Effect of a government funded medication programme on paediatric asthma hospital admissions in Antigua and Barbuda.

OBJECTIVE: To assess the effect of a government funded asthma medication programme on paediatric (age < or = 12 years) asthma hospital admissions in Antigua and Barbuda. METHODS: A retrospective review of all hospital admissions for asthma in children was performed for the six years before and six years after a Medical Benefits Scheme (MBS) programme was established in 1997 to provide asthma medications at no out-of-pocket cost. Holberton Hospital records (1992 to 2003) which include all paediatric asthma admissions in Antigua and Barbuda, were reviewed RESULTS: Paediatric admissions for asthma fell from mean +/- standard deviation of 77.0 +/- 24.8 per year before the MBS programme was started to 48.0 +/- 17.1 per year (p < 0.05) after the MBS programme was started. The number of multiple admissions fell from 18.7 +/- 2.7 to 9.5 +/- 4.8 (p < 0.005) and the number of children admitted multiple times per year fell from 7.8 +/- 1.9 to 4.7 +/- 2.5 (p < 0.05). The number of children aged four to nine years admitted with asthma fell from 7.8 per 1000 annually during 1992 to 1997 to 4.4 per 1000 per year during 1998 to 2003. CONCLUSIONS: The government funded MBS programme for asthma medication has resulted in a 38% decrease in hospital admissions for paediatric asthma over a six-year period. The benefits of a similar programme in other developing countries should be considered.

Effect of a government funded medication programme on paediatric asthma hospital admissions in Antigua and Barbuda / Efecto de un programa de medicación subvencionado por el gobierno, sobre los ingresos por asma al hospital pediátrico en Antigua y Barbuda

OBJECTIVE: To assess the effect of a government funded asthma medication programme on paediatric (age # 12 years) asthma hospital admissions in Antigua and Barbuda. METHODS: A retrospective review of all hospital admissions for asthma in children was performed for the six years before and six years after a Medical Benefits Scheme (MBS) programme was established in 1997 to provide asthma medications at no out-of-pocket cost. Holberton Hospital records (1992 to 2003) which include all paediatric asthma admissions in Antigua and Barbuda, were reviewed. RESULTS: Paediatric admissions for asthma fell from mean ± standard deviation of 77.0 ± 24.8 per year before the MBS programme was started to 48.0 ± 17.1 per year (p < 0.05) after the MBS programme was started. The number of multiple admissions fell from 18.7 ± 2.7 to 9.5 ± 4.8 (p < 0.005) and the number of children admitted multiple times per year fell from 7.8 ± 1.9 to 4.7 ± 2.5 (p < 0.05). The number of children aged four to nine years admitted with asthma fell from 7.8 per 1000 annually during 1992 to 1997 to 4.4 per 1000 per year during 1998 to 2003. CONCLUSIONS: The government funded MBS programme for asthma medication has resulted in a 38% decrease in hospital admissions for paediatric asthma over a six-year period. The benefits of a similar programme in other developing countries should be considered.

OBJETIVO: Evaluar el efecto de un programa de medicación subvencionado por el Gobierno, sobre los ingresos por asma al hospital pediátrico (edad # 12 años) en Antigua y Barbuda. MÉTODOS: Se llevó a cabo un examen retrospectivo de todos los casos de niños ingresados al hospital por asma, durante los seis años previos y los seis años posteriores a la puesta en marcha del programa de beneficios médicos, conocido como Medical Benefits Scheme (MBS). Dicho programa fue establecido en 1997 con el propósito de ofrecer medicamentos para asmáticos, sin costo alguno. Se examinaron las historias clínicas del Hospital Holberston, de 1992 al 2003, las cuales incluían todos los ingresos pediátricos por asma en Antigua. RESULTADOS: Los ingresos pediátricos por asma descendieron de un promedio ± desviación estándar de 77.0 ± 24.8 por año antes de que comenzara el programa MBS, 48.0 ± 17.1 por año (p < 0.05) después del comienzo del programa MBS. El número de ingresos múltiples descendió de 18.7 ± 2.7 a 9.5 ± 4.8 (p < 0.005) y el número de niños ingresados múltiples veces por año disminuyó de 7.8 ± 1.9 a 4.7 ± 2.5 (p < 0.05). El número de niños de cuatro a nueve años de edad, ingresados por asma, descendió de 7.8 por 1000 anualmente de 1992 a 1997 hasta 4.4 por 1000 por año, de 1998 a 2003. CONCLUSIONES: El programa MBS para la medicación por asma, subvencionado por el gobierno, ha tenido por resultado una disminución del 38% de los ingresos hospitalarios infantiles a causa de asma por un período de seis años. Debe tomarse en consideración los beneficios de posibles programas similares en otros países en vías de desarrollo.

Expression of fibroblast growth factor 13 (Fgf13) mRNA in bovine antral follicles and corpora lutea

Recent studies have suggested a paracrine role for several fibroblast growth factors (FGFs) in the regulation of follicle and luteal development. Fgf13 is a non-secreted FGF that has been previously localized to the developing gonads, but it is not known if it is expressed in the adult ovary. The objective of the present study was to determine the expression pattern of Fgf13 mRNA in the bovine ovary. Fgf13 mRNA expression was examined by semiquantitative RT-PCR using Gapdh as the internal control gene in theca and granulosa cells, corpora lutea (CL) and oocytes collected from abattoir ovaries. Follicles were grouped according to estradiol content (20-100 and >100 ng/ml) and size (5-7, 8-10 and >10 mm diameter). CL samples were morphologically classified into four developmental stages. Fgf13 mRNA expression was assessed in pools containing 50 oocytes aspirated from follicles larger than 4 mm in diameter. ANOVA was used to test for the main effects of follicle size group, and estradiol concentration group in granulosa and theca cells, and to test the effect of CL developmental stage on Fgf13 mRNA abundance. Fgf13 mRNA was detected in the CL and in somatic follicle cells, but not in oocytes. Thecal Fgf13 expression increased with increasing follicle diameter but did not change with intrafollicular estradiol concentrations. No evidence of developmental regulation of Fgf13 mRNA expression was observed in granulosa cells and CL. The present data demonstrate for the first time the expression of an intracellular FGF in the bovine ovary and suggests that Fgf13 mRNA is upregulated in bovine theca cells during antral follicle growth.

Expression of fibroblast growth factor 13 (Fgf13) mRNA in bovine antral follicles and corpora lutea

Recent studies have suggested a paracrine role for several fibroblast growth factors (FGFs) in the regulation of follicle and luteal development. Fgf13 is a non-secreted FGF that has been previously localized to the developing gonads, but it is not known if it is expressed in the adult ovary. The objective of the present study was to determine the expression pattern of Fgf13 mRNA in the bovine ovary. Fgf13 mRNA expression was examined by semiquantitative RT-PCR using Gapdh as the internal control gene in theca and granulosa cells, corpora lutea (CL) and oocytes collected from abattoir ovaries. Follicles were grouped according to estradiol content (<5, 5-20, >20-100 and >100 ng/ml) and size (5-7, 8-10 and >10 mm diameter). CL samples were morphologically classified into four developmental stages. Fgf13 mRNA expression was assessed in pools containing 50 oocytes aspirated from follicles larger than 4 mm in diameter. ANOVA was used to test for the main effects of follicle size group, and estradiol concentration group in granulosa and theca cells, and to test the effect of CL developmental stage on Fgf13 mRNA abundance. Fgf13 mRNA was detected in the CL and in somatic follicle cells, but not in oocytes. Thecal Fgf13 expression increased with increasing follicle diameter but did not change with intrafollicular estradiol concentrations. No evidence of developmental regulation of Fgf13 mRNA expression was observed in granulosa cells and CL. The present data demonstrate for the first time the expression of an intracellular FGF in the bovine ovary and suggests that Fgf13 mRNA is upregulated in bovine theca cells during antral follicle growth.(AU)

Inositols prevent and reverse endothelial dysfunction in diabetic rat and rabbit vasculature metabolically and by scavenging superoxide.

Endothelial dysfunction (ED) is an early feature of cardiovascular risk and diabetes. Hyperglycemia and hyperlipidemia are causative factors. Excessive endothelial mitochondrial superoxide (ROS) production with hyperglycemia and hyperlipidemia is a key mechanism. Inositol components of an insulin inositol glycan mediator, d-chiro-inositol (DCI) and 3-O-methyl DCI (pinitol), decrease hyperglycemia and hyperlipidemia. We tested whether these, myoinositol and dibutyryl DCI (db-DCI), would prevent or reverse ED in diabetic rats and rabbits. Oral inositols reduced hyperglycemia and hypertriglyceridemia with different potencies and prevented ED in rat aortic rings and mesenteric beds. Inositols added in vitro to five diabetic tissues reversed ED. Relaxation by Ach, NO, and electrical field stimulation was potentiated by inositols in vitro in rabbit penile corpus cavernosa. Inositols in vitro restored impaired contraction by the eNOS inhibitor l-NAME and increased NO effectiveness. DCI and db-DCI decreased elevated ROS in endothelial cells in high glucose and db-DCI reduced PKC activation, hexosamine pathway activity, and advanced glycation end products to basal levels. Xanthine/xanthine oxidase generated superoxide was reduced by superoxide dismutase or inositols, with db-DCI efficacious in a mechanism requiring chelated Fe(3+). Histochemical examination of rat aortic rings for protein SNO demonstrated a decrease in diabetic rings with restoration by inositols. In summary, inositols prevented and reversed ED in rat and rabbit vessels, reduced elevated ROS in endothelial cells, potentiated nitrergic or vasculo-myogenic relaxations, and preserved NO signaling. These effects are related to their metabolic actions, direct superoxide scavenging, and enhancing and protecting NO signaling. Of the inositols tested, db-DCI was most effective.

Human T-cell leukaemia/lymphoma virus risk may be enhanced in some selected donor populations.

BACKGROUND AND OBJECTIVES: Certain patient ethnic groups may require blood components from donors under-represented in the UK donor population. Selective recruitment of Afro-Caribbean donors is therefore necessary but was considered to pose an increased risk of human T-cell leukaemia/lymphoma virus (HTLV) infection. To assess this a seroprevalence study of HTLV was undertaken in Afro-Caribbean and Caucasian donors. MATERIALS AND METHODS: Sera from 1100 Afro-Caribbean and 1100 Caucasian donors were tested for antibody to HTLV. Reactive samples were confirmed for specificity using an algorithm comprising two additional assays and polymerase chain reaction (PCR) where possible. RESULTS: Six Afro-Caribbean donors (0.55%) were considered to be infected with HTLV I. CONCLUSION: Donor selection in this case caused a significantly elevated prevalence of HTLV infection and serves as a warning of the need for care in the design of policies for selective donor recruitment.

Increased prevalence of hospital admissions for asthma in Antigua

In the 1980s, the prevalence of asthma increased in developed countries and the purpose of this study was to access trends in asthma morbidity in a small, developing caribbean island nation. A retrospective review of asthma admissions was undertaken at the Holberton Hospital, the only full service medical centre serving this country of 65,000. Asthma was defined clinically as more than one episode of wheezing. Two sources of data were obtained from the admission book on children's Ward (aged below 13 years) from 1987-1995 (admission diagnosis) and the Medical Records (all age groups) from 1992-1995 (discharge diagnosis). There was a 97 percent increase in paediatric admissions for asthma from 59 in 1989 to 116 in 1995. The average number of annual paediatric admission increased from 47 in 1989 to 1992, to 89 in 1993 to 1995 (p = 0.05). Patients with >l admission accounted for 28 percent of admissions (average 6 patients) in the earlier period and 22 percent of admissions (average 8 patients) in the later period (p=NS). Adult asthma increased from 77 cases in 1992 to 168 cases in 1995 (118 percent increase). Similar to developed countries, Antigua has experienced an increase in asthma morbidity. Young children make up the largest part of the increase. Environmental factors associated with a more "Western" lifestyle are probably responsible.(AU)

Some preliminary studies on the ability of Africanized honey bees (Apis mellifera L.) to tolerate cold temperatures when placed inside a refrigerator.

Cold is often suggested as an ecological mechanism to prevent the migration of Africanized honey bees. The ability of Africanized honey bees to tolerate cold temperatures was investigated. In one study an observation hive was placed inside a refrigerator at 25 degrees C. The study was conceptualized as a choice experiment in which the colony could remain in a cold environment or leave for a warm environment. Analysis indicated that the bees remained at 9 +/- 1 degrees C for 14 days before leaving. In a second series of studies, testing the tolerance to 0 degree C, 280 bees were placed individually in small metal tubes. The data gathered included survival rate, time to regain consciousness, and ability to feed. Analysis indicated that Africanized bees can survive for up to 3 hr. at 0 degree C with few ill effects. At 4 hr., however, the survival rate is low. Limitations of the study, the use of cold as a possible deterrent to honey bee mites, and suggestions for additional research are discussed.

Linkage of the angiotensinogen gene locus to human essential hypertension in African Caribbeans.

The renin-angiotensin system regulates blood pressure and sodium balance. The angiotensinogen gene which encodes the key substrate within this system has been linked to essential hypertension in White Europeans. It has been suggested that people of West African ancestry may have a different genetic basis for hypertension. In this study we have tested whether there is linkage of the angiotensinogen gene to essential hypertension in African Caribbeans from St. Vincent and the Grenadines. DNA from 63 affected sibling pairs with hypertension was tested for linkage by analyzing whether there was excess allele sharing among siblings genotyped using an angiotensinogen dinucleotide repeat sequence. There was significant support for linkage (T = 3.07, P = 0.001) and association of this locus to hypertension (chi 2 = 50.2, 12 degrees of freedom, P << 0.001). A DNA polymorphism which alters methionine to threonine at position 235 (M235T) within the angiotensinogen peptide has been associated previously with hypertension. However, we found no association of this variant with hypertension in this study. These findings provide support for linkage and association of the angiotensinogen locus to hypertension in African Caribbeans and suggest some similarities in the genetic basis of essential hypertension in populations of different ethnicity.

Tumor cell dissemination patterns and metastasis of murine mammary carcinoma.

Quantitative studies on the distribution kinetics of isotope-labeled cells from spontaneous murine mammary tumors injected intravenously or arterially showed that cells were rapidly distributed to all organs examined and indicated that the distribution patterns of metastases from such tumors are not primarily determined by the dose of cells delivered to each organ. The preferential colonization of certain organs is therefore considered to depend as much on differential survival and growth of the disseminated tumor cells in unfamiliar metabolic microenvironments, as on vascular sieving effects in organ capillary networks. Further experiments involved transplantation of pieces of nonpulmonary tissue containing trapped mammary tumor cells into syngeneic mice, followed by observation of the animals for several months. From these studies it is concluded that the absence of tumor colonies in extrapulmonary sites after i.v. inoculation is due to their inability to thrive in the organs concerned and not to early death of the original host from heavy pulmonary tumor growth. These results provide further evidence strengthening the conclusion emerging from several independent lines of investigation (Potter et al., Invasion Metastasis, 3: 221-233, 1983; Tarin et al., Cancer Res., 41: 3604-3609, 1981; Tarin et al., Cancer Res., 44: 3584-3592, 1984; Horak et al., J. Natl. Cancer Inst., 76: 913-922, 1986; Nicolson et al., Int. J. Cancer, 38: 289-294, 1986; Naito et al., Invasion Metastasis, 7: 16-29, 1987) that the growth of disseminated tumor cells is inhibited or even abrogated by many of the organs in which the cells sequester after vascular dissemination.

Serological evidence of infection of Tacaribe virus and arboviruses in Trinidadian bats.

Sera from 39 species of bats collected in Trinidad between 1972 and 1974 were tested against some or all of 18 arboviruses in hemagglutination inhibition (HI) and/or suckling mouse neutralization (N) tests. A few sera were HI-positive with Mucambo, eastern equine encephalitis (EEE), Oriboca, Restan, Manzanilla, Guama, Bimiti, and Catu. No sera were HI-positive with Mayaro, Caraparu or Maguari. Many ser inhibited one or more of the group B hemagglutinins: Ilheus, St. Louis encephalitis (SLE), dengue 2, and yellow fever (YF), positives occurred in nearly every species of bat, being most frequent with Ilheus. In N tests, a few or single sera were found to protect against Ilheus, Nepuyo, Guama, Bimiti, and Cocal, while none protected against EEE, SLE, YF or Catu. Many sera positive in HI test with Ilheus, SLE or YF failed to neutralize the respective virus. Tacaribe neutralizing antibody was demonstrated in Artibeus jamaicensis and A. lituratus, the sources of past virus isolation, in the fruit bats Sturnira lilium and Vampyrops helleri, and in the vampire bat Desmodus rotundus. Sera from 19 other species gave either negative or inconclusive results. No convincing evidence of Tacaribe antibody was found in 29 human sera, 20 from bat collectors.

Rabies virus and antibody in bats in Grenada and Trinidad.

Rabies virus was detected by fluorescent-antibody and mouse inoculation tests in the brain of one bat, Artibeus jamaicensis, collected at La Tante, Grenada on 19 June 1974. No rabies virus was found in the brains and/or salivary glands of 411 other Grenadian bats of 6 species tested, including 56 A. jamaicensis. Rabies neutralizing antibody was detected by the rapid fluorescent focus inhibition test (RFFIT) in 27 of 353 Grenadian bats. Positives occurred in each of the 6 species sampled, with 40.5% prevalence in A. jamaicensis. In 11 of 86 Trinidadian bats of 4 species known to carry rabies, positive sera occurred only in A. jamaicensis (18.6%) and A. lituratus (18.1%). The potential use of the REFIT indetermining rabies activity is discussed.