings confirm that the Elista and Rostov groups shared a common HIV source. They also suggest that breast feeding was the route of HIV transmission for the mother. The genetic variability of HIV-1 V3 in the control group demonstrated the heterogeneity of HIV-1 in the former USSR.

Statistics from the World Health Organization and the Centers for Disease Control.

PIP: 7 tables show the worldwide incidence of AIDS as of Jan. 1988. Table 1 gives the number of cases worldwide by region and country. Table 2 shows the number of reported cases in the US by transmission group for adults and children and for males and females. Transmission groups include homosexuals, heterosexuals, intravenous drug users, hemophiliacs, blood recipients, and others. Table 3 shows US cases reported by transmission category, broken down by children and adults, by race and ethnic group. Table 4 shows 12-month totals of US cases by transmission categories for adults and children in Jan. 1987 and Jan. 1988 and cumulative incidence and mortality since 1981. Table 5 shows the total number of AIDS cases reported in 28 European countries and estimated rates per million population of each country as of Sept. 1987. Table 6 shows incidence of AIDS in children under 15 by risk category and country as of Sept. 1987. Table 7 shows AIDS cases by transmission group and geographic origin for 28 European countries. The geographic origins breakdown is: Europe, Africa, Caribbean, and Other.^ieng

Undernutrition among Bedouin Arab children: a follow-up of the Bedouin Infant Feeding Study.

After 10 y of urban settlement, 680 Bedouin Arab children, who had had anthropometric assessment from birth (1981-1982) through early childhood, were reassessed in 1991-1992 to compare the rates of stunting in early and later childhood as well as to describe the factors influencing current height-for-age. Stunting had dropped from 32.7% at 18 mo to 7.2% at 10 y in the 1981 birth cohort and dropped from 17.5% at 9 mo to 8.2% at 9 y in the 1982 birth cohort. Based on a multiple-linear-regression analysis, height in early childhood and maternal height were statistically significantly and positively associated with current mean height-for-age in both cohorts. In the 1982 cohort socioeconomic status in early childhood was positively and current family size was negatively and significantly associated with current mean height-for-age. Thus, conditions that were present in early childhood had the largest influence on current height. In 1992, 10% and 6% of the infant siblings of the 1981 and 1982 cohorts, respectively, were stunted compared with 17% and 1% of the siblings aged 1-2 y of the respective cohorts. Therefore, the high rates of early childhood stunting in 1981-1982 appeared to be a birth cohort-specific phenomenon.

PIP: During 1991-1992 in Israel, researchers re-examined the anthropometric assessment of Bedouin children 9-10 years old, living in the Negev, whose anthropometric assessment was initially examined when they were 6-18 months old, to compare the rates of stunting in early and later childhood and to determine the factors affecting current height-for-age. For the 1981 birth cohort, stunting fell from 32.7% at 18 months to 7.2% at 10 years. The corresponding figures for the 1982 birth cohort were 17.5% at 9 months and 8.2% at 9 years. Thus, despite the social change and urban settlement the children experienced in the 10 year span, they still had some catch-up growth. Stunting among the siblings less than 2 years old of the 1991-1992 cohorts was much less common than stunting of the index children in early childhood in 1981 (17% vs. 44%), but not so in 1982 (14% vs. 11%). In 1992, the prevalence of stunting stood at 10% and 6% of siblings less than one year old of the 1981 and 1982 cohorts, respectively, while it was 17% and 1% for siblings 1-2 years old of the 1981 and 1982 cohorts, respectively. Maternal height and index child's height-for-age in early childhood were positively associated with current height-for-age in the 1981 cohort (p = 0.0001). They explained 33% of the variation in height-for-age. In the 1981 cohort, neither socioeconomic status (SES) in early childhood nor family size were associated with current height-for-age. Yet, in the 1982 cohort, both SES in early childhood and family size were associated with current height-for-age, SES positively (p = 0.04) and family size negatively (p = 0.03). Maternal height and height-for-age in early childhood were positively associated with current height-for-age (p = 0.002 and 0.0001, respectively). These 4 variables accounted for 34% of the variation in height-for-age in the 1982 cohort. These findings indicate that factors or conditions present in early childhood had the greatest impact on current height-for-age.

Undernutrition among Bedouin Arab infants: the Bedouin Infant Feeding Study.

Two hundred seventy-four healthy Bedouin Arab newborns in 1981 were followed for 18 mo to examine the relationship between infant-feeding practices and growth during planned social change. Although wasting was not prevalent, the prevalence rate of stunting (less than or equal to -2 SDs) increased from 12% to 19% to 32% at 6, 12, and 18 mo, respectively. After multiple-logistic-regression adjustment for covariates, the odds ratio (OR) of stunting at 6 mo was reduced among infants breast-fed only or fed with supplement compared with weaned infants. Infant-feeding practices were not associated with stunting in later infancy; however, those stunted at 6 mo had an OR of 13 of stunting at 12 mo and those stunted at 12 mo had an OR of 14 of stunting at 18 mo. In a multiple-linear-regression analysis, seasonality, duration of breast-feeding, hospitalized morbidity, and residual of height at 6 mo were negatively associated with daily average linear growth from 6 to 12 mo; these factors only explained 12% of the variation in daily linear growth.