Treatment of Obesity with Thyroid hormones in Europe. Data from the THESIS* Collaboration.

PURPOSE: The use of thyroid hormones (TH) to treat obesity is unsupported by evidence as reflected in international guidelines. We explored views about this practice, and associations with respondent characteristics among European thyroid specialists. METHODS: Specialists from 28 countries were invited to a survey via professional organisations. The relevant question was whether "Thyroid hormones may be indicated in biochemically euthyroid patients with obesity resistant to lifestyle interventions". RESULTS: Of 17,232 invitations 5695 responses were received (33% valid response rate; 65% women; 90% endocrinologists). Of these, 290 (5.1%) stated that TH may be indicated as treatment for obesity in euthyroid patients. This view was commoner among non-endocrinologists (8.7% vs. 4.7%, p < 0.01), private practice (6.5% vs. 4.5%, p < 0.01), and varied geographically (Eastern Europe, 7.3%; Southern Europe, 4.8%; Western Europe, 2.7%; and Northern Europe, 2.5%). Respondents from Northern and Western Europe were less likely to use TH than those from Eastern Europe (p < 0.01). Gross national income (GNI) correlated inversely with this view (OR 0.97, CI: 0.96-0.97; p < 0.001). Having national guidelines on hypothyroidism correlated negatively with treating obesity with TH (OR 0.71, CI: 0.55-0.91). CONCLUSIONS: Despite the lack of evidence, and contrary to guidelines' recommendations, about 5% of respondents stated that TH may be indicated as a treatment for obesity in euthyroid patients resistant to life-style interventions. This opinion was associated with (i) respondent characteristics: being non-endocrinologist, working in private practice, treating a small number of hypothyroid patients annually and (ii) national characteristics: prevalence of obesity, Eastern Europe, low GNI and lack of national hypothyroidism guidelines.

Seroprevalence of Toxoplasma gondii infection among pregnant women in Windhoek, Namibia, in 2016.

BACKGROUND: When a pregnant woman contracts Toxoplasma gondii (T. gondii) infection during pregnancy, it may be vertically transmitted to the foetus. Information on the incidence of congenital toxoplasmosis (CT) in developing countries is scarce. Most studies focus on the seroprevalence of T. gondii infection among pregnant women. This study aimed to determine the seroprevalence of T. gondii infection among pregnant women attending public antenatal care in Windhoek, Namibia, in 2016. METHODS: In this descriptive study, 344 urban pregnant women attending public antenatal care were voluntarily enrolled in the study. Seroprevalence of anti-T. gondii Immunoglobulin G (IgG) was determined by automated immunoassay. Samples with a positive T. gondii IgG result were tested for T. gondii Immunoglobulin M (IgM) and specific IgG avidity by using an enzyme-linked immunosorbent assay (ELISA) test. A questionnaire captured demographic data and exposure to risk factors. Data were analysed using Statistical Package for the Social Sciences (SPSS) and R. RESULTS: Anti-T. gondii IgG was found in nine (2.61%) pregnant women. There was no association of anti-T. gondii IgG with demographic characteristics or exposure to risk factors.Anti-T. gondii IgM was positive in one (0.3%) woman, while three (0.9%) women had borderline anti-T. gondii IgM results. Specific IgG avidity was low, equivocal and high in 0%, 33% and 67% of seropositive pregnant women, respectively. CONCLUSION: Seroprevalence of anti-T. gondii IgG is much lower in Namibia than is reported in other developing countries. Investigation into specific IgM seropositivity and IgG avidity showed that pregnant women in the central region of Namibia are at low risk of vertical transmission and development of CT.

Novel Classifications for Muscular Contraction of the Lower Face and Neck.

BACKGROUND: Currently, there are no scales that address lower-face muscular contraction patterns, and there is only one that addresses platysmal bands. OBJECTIVE: The goal of this article is to create scales to classify the strength and contraction patterns of the lower face and neck based on (1) the muscular anatomy and contraction patterns of the platysma and (2) the strength of the depressor anguli oris (DAO). METHODS: Three hundred sixty patients participated in the study. Standardized photogarphs were taken in an effort to characterize muscle contraction patterns. RESULTS: A novel classification measuring the strength of the DAO is presented. For the DAO, 4 different contraction patterns were observed: Type 1 (38%), Type 0 (26.3%), Type 2 (25.2%), and Type 3 (8.6%). The remainder (1.9%) used asymmetric contraction. For platysmal bands, 3 different contraction patterns were observed: complete contraction (64.53%), lateral contraction (19.83%), and central contraction pattern (11.73%). A small percentage of patients (3.91%) had an asymmetric contraction pattern. CONCLUSION: Categorization of contraction of the DAO and platysmal bands into these proposed classifications provides objective measurements that can be helpful for designing treatment protocols and assessing response to treatment.

Role of sialendoscopy in juvenile recurrent parotitis (JRP).

Juvenile recurrent parotitis (JRP) is a rare disease of childhood occurring between the ages of 3 and 5 years, characterized by recurrent non-suppurative parotitis, spontaneously evolving towards parotid gland dysfunction. Clinically, JRP presents in the form of unilateral or bilateral, usually asynchronous, swelling of the parotid gland. The diagnosis is based on ultrasound characteristics. Widespread use of sialendoscopy has opened up new prospects for the management of this disease. This review of the literature evaluates the role of sialendoscopy in the management of JRP. A Medline search retrieved 68 articles, 18 of which concerned JRP. Standard treatment consists of antibiotics for at least 10 days at the acute phase of the disease. All studies demonstrated the diagnostic value of sialendoscopy by visualizing strictures, hypovascularization and whitish intraductal debris. Sialendoscopy is also useful for treatment, by allowing intraductal lavage and, when possible, dilatation of strictures. Lavage is performed with saline solution, hydrocortisone, antibiotics or a combination of these solutions, with no significant differences in terms of efficacy. The mode of administration with or without sialendoscopy also appears to provide similar results. Sialendoscopy appears to be a diagnostic and therapeutic option, although it has not been shown to be more effective than simple lavage. All lavage solutions appear to be effective.

Supracricoid partial laryngectomy with crico-hyoido-epiglottopexy for glottic carcinoma with anterior commissure involvement.

Glottic cancers discovered at an early stage (T1-T2) can be treated with either radiotherapy or surgery. The aim of our study is to analyse survival and functional results of supra-cricoid partial laryngectomy (SCPL) with crico-hyoido-epiglottopexy (CHEP) as surgical treatment for glottic carcinoma with anterior commissure involvement. We performed a retrospective study (1996-2013) which included patients who underwent SCPL-CHEP for glottic squamous cell carcinoma with involvement of the anterior commissure. Before surgery, all patients underwent staging including head, neck and chest CT-scan with contrast injection as well as suspension laryngoscopy under general anaesthesia. A total of 53 patients were included. The median follow-up period was 124 months. Tumour resection was complete in 96.2% of cases. The overall, specific and recurrence-free survival rates at 5 years were, respectively, 93.7%, 95.6% and 87.7%. The average period of hospitalisation was 18 days. The average time elapsed before decannulation and before restoration of oral feeding were 15 and 18 days, respectively. SCPL-CHEP is an important option for laryngeal surgical preservation. It allows adequate disease control as well as good functional results as long as the indications are well respected and the surgical techniques are mastered.

[Vestibular disorders and nausea during head and neck intensity-modulated radiation therapy]. / Nausées et troubles vestibulaires lors de la radiothérapie conformationnelle avec modulation d'intensité de la tête et du cou.

PURPOSE: We studied whether there is a relationship between nausea and vestibular disorders in patients treated with intensity modulated radiation therapy (IMRT) for head and neck cancer. PATIENTS AND METHODS: We performed a prospective single-centre study that enrolled 31 patients. A videonystagmography was carried out before and within 15 days after radiation therapy for each patient. Nausea was assessed at baseline, every week, and at the post-radiotherapy videonystagmography visit. RESULTS: Twenty-six patients had benefited from a complete interpretable videonystagmography. For 14 of these patients vestibular damage was diagnosed post-radiotherapy. During irradiation, six patients felt nauseous, but without dizziness. In univariate analysis, we found a relationship statistically significant between the average dose received by the vestibules and vestibular disorder videonystagmography (P=0.001, odds ratio [OR]: 1.08 [1.025-.138]), but there was no relationship between vestibular disorder videonystagmography and nausea (P=0.701). CONCLUSIONS: Irradiation of the vestibular system during IMRT does not seem to explain the nausea.

Biofertilization with Azospirillum brasilense improves in vitro culture of Handroanthus ochraceus, a forestry, ornamental and medicinal plant.

Biofertilization with plant growth-promoting rhizobacteria is a potential alternative to plant productivity. Here, in vitro propagation of Handroanthus ochraceus (yellow lapacho), a forest crop with high economic and environmental value, was developed using the Azospirillum brasilense strains Cd and Az39 during rhizogenesis. Epicotiles of in vitro plantlets were multiplied in Woody Plant Medium (WPM). For rooting, elongated shoots were transferred to auxin-free Murashige-Skoog medium with Gamborg's vitamins and WPM, both at half salt concentration (½MSG and ½WPM), and inoculated with Cd or Az39 at the base of each shoot. Anatomical studies were performed using leaves cleared and stained with safranin for optical microscopy and leaves and roots metalized with gold-palladium for scanning electron microscopy (SEM). In ½WPM auxin-free medium, A. brasilense Cd inoculation produced 55% of rooting, increased root fresh and dry weight (45% and 77%, respectively), and led to lower stomata size and density with similar proportion of open and closed stomata. Both strains selectively increased the size or density of glandular trichomes in ½MSG. Moreover, bacteria were detected on the root surface by SEM. In conclusion, the difference in H. ochraceus response to A. brasilense inoculation depends on the strain and the plant culture media. Cd strain enhanced rooting in auxin-free ½WPM and produced plantlets with features similar to those expected in ex vitro plants. This work presents an innovative in vitro approach using beneficial plant-microorganism interaction as an ecologically compatible strategy in plant biotechnology.

Aortic stiffness and left ventricular function in patients with differentiated thyroid cancer.

OBJECTIVE: The aim of this study was to investigate aortic stiffness and left ventricular (LV) systolic and diastolic function in patients with differentiated thyroid cancer (DTC) on thyroxine (L-T4) therapy and after L-T4 withdrawal to assess the cardiovascular impact of long-term subclinical hyperthyroidism and short-term overt hypothyroidism. METHODS: Twenty-four patients who had had total thyroidectomy and radioiodine ablation for differentiated thyroid cancer were studied on two occasions: on TSH suppressive L-T4 therapy (sTSH 0.24 ± 0.11 mU/L), and 4 weeks after L-T4 withdrawal (sTSH 89.82 ± 29.36 mU/L). Echocardiography was performed and thyroid function, serum thyroglobulin, lipid parameters, homocystine, C-reactive protein, fibrinogen and von Willebrand factor activity (vWF) were measured. Twenty-two healthy volunteers matched for age and sex served as euthyroid controls. RESULTS: Aortic stiffness was increased both in hypothyroidism (6.04 ± 2.88 cm(2)/dyn/10(3), p < 0.05) and subclinical hyperthyroidism (9.27 ± 4.81 cm(2)/dyn/10(3), p < 0.05) vs. controls (3.92 ± 1.84 cm(2)/dyn/10(3)). Subclinical hyperthyroidism had a more marked effect (p < 0.05). LV dimensions and ejection fractions were similar before and after L-T4 withdrawal. The E'/A' was higher in euthyroid controls (1.34 ± 1.02) as compared to both subclinical hyperthyroidism (1.0 ± 0.14, p < 0.05) and overt hypothyroidism (1.13 ± 0.98, p < 0.05). Change of aortic stiffness correlated with change of free-thyroxine (fT4), vWF and fibrinogen levels in a positive manner. CONCLUSION: Long-term thyrotropin-suppression therapy has continuous adverse effects on the arterial wall. The degree of TSH suppression in patients with DTC should be kept at the possible minimum, based on individually determined potential benefits and risks of treatment, especially in patients with cardiovascular co-morbidities.

Profile, perceptions and future expectations of medical laboratory scientists in Namibia.

Background: Public healthcare systems in sub-Saharan Africa are challenged by healthcare worker shortages, loss of trained staff and attrition to the private sector. Studies have historically focused on medical doctors, nurses and pharmacists, with limited focus on medical laboratory scientists. Objectives: This study addresses the professional perspectives and expectations of the first two classes of biomedical science students, who graduated from the Polytechnic of Namibia in 2012 and 2013. Methods: A questionnaire was developed to capture qualitative and quantitative data from fourth-year students completing their final semester. Data collected included: demographic information; students' experience; professional expectations; and perceptions about the future of biomedical science education in Namibia. Results: Amongst the 42 of 45 enrolled students who completed the questionnaire, nearly two-thirds anticipated working in government hospitals (29%) or industry (35%), with fewer planning careers in private hospitals (12%) or academia (14%). Most expressed an interest in working abroad (64%) and/or in the capital (64%), with fewer interested in small urban areas (48%). Only 7% expressed interest in working in a rural area. Regarding their view of the future of biomedical science in Namibia, 38% responded that it was encouraging, whereas the rest responded that it was uncertain (52%), negative (2%) or unknown (7%). Conclusion: Members of the first graduating classes of Namibia's nascent Biomedical Science degree programme reported a perceived lack of opportunity for professional advancement in the field if they remained in Namibia. Continued thought needs to be given to develop sustainable strategies and opportunities to retain Namibian biomedical laboratory scientists in Namibia.

The role of tonsillectomy in the initial diagnostic work-up of head and neck squamous cell carcinoma of unknown primary.

OBJECTIVE: The aim of the present study was to determine the value of tonsillectomy in the initial diagnostic work-up of head and neck squamous cell carcinoma of unknown primary (HNSCCUP). MATERIAL AND METHODS: A single-center retrospective study (1999­2012) included 45 patients. All cases underwent physical examination, panendoscopy and contrast-enhanced neck and chest CT scan; 27 (60%)also underwent 18-FDG PET scan. Imaging was systematically performed before panendoscopy. In 34 cases (75%), histologic tonsil samples ipsilateral to the HNSCCUP were collected (28 tonsillectomies and 6 biopsies) during panendoscopy. Categoric variables were compared on Chi-square test. RESULTS: Clinical examination and CT did not identify any primary tumor. In 13 cases (38%), invasive squamous cell carcinoma (SCC) was diagnosed on histological samples (12 tonsillectomies, 1 biopsy). For these 13 cases, lymph nodes were located in the upper or middle jugular group, and in 3 cases lymph nodes were cystic on CT scan. In 7 cases (26%), there was an abnormal tonsillar 18-FDG uptake ipsilateral to the cervical lymphadenopathy; tonsillectomy was performed, and SCC was found in 5 of these cases:i.e., 18-FDG PET showed sensitivity and specificity of respectively 55.5 and 88.8%. CONCLUSION: Tonsillectomy has a role in the initial diagnostic work-up of HNSCCUP. It is especially useful when lymph nodes are located in the upper and/or middle jugular group with a cystic aspect on CT.

Exposure and risk factors to coxiella burnetii, spotted fever group and typhus group Rickettsiae, and Bartonella henselae among volunteer blood donors in Namibia.

BACKGROUND: The role of pathogen-mediated febrile illness in sub-Saharan Africa is receiving more attention, especially in Southern Africa where four countries (including Namibia) are actively working to eliminate malaria. With a high concentration of livestock and high rates of companion animal ownership, the influence of zoonotic bacterial diseases as causes of febrile illness in Namibia remains unknown. METHODOLOGY/PRINCIPAL FINDINGS: The aim of the study was to evaluate exposure to Coxiella burnetii, spotted fever and typhus group rickettsiae, and Bartonella henselae using IFA and ELISA (IgG) in serum collected from 319 volunteer blood donors identified by the Blood Transfusion Service of Namibia (NAMBTS). Serum samples were linked to a basic questionnaire to identify possible risk factors. The majority of the participants (64.8%) had extensive exposure to rural areas or farms. Results indicated a C. burnetii prevalence of 26.1% (screening titre 1∶16), and prevalence rates of 11.9% and 14.9% (screening titre 1∶100) for spotted fever group and typhus group rickettsiae, respectively. There was a significant spatial association between C. burnetii exposure and place of residence in southern Namibia (P<0.021). Donors with occupations involving animals (P>0.012), especially cattle (P>0.006), were also significantly associated with C. burnetii exposure. Males were significantly more likely than females to have been exposed to spotted fever (P<0.013) and typhus (P<0.011) group rickettsiae. Three (2.9%) samples were positive for B. henselae possibly indicating low levels of exposure to a pathogen never reported in Namibia. CONCLUSIONS/SIGNIFICANCE: These results indicate that Namibians are exposed to pathogenic fever-causing bacteria, most of which have flea or tick vectors/reservoirs. The epidemiology of febrile illnesses in Namibia needs further evaluation in order to develop comprehensive local diagnostic and treatment algorithms.

Effect of thyroid hormone status and concomitant medication on statin induced adverse effects in hyperlipidemic patients.

Statins are effective treatment for the prevention of cardiovascular diseases and used extensively worldwide. However, adverse effects induced by statins are the major barrier of maximalizing cardiovascular risk reduction. Hypothyroidism and administration of drugs metabolized on the same cytochrome P450 (CYPP450) pathways where statin biotransformation occurs represent a significant risk factor for statin induced adverse effects including myopathy. Simvastatin, atorvastatin and lovastatin are metabolized by CYP3A4, fluvastatin by CYP2C9, while rosuvastatin by CYP2C9 and 2C19. We investigated the levels of the free thyroid hormones and CYP metabolism of concomitant medication in 101 hyperlipidemic patients (age 61.3 +/- 9.9 ys) with statin induced adverse effects including myopathy (56 cases; 55.4%), hepatopathy (39 cases; 38.6%) and gastrointestinal adverse effects (24 cases; 23.8%). Abnormal thyroid hormone levels were found in 5 patients (4.95%); clinical hypothyroidism in 2 and hyperthyroidism in 3 cases. 11 patients had a positive history for hypothyroidism (10.9%). Myopathy occured in one patient with hypothyroidism and two patients with hyperthyroidism. There were no significant differences in the TSH, fT4 and fT3 levels between patients with statin induced myopathy and patients with other types of adverse effects. 78 patients (77.2%) were administered drugs metabolized by CYP isoforms also used by statins (3A4: 66 cases (65.3%); 2C9: 67 cases (66.3%); 2C19: 54 cases (53.5%)). Patients with myopathy took significantly more drugs metabolized by CYP3A4 compared to patients with other types of adverse effects (p < 0.05). More myopathy cases were found in patients on simvastatin treatment (52% vs. 38%, ns.), while significantly less patients with myopathy were on fluvastatin treatment (13% vs. 33%, p < 0.05) compared to patients with other types of statin induced adverse effects. Both abnormal thyroid hormone status and administration of drugs metabolized by CYP3A4, 2C9 and 2C19 are common in our patients with statin induced adverse effects. Normalizing the thyroid hormone status and optimizing of the concomitant medication may reduce the risk of statin induced adverse effects.

The c.-133A > G polymorphism in NPC1L1 gene influences the efficacy of ezetimibe monotherapy on apolipoprotein A1 in hyperlipidemic patients.

Niemann-Pick C1-like 1 protein (NPC1L1) plays a critical role in intestinal cholesterol absorption. Previous studies found that the NPC1L1 c.-133A > G SNP, but not other NPC1L1 SNPs, was associated with response to statin treatment and statin-ezetimibe combinations. To date effect of NPC1L1 c.-133A > G SNP on ezetimibe monotherapy has not been studied. Our objective was to examine whether SNP c.-133A > G at the NPC1L1 gene has effects on lipid levels and on the efficacy of 3, 6 and 12 months of 10 mg daily ezetimibe monotherapy in hyperlipidemic patients with statin induced adverse effects. One hundred and one type IIa and IIb hyperlipidemic patients (72 females, 29 males; age: 61.23 +/- 9.87 ys; BMI: 28.18 +/- 4.29 kg/m2) were enrolled. The genotype frequencies were conformed to Hardy-Weinberg equilibrium. We could not find significant differences in initial lipid levels between AA and AG + GG patients. While plasma levels of apolipoprotein A1 (ApoA1) did not significantly decrease after ezetimibe treatment (1.96; 3.39 and 2.74%) in AA patients, a significant elevation in ApoA1 levels has been found after treatment in AG + GG patients (9.15; 8.54 and 13.58%). The effect of NPC1L1 c.-133A > G on the ApoA1 levels was found significant (p < 0.05). Efficacy of treatment with ezetimibe on other plasma lipid parameters after 3, 6 or 12 months did not differ significantly. NPC1L1-133A > G SNP influences the ApoA1 response to ezetimibe monotherapy, therefore, may alter the effect of ezetimibe on the structure and function of the high-density lipoprotein particles.

Fertility of testicular cancer patients after anticancer treatment--experience of 11 years.

Testicular cancer affects men mostly in their reproductive age with a cure rate over 90%. Preserved fertility is one of the main concerns of the survivors. To further elucidate the question of fertility after anticancer treatment for testicular cancer, we performed a survey among patients who underwent sperm cryopreservation procedure in our department. A structured questionnaire was designed to collect data on demography, anticancer treatment, histological type of cancer, family planning intentions and fertility prior to and after treatment. During a period of 11 years 86 men underwent semen cryopreservation before starting chemo-or radiotherapy. Fifty-nine of them consented to participate in the study. The average length of follow up was 4.6 +/- 3.8 years. In case of 11.9% of the patients their banked sperm was used, which led to live birth in 57% of the couples. The partners of 6 patients became pregnant after in vitro fertilization (IVF) resulting in 4 live births and 2 miscarriages. The spontaneous pregnancy rate was 22%. Spontaneous pregnancy occurred in 13 partners resulting in 18 pregnancies followed by 12 live births, 2 artificial abortions and 4 miscarriages. We could not prove any association between preserved fertility and anticancer treatment or the histological type of the cancer. In conclusion, although spontaneous pregnancy rate is remarkably high after anticancer treatment for testicular cancer, the risk of infertility after receiving gonadotoxic treatment cannot be predicted. Cryopreservation is a safe and effective method to preserve fertility in these cases. As a result we strongly recommend discussing the advantages of semen cryopreservation with all patients awaiting treatment for testicular cancer.

Use of artichoke (Cynara scolymus) flower extract as a substitute for bovine rennet in the manufacture of Gouda-type cheese: characterization of aspartic proteases.

Artichoke (Cynara scolymus L.) flower extract was assayed with the aim of replacing animal rennet in the manufacture of Gouda-type cheeses from bovine milk. Floral extract coagulated milk within a suitable time for use on an industrial scale, while the yield of cheese obtained was equal to that achieved with bovine abomasum. Five proteolytic fractions with milk-clotting activity were isolated in a two-step purification protocol, three belonging to the cardosin group. Cheeses made with C. scolymus proteases must be brined for a longer period (40 h) to prevent overproteolysis and avoid the development of a background flavor. The type of coagulant (bovine or vegetable) had no significant effect on the cheeses' chemical parameters analyzed throughout ripening, and no significant organoleptic differences were detected between those manufactured with C. scolymus or animal rennet. The results indicate that C. scolymus flower extract is suitable for replacing animal rennet in the production of Gouda-type cheeses.

Intramuscular cavernous hemangioma arising from the masseter muscle.

INTRODUCTION: Only 10% of intramuscular hemangiomas (IMH) are located in the head and neck region. There are very few reports of masseteric location. The present study of a case of intra-masseteric cavernous hemangioma discusses clinical presentation, paraclinical diagnostic workup and treatment options. CASE REPORT: A 70-year-old male patient consulted for a swelling of 2 years' evolution, anterior to the left parotid gland. The swelling was firm, painless, well-contoured, oblong, 3 cm on its long axis, and located in the masseter muscle. There was no effect of head position on tumor volume. MRI showed a vascular tumor. Surgical resection was performed via parotidectomy. There were no postoperative complications. Pathological examination confirmed the diagnosis of cavernous hemangioma. DISCUSSION: Head and neck IMH is commonly located in the masseter muscle. Evolution is slow. Size is variable, contours are well defined and the surface is smooth. MRI is essential ahead of treatment, which is surgical on an external or intra-oral approach.

Complete agenesis of major salivary glands.

A 4 year-old female patient was treated for persistent right-sided dacryocystitis and xerostomia. MRI was performed to screen for a dry syndrome; which resulted in the diagnosis of agenesis of the parotid and submandibular glands as well as lacrimal duct malformation. An MRI of each parent was normal. The mother's history revealed 4 days of pyrexia during the 8th week of amenorrhea. This was an isolated case, with no family history, characterized by a febrile episode during pregnancy at the period of main salivary gland genesis. Epigenetic mechanisms could be implicated.

Neglected tropical diseases of Namibia: unsolved mysteries.

Neglected tropical diseases (NTDs) are diseases most commonly found in settings of poverty and are responsible for the morbidity and/or mortality of millions each year. As an upper-middle income country, Namibia is not normally considered to have many NTDs but published reports indicate the possible presence of over 30. Because much of the data is buried in historical studies published before Independence in 1990, there is a risk of losing valuable information on which to build current and future integrated public health strategies. The purpose of this review, therefore, is to bring together these significant fragments to identify existing knowledge gaps which need to be addressed to build effective control, prevention, and even elimination strategies. The review focuses on intestinal helminthes, schistosomes/snail 'vectors', viruses (Rift Valley Fever, Crimean Congo Hemorrhagic Fever, rabies), protozoa (Leishmania, Toxoplasma, Amoeba, Giardia), bacteria (Rickettsia, Ehrlichia, Leptospira, Coxiella, Brucella, and Borrelia), fungi (Pneumocystis) and myiasis. Each NTD speaks to the possible need for surveillance and the creation of integrated disease risk maps, linking prevalence of related NTDs with environmental and ecological factors to assist control and prevention efforts. The predominance of zoonotic disease suggests a need to integrate veterinary and public health components as the national public health surveillance system is established.

In vitro propagation of jojoba.

Jojoba (Simmondsia chinensis (Link) Schn.) is a nontraditional crop in arid and semi-arid areas. Vegetative propagation can be achieved by layering, grafting, or rooting semi-hardwood cuttings, but the highest number of possible propagules is limited by the size of the plants and time of the year. Micropropagation is highly recommended strategy for obtaining jojoba elite clones. For culture initiation, single-node explants are cultivated on Murashige and Skoog medium (MS) supplemented with Gamborg's vitamins (B5), 11.1 µM BA (N(6)-benzyl-adenine), 0.5 µM IBA (indole-3-butyric acid), and 1.4 µM GA(3) (gibberellic acid). Internodal and apical cuttings proliferate on MS medium containing B5 vitamins and 4.4 µM BA. Rooting is achieved on MS medium (half strength mineral salt) amended with B5 vitamins and 14.7 µM IBA during 7 days and transferred to develop in auxin-free rooting medium. Plantlets are acclimatized using a graduated humidity regime on soil: peat: perlite (5:1:1) substrate. This micropagation protocol produces large numbers of uniform plants from selected genotypes of jojoba.

In vitro propagation of fraser photinia using Azospirillum-mediated root development.

Fraser photinia (Photinia × fraseri Dress.) is a woody plant of high ornamental value. The traditional propagation system for photinia is by rooting apical cuttings using highly concentrated auxin treatments. However, photinia micropropagation is an effective alternative to traditional in vivo propagation which is affected by the seasonal supply of cuttings, the long time required to obtain new plants, and the difficulties in rooting some clones.A protocol for in vitro propagation of fraser photinia using the plant growth-promoting ability of some rhizobacteria is described here. Bacterial inoculation is a new tool in micropropagation protocols that improves plant development in in vitro culture. Shoots culture on a medium containing MS macro- and microelements, Gamborg's vitamins (BM), N (6)-benzyladenine (BA, 11.1 µM), and gibberellic acid (1.3 µM) produce well-established explants. Proliferation on BM medium supplemented with 4.4 µM BA results in four times the number of shoots per initial shoot that develops monthly. Consequently, there is a continuous supply of plant material since shoot production is independent of season. Azospirillum brasilense inoculation, after 49.2 µM indole-3-butyric acid pulse treatment, stimulates early rooting of photinia shoots and produces significant increase in root fresh and dry weights, root surface area, and shoot fresh and dry weights in comparison with controls. Furthermore, inoculated in vitro photinia plants show anatomical and morphological changes that might lead to better adaptation in ex vitro conditions after transplanting, compared with the control plants.