Potentially toxic metals in irrigation water, soil, and vegetables and their health risks using Monte Carlo models.

Food safety has become a serious global concern because of the accumulation of potentially toxic metals (PTMs) in crops cultivated on contaminated agricultural soils. Amongst these toxic elements, arsenic (As), cadmium (Cd), chromium (Cr), and lead (Pb) receive worldwide attention because of their ability to cause deleterious health effects. Thus, an assessment of these toxic metals in the soils, irrigation waters, and the most widely consumed vegetables in Nigeria; Spinach (Amaranthushybridus), and Cabbage (Brassica oleracea) was evaluated using inductively coupled plasma-optical emission spectroscopy (ICP-OES). The mean concentration (measured in mg kg-1) of the PTMs in the soils was in the sequence Cr (81.77) > Pb(19.91) > As(13.23) > Cd(3.25), exceeding the WHO recommended values in all cases. This contamination was corroborated by the pollution evaluation indices. The concentrations (measured in mg l-1) of the PTMs in the irrigation water followed a similar pattern i.e. Cr(1.87) > Pb(1.65) > As(0.85) > Cd(0.20). All the PTMs being studied, were found in the vegetables with Cr (5.37 and 5.88) having the highest concentration, followed by Pb (3.57 and 4.33), and As (1.09 and 1.67), while Cd (0.48 and 1.04) had the lowest concentration (all measured in mg kg-1) for cabbage and spinach, respectively. The concentration of the toxic metals was higher in spinach than in cabbage, which may be due to the redistribution of the greater proportion of the metals above the ground tissue, caused by the bioavailability of metals in the aqueous phase. Expectedly, the hazard index (HI),and carcinogenic risk values of spinach were higher than that of cabbage. This implies that spinach poses potentially higher health risks. Similarly, the Monte Carlo simulation results reveal that the 5th percentile, 95th percentile, and 50th percentile of the cumulative probability of cancer risks due to the consumption of these vegetables exceeds the acceptable range of 1.00E-6 and 1.00E-4. Thus, the probable risk of a cancerous effect is high, and necessary remedial actions are recommended.

ACCIDENTAL INTRAOPERATIVE FINDING OF PARASITIC FIBROIDS IN THE MESENTERY OF A MIDDLE-AGED WOMAN.

Fibroid (myoma) is the most common benign tumor of the female genital tract. The tumour may occur in the uterine corpus as intramural, submucous, subserous, cervical fibroid; or in the broad ligament as intraligamentary fibroid or outside of uterus as parasitic fibroid. Parasitic fibroid is rare as a primary or secondary tumour. It is commonly diagnosed as an incidental finding during radiologic or abdominal surgical procedures. This was a case report of histologically confirmed multiple parasitic fibroids in a 39-year-old woman coexisting with primary uterine fibroids. The woman presented with a history of progressive abdominal swelling and associated lower abdominal pain of 8 years duration. There was an antecedent history of exploratory laparotomy with excision of uterine mass. Abdominal ultrasonography revealed multiple uterine fibroid nodules in the submucous, intramural and subserous layers of the uterus with bilateral normal ovaries. She had abdominal myomectomy. The intraoperative findings revealed multiple uterine fibroid nodules with a total weight of 1670g. There were multiple parasitic fibroid nodules attached to the serosa of the colon with the largest measuring 3.5 x 2cm. We discussed the management and associated challenges of unanticipated parasitic fibroids at surgery. We highlighted the role of multi-disciplinary care and advocated for a high index of suspicion while preparing for surgical intervention in women with multiple uterine fibroids.

UK national guideline on safer sex advice.

This guideline provides evidence-based guidance on the content of safer sex advice and the provision of brief behaviour change interventions deliverable in genitourinary (GU) medicine clinics. Much of the advice is applicable to other healthcare settings including general practice and clinics providing HIV care. Advice on condom use and effectiveness, oral sex and other sexual practices, testing for sexually transmitted infections (STI) and partner reduction is provided. Advice specific to the transmission of HIV infection including seroadaptive behaviours and negotiated safety is also included. An accompanying review of the evidence supporting the guideline with a complete reference list is available online. A patient information leaflet based on the advice statements developed is also available through the BASHH website.

HIV voluntary counselling and testing for African communities in London: learning from experiences in Kenya.

OBJECTIVES: To explore the feasibility and acceptability of translating a successful voluntary counselling and testing (VCT) service model from Kenya to African communities in London. METHODS: Qualitative study with focus group discussions and a structured workshop with key informants. Five focus group discussions were conducted in London with 42 participants from 14 African countries between August 2006 and January 2007. A workshop was held with 28 key informants. Transcripts from the group discussions and workshop were analysed for recurrent themes. RESULTS: Participants indicated that a community-based HIV VCT service would be acceptable to African communities in London, but also identified barriers to uptake: HIV-related stigma, concerns about confidentiality, and doubts about the ability of community-based services to maintain professional standards of care. Workshop participants highlighted three key requirements to ensure feasibility: (a) efficient referrals to sexual health services for the newly diagnosed; (b) a locally appropriate testing algorithm and quality assurance scheme; (c) a training programme for VCT counsellors. CONCLUSIONS: Offering community-based VCT with rapid HIV tests appears feasible within a UK context and acceptable to African communities in London, provided that clients' confidentiality is ensured and appropriate support is given to the newly diagnosed. However, the persistence of concerns related to HIV-related stigma among African communities suggests that routine opt-out testing in healthcare settings may also constitute an effective approach to reducing the proportion of late diagnoses in this group. HIV service models and programmes from Africa constitute a valuable knowledge base for innovative interventions in other settings, including developed countries.

Effects of breast cancer and mastectomy on fibrinolytic activity in African women.

Reduced blood fibrinolytic activity (FA) has been postulated in cancer. It is good to know if this is also the case in Africans with breast cancer. Africans are known to possess enhanced fibrinolysis. This study was designed to assess the effect o breast cancer on fibrinolytic activity and the effect of mastectomy on fibrinolysis in African women. Sixty histo-patholically proven breast cancer patients aged 25 - 45 years were compared with 50 healthy age-matched controls. Plasma fibrinogen levels and euglobulin lysis time (ELT) were estimated in breast cancer patients and th controls. Patients with breast cancer had significantly increased fibrinogen levels euglobulin lysis time (P < 0.001) compare with controls. There was significant mean difference between pre and post-mastectomy fibrinogen and euglobulin lysis time values (p < 0.05). Progressive significant decrease in fibrinogen levels and euglobulin lysis time values (P < 0.05) were observed over the weeks studied respectively. African women with breast cancer have defective fibrin clearing which could predispose them to thrombotic diathesis and early mastectomy may be beneficial. We suggest that fibrinolytic components may be a prognostic marker for breast cancer.

Acute onset lactic acidosis and pancreatitis in the third trimester of pregnancy in HIV-1 positive women taking antiretroviral medication.

We report the case histories of two HIV-1 positive women in the third trimester of pregnancy who presented with acute lactic acidosis and acute pancreatitis, respectively. One case was fatal for mother and baby. Both women had been stable on regimens containing stavudine and didanosine for at least 2 years before their acute presentations. We speculate on the differential diagnosis, discuss possible reasons for an increased risk of these presentations in pregnant women taking antiretrovirals, and advocate increased vigilance of these women, particularly in the last trimester.

Antiretroviral therapy for HIV-2 infected patients.

OBJECTIVES: To evaluate clinical and RNA load response to antiretroviral therapy amongst patients infected with HIV-2 and to study the development of drug resistance. METHODS: Seven HIV-2 seropositive patients were monitored with clinical examination, CD4 cell count and HIV-2 viral RNA load. Viruses from four subjects were genotyped and in vitro recovery of virus by co-cultivation with PBMCs and HVS T-cells was attempted. Viruses isolated from two subjects were assayed for phenotypic antiviral resistance. The main outcome measures were the relationship between disease stage, viral load, CD4 cell count, viral subtype and the clinical course of HIV-2 infection and the effect of combination antiretroviral therapy on disease progression, CD4 cell count, HIV-2 RNA viral load and drug resistance. RESULTS: The median time of follow-up was 3 years (range 0-8 years). Three patients had AIDS, and one had symptomatic disease. Of the four patients genotyped, three were infected with HIV-2 subtype B and one with subtype A. Viraemia was detectable only at CD4 counts of less than 300 x 10(6)/ml. Two patients with high viral loads failed to respond to antiretroviral therapy although their treatment may not have been optimal. One developed in vitro phenotypic antiviral resistance. The genotype of this patient's viral reverse transcriptase is being analysed. CONCLUSIONS: In contrast to HIV-1, HIV-2 RNA levels were often undetectable despite advanced disease and low CD4 cell counts. However, HIV-2 was clearly capable of causing CD4 cell depletion resulting in symptomatic disease. The principles of highly active antiretroviral therapy seem to apply to HIV-2 and suboptimal therapy may lead to drug resistance. The timing of therapy initiation, monitoring of response and the measurement of resistance remain unresolved issues and conclusions cannot be extrapolated from HIV-1.

Africans in London continue to present with advanced HIV disease in the era of highly active antiretroviral therapy.

Our findings show that despite the numerous advances in the management of HIV disease, this has not resulted in earlier presentation in Africans or non-Africans. African patients are still presenting with significantly more advanced disease than non-Africans, and are more likely to have AIDS at presentation in 1998-1999 than in 1982-1995. An urgent need exists to identify the factors associated with delayed presentation, both to optimize clinical outcomes and reduce the possibility of onward transmission.

HIV infection alters the production of both type 1 and 2 cytokines but does not induce a polarized type 1 or 2 state.

OBJECTIVE: To test the T-helper (TH)1/TH2 cytokine paradigm in HIV infection. DESIGN AND METHODS: Cytokine profiles in two separate studies of HIV patients and controls are presented: (i) a longitudinal study of HIV patients with CD4 counts > 500 x 10(6)/l tested at three timepoints compared with controls; (ii) a blinded cross-sectional study of controls and patients with high (> 500 x 10(6)/l) and low (< 500 x 10(6)/l) CD4 counts. Peripheral blood mononuclear cells (PBMC) from patients and controls were tested for the production of two type 1 [interleukin (IL)-2, interferon (IFN)-gamma] and two type 2 (IL-4, IL-10) cytokines by enzyme-linked immunosorbent assay. Both spontaneous and mitogen-induced cytokine production was measured. RESULTS: HIV infection was noted to have the following effects on cytokine production: (i) it led to the in vivo activation of type 2 cytokines in a small group of individuals with high CD4 numbers characterized by the spontaneous release of IL-4 and IL-10. Longitudinal data showed high spontaneous IL-4 and IL-10 to be a consistent feature of the patient group (at each timepoint some patients were high producers) but to be variable in a given individual; (ii) HIV infection impaired the ability of PBMC to respond to stimuli (selected for their ability to optimally induce each cytokine) in terms of IL-2, IL-4 and IL-10 production in patients with both high and low CD4 cell counts; and (iii) conversely, HIV infection led to an overproduction of IFN-gamma in patients with high CD4 counts; patients with low CD4 produced normal levels of IFN-gamma. CONCLUSIONS: Our observations did not suggest polarization of the type 1/type 2 cytokine profile in HIV patients. Instead, the data suggested more complex changes to type 1/type 2 cytokine patterns in HIV infection than originally proposed by the TH1/TH2 dichotomy.

Clinical and laboratory features of patients with loiasis (Loa loa filariasis) in the U.K.

To assess differences between Africans and expatriates, we reviewed records of 100 patients with loiasis presenting to The Hospital for Tropical Diseases, London. Fifty-one were black Africans, and 49 were white expatriates. A history of Calabar swellings was more common amongst expatriates (P = 0.0001, OR 8.1), whilst eyeworm was reported more frequently in Africans (P = 0.0038, OR 4.2). Higher eosinophil levels (P < 0.0001) and filarial antibody levels, whether measured by immunofluorescence (P = 0.047) or ELISA (P < 0.0001) were present in the expatriates. Africans were more likely to have microfilaraemia (P < 0.0025, OR 7.3), and among microfilaraemic patients, Africans had denser microfilaraemia (P = 0.012). The sensitivity of microfilaremia as a screening test for loiasis was 75% in Africans and 29% in expatriates. The sensitivities of filarial antibody tests in Africans and expatriates were 81% and 100% for IFAT, and 28% and 93% for ELISA. Following treatment, 63% of patients were considered cured, 25% were lost to follow-up and 12% had a documented relapse. The differences between the two groups of patients could be caused by differences in the chronicity of loiasis, but other explanations are also discussed.

Reference ranges and sources of variability of CD4 counts in HIV-seronegative women and men.

BACKGROUND: CD4 lymphocyte counts are used to monitor immune status in HIV disease. An understanding of the variability of CD4 counts which occurs in the absence of HIV infection is essential to their interpretation. The sources and degree of such variability have not been extensively studied. OBJECTIVES: To establish reference ranges for CD4 counts in HIV-seronegative women and heterosexual men attending a genitourinary medicine (GUM) clinic, and to identify possible differences according to gender and cigarette smoking and, in women, any effect of the menstrual cycle, oral contraceptive use and cigarette smoking. DESIGN: Female and heterosexual male patients attending a GUM clinic and requesting an HIV-antibody test were recruited prospectively. Results from an earlier study of CD4 counts in homosexual men were available for comparison. METHODS: Lymphocyte subpopulation analysis on whole blood by flow cytometry. RESULTS: The absolute CD4 count and percentage of CD4 cells (CD4%) were significantly higher in women (n = 195) than heterosexual men (n = 91) [difference between the means 111 x 106/1 (95% CI 41, 180) and 3.1% (1.30, 4.88)]. The absolute CD4 count and CD4% were also significantly higher in smokers (n = 143) than non-smokers (n = 140) [difference 143 (79, 207) and 2.1% (0.43, 3.81)]. Reference ranges for absolute CD4 counts (geometric mean +/- 2SD) were calculated on log transformed data as follows; female smokers 490-1610, female non-smokers 430-1350, heterosexual male smokers 380-1600, heterosexual male non-smokers 330-1280. Among other variables examined, combined oral contraceptive pill use was associated with a trend towards a lower absolute CD4 count. Changes were seen in CD4% with the menstrual cycle. CD4 counts and CD4% did not differ significantly between heterosexual men and homosexual men (n = 45). CONCLUSION: There is a significant gender and smoking effect on CD4 counts. The effects of oral contraceptive use and the menstrual cycle warrant further investigation.

Fatty acid composition of breast milk from Nigerian and Japanese women.

The fatty acid composition of samples of breast milk obtained from well-nourished Nigerian and Japanese women was determined by gas chromatography. The cultural differences in dietary intake was reflected in the fatty acid composition of breast milk samples. The milk of Nigerian women contained a significantly higher percentage of saturated fatty acids (48.75%) than that of Japanese women (46.65%). Nigerian milks were also richer in arachidonic (20:4 n-6), eicosatrienoic (20:3 n-6), and docosatetraenoic (22:4 n-6) acids. Conversely, the milk of Japanese woman contained significantly higher percentages of monoun-saturates as palmitoleic, heptadecenoic, oleic, and polyunsaturates of n-3 series as alpha-linolenic, eicosapentaenoic, and docosahexaenoic acid.