Equity of the HIV epidemic response in 13 African countries.

For over 25 years, new programs to attempt to stem the HIV epidemic have been developed in Africa by country governments as well as external donors. These programs and activities have built and operated facilities, trained clinicians, financed drugs and commodities, supported and helped finance government health planning and operations, and contributed in other ways. Who has benefited from this massive mobilization? While some single country and narrowly focused studies have been done, the issue of equity of HIV programs for vulnerable populations has not been examined in a large set of countries. Using Population-based HIV Impact Assessment (PHIA) data, we examine equity of the HIV programs in 13 African countries to determine if vulnerable groups (such as those with low wealth, rural populations, young adults, and females) have achieved comparable levels of access to HIV program services. In contrast, we also compare the equity of the HIV response to rural and low-wealth populations with the equity of corresponding domestic health systems using Demographic and Health Survey data.This study found that in over half of the countries, the HIV response indicators were equitable for vulnerable population segments including the low-wealth population (in seven countries) and rural population segment (in nine countries). In no country was the domestic health system equitable for these two groups. However, HIV programming does show some clear patterns of inequity for low-wealth and rural populations in some countries. For gender and young adults, the HIV response indicators show that in all 13 countries men and young adults are consistently underserved relative to their counterparts.

Evaluation of different protein extraction methods for banana (Musa spp.) root proteome analysis by two-dimensional electrophoresis.

Four protocols viz., the trichloroacetic acid-acetone (TCA), phenol-ammonium acetate (PAA), phenol/SDS-ammonium acetate (PSA) and trisbase-acetone (TBA) were evaluated with modifications for protein extraction from banana (Grand Naine) roots, considered as recalcitrant tissues for proteomic analysis. The two-dimensional electrophoresis (2-DE) separated proteins were compared based on protein yield, number of resolved proteins, sum of spot quantity, average spot intensity and proteins resolved in 4-7 pI range. The PAA protocol yielded more proteins (0.89 mg/g of tissues) and protein spots (584) in 2-DE gel than TCA and other protocols. Also, the PAA protocol was superior in terms of sum of total spot quantity and average spot intensity than TCA and other protocols, suggesting phenol as extractant and ammonium acetate as precipitant of proteins were the most suitable for banana rooteomics analysis by 2-DE. In addition, 1:3 ratios of root tissue to extraction buffer and overnight protein precipitation were most efficient to obtain maximum protein yield.

Phenylpropanoid enzymes, phenolic polymers and metabolites as chemical defenses to infection of Pratylenchus coffeae in roots of resistant and susceptible bananas (Musa spp.).

Activity differences of the first (phenylalanine ammonia lyase, PAL) and the last (cinnamyl alcohol dehydrogenase, CAD) enzymes of phenylpropanoid pathway in the roots of resistant (Yangambi Km5 and Anaikomban) and susceptible (Nendran and Robusta) banana cultivars caused by root lesion nematode, Pratylenchus coffeae, were investigated. Also, the accumulation of phenolics and deposition of lignin polymers in cell walls in relation to resistance of the banana cultivars to the nematode were analyzed. Compared to the susceptible cultivars, the resistant cultivars had constitutively significantly higher PAL activity and total soluble and cell wall-bound phenolics than in susceptible cultivars. The resistant cultivars responded strongly to the infection of the nematode by induction of several-time higher PAL and CAD enzymes activities, soluble and wall-bound phenolics and enrichment of lignin polymers in cell wall and these biochemical parameters reached maximum at 7th day postinoculation. In addition, profiles of phenolic acid metabolites in roots of Yangambi Km5 and Nendran were analyzed by HPLC to ascertain the underlying biochemical mechanism of bananas resistance to the nematode. Identification and quantification of soluble and cell wall-bound phenolic acids showed six metabolites and only quantitative, no qualitative, differences occurred between the resistant and susceptible cvs. and between constitutive and induced contents. A very prominent increase of p-coumaric, ferulic and sinapic acids, which are precursors of monolignols of lignin, in resistant cv. was found. These constitutive and induced biochemical alterations are definitely the chemical defenses of resistant cvs. to the nematode infection.

Health expenditures, health outcomes and the role of good governance.

This paper examines the relationship between country health spending and selected health outcomes (infant mortality and child mortality), using data from 133 low and middle-income countries for the years 1995, 2000, 2005, and 2006. Health spending has a significant effect on reducing infant and under-5 child mortality with an elasticity of 0.13 to 0.33 for infant mortality and 0.15 to 0.38 for under-5 child mortality in models estimated using fixed effects methods (depending on models employed). Government health spending also has a significant effect on reducing infant and child mortality and the size of the coefficient depends on the level of good governance achieved by the country, indicating that good governance increases the effectiveness of health spending. This paper contributes to the new evidence pointing to the importance of investing in health care services and the importance of governance in improving health outcomes.

Diethyl [(2-chloro-anilino)(1,3-diphenyl-1H-pyrazol-4-yl)meth-yl]phospho-nate.

In the title compound, C(26)H(27)ClN(3)O(3)P, the mean plane of the central pyrazole ring forms a dihedral angle of 71.37 (14)° with the chloro-phenyl ring. In the crystal, mol-ecules are linked by pairs of N-H⋯O hydrogen bonds, forming inversion dimers with R(2) (2)(10) ring motifs. The 3-phenyl ring is disordered with four C atoms occupying two sets of sites with an occupancy ratio of 0.748 (4):0.252 (4).

Population-based cancer incidence in Sikkim, India: report on ethnic variation.

BACKGROUND: A Population-Based Cancer Registry (PBCR) was set up in Sikkim (a state in the North Eastern India) in 2003. We examined incidence rates by ethnic groups from 2003-2008. METHODS: Age-adjusted incidence rates (AARs) per 100,000 person-years were calculated by direct method using the world standard population, and analysed by ethnic group (Bhutia, Rai and other). RESULT: There were a total of 1148 male and 1063 female cases of cancer between 2003 and 2008 on the Sikkim PBCR. The overall AARs were 89.4 and 99.4 per 100,000 person-years in males and females, respectively. Incidence rates were highest amongst the Bhutia group (AAR=172.4 and 147.4 per 100,000 person-years in males and females, respectively), and the largest difference in rates were observed for stomach cancers with AARs being 12.6 and 4.7 times higher in the Bhutia group compared with other ethnic groups in males and females, respectively. CONCLUSION: These observations call for further epidemiological investigations and the introduction of screening programmes.

The income elasticity of health care spending in developing and developed countries.

To date, international analyses on the strength of the relationship between country-level per capita income and per capita health expenditures have predominantly used developed countries' data. This study expands this work using a panel data set for 173 countries for the 1995-2006 period. We found that health care has an income elasticity that qualifies it as a necessity good, which is consistent with results of the most recent studies. Furthermore, we found that health care spending is least responsive to changes in income in low-income countries and most responsive to in middle-income countries with high-income countries falling in the middle. Finally, we found that 'Voice and Accountability' as an indicator of good governance seems to play a role in mobilizing more funds for health.

Diethyl [(2-bromo-anilino)(1,3-diphenyl-1H-pyrazol-4-yl)meth-yl]phospho-nate.

In the title compound, C(26)H(27)BrN(3)O(3)P, the central pyrazole ring forms a dihedral angle of 71.7 (2)° with the bromo-phenyl ring. In the crystal, mol-ecules are linked by pairs of N-H⋯O hydrogen bonds, forming inversion dimers with R(2) (2)(10) ring motifs. Four C atoms of the 3-phenyl ring are disordered over two sets of sites [site occupancies = 0.745 (6) and 0.225 (6)].

One-pot multicomponent synthesis and anti-microbial evaluation of 2'-(indol-3-yl)-2-oxospiro(indoline-3,4'-pyran) derivatives.

A simple and efficient method for the one-pot three-component synthesis of new spirooxindoles in room temperature is described. The newly synthesized spirooxindoles were screened for anti-microbial activity and the results are good on comparison with of standard antibacterial compounds.

Simple and convenient approach to the Kreohnke pyridine type synthesis of functionalized indol-3-yl pyridine derivatives using 3-cyanoacetyl indole.

Access to privileged heterocyclic scaffolds involving 4-aryl-6-(1H-indol-3-yl)-2,2-bipyridine-5-carbonitriles and 6-(2-furyl)-2-(1H-indol-3-yl)-4-arylpyridine-3-carbonitriles frameworks has been achieved via a single-step multicomponent reaction of structurally diverse aldehydes, 2-acetylpyridine (or) 2-acetylfuran and 3-cyanoacetyl indole in ammonium acetate under neat condition. Also a series of 6,6'-di(1H-indol-3-yl)-4,4'-diaryl-2,2'-bipyridine-5,5'-dicarbonitrile and 7,7,7',7'-tetramethyl-4,4'-bis(aryl)-4,6,7,8,4',6',7',8'-octahydro-1H,1H-[2,2']biquinolinyl-5,5'-dione derivatives are synthesized using cinnamil, 3-cyanoacetyl indole (or) dimedone and ammonium acetate.

A randomised single blinded study of the administration of pre-warmed fluid vs active fluid warming on the incidence of peri-operative hypothermia in short surgical procedures.

We compared the effect of delivering fluid warmed using two methods in 76 adult patients having short duration surgery. All patients received a litre of crystalloid delivered either at room temperature, warmed using an in-line warming device or pre-warmed in a warming cabinet for at least 8 h. The tympanic temperature of those receiving fluid at room temperature was 0.4 °C lower on arrival in recovery when compared with those receiving fluid from a warming cabinet (p = 0.008). Core temperature was below the hypothermic threshold of 36.0 °C in seven (14%) patients receiving either type of warm fluid, compared to eight (32%) patients receiving fluid at room temperature (p = 0.03). The administration of 1 l warmed fluid to patients having short duration general anaesthesia results in higher postoperative temperatures. Pre-warmed fluid, administered within 30 min of its removal from a warming cabinet, is as efficient at preventing peri-operative hypothermia as that delivered through an in-line warming system.

Synthesis and NMR spectral assignments of indol-3-yl pyridines through one-pot multi-component reaction.

Asimple protocol for the efficient preparation of 6-(ferrocene-1-yl)-2-(indol-3-yl)pyridine and 2-(1H-indol-3-yl)-6-(2-thienyl)pyridine derivatives has been achieved through multi-component reaction, and these compounds were thoroughly characterised by 2D NMR spectral techniques.

Zirconium-based metallic glass and zirconia coatings to inhibit bone formation on titanium.

Surface-modified commercially pure titanium (Cp-Ti) with zirconium (Zr)-based thin film metallic glasses (Zr-TFMGs) and ZrO2 thin films were surgically implanted into the tibiae of rats; the bone formation was analyzed to examine the performance of the coatings as a biomaterial. Zr-TFMGs and ZrO2 thin films were coated on Cp-Ti substrates to monitor the control of assimilation in vitro and in vivo. The microstructural and elemental analyses were carried out for the as deposited thin films by x-ray diffraction (XRD), transmission electron microscopy and x-ray photoelectron spectroscopy. TFMG- and ZrO2-coated Ti specimens were immersed in simulated body fluid (SBF) for a period of 21 days to evaluate the calcium phosphate precipitation in vitro. XRD, x-ray photoelectron spectroscopy and scanning electron microscopy/energy dispersive x-ray spectroscopy were used to quantify the mineralization on the coated Zr-TFMG and ZrO2. In vitro corrosion studies showed that the Zr-based TFMG and ZrO2 coatings sustained in the SBF, exhibited superior corrosion resistance to the bare crystalline Ti substrate. Wettability studies showed TFMG and ZrO2 coatings with a hydrophobic nature, and the TFMG-coated SBF-submerged specimens showed a hydrophilic nature. The in vitro cell viability of MC3T3-E1 cells showed good cell proliferation and low cytotoxicity. The calcification deposits were evaluated by staining with alizarin red S, which showed a lower calcium formation on Zr-TFMG compared to ZrO2. The present work also aims to assess the assimilation behavior of Cp-Ti, Zr-TFMG and ZrO2 in vivo by inserting the coated specimen in the femur of rats. After post-implantation of 8 weeks, specimens were examined by micro-CT evaluation. The bone contact ratios as calculated were 72.75%, 15.32% and 38.79%. Consequently, the bone affinity was Cp-Ti wire >ZrO2-coated Ti wire >Zr48Cu36Ag8Al8-coated Ti wire.

The magnitude of cancer cervix in India.

The Indian Council of Medical Research initiated a network of cancer registries under the National Cancer Registry Programme (NCRP) in 1981 and data collection commenced in these registries from January 1982. The results on incidence rates provided by the Population Based Cancer Registries (PBCRs) have shown the variation in patterns of cancer in general and that of cancer cervix in particular. Cancer of the cervix has been the most important cancer in women in India, over past two decades. All the urban Population Based Cancer Registries at Bangalore, Bhopal, Chennai, Delhi and Mumbai have shown a statistically significant decrease in incidence rates of this site of cancer. Since over 70 per cent of the Indian population resides in the rural areas, cancer cervix still constitutes the number one cancer in either sex. Based on the data of the PBCRs, the estimated number of new cancers during 2007 in India was 90.708. The relative five year survival reported some time earlier averaged 48.7 per cent.

Factors determining choice of health care provider in Jordan.

This paper examines factors influencing a patient's choice of provider for outpatient health care services in Jordan. Factors including demographic, socioeconomic, insurance status, quality of care, household size and cost of health care were studied using a multinomial logit model applied to a sample of 1031 outpatients from the Jordan heathcare utilization and expenditure survey, 2000. The patient's socioeconomic and demographic characteristics affected provider choice. Insurance was not statistically significant in choosing Ministry of Health facilities over other providers. Patients utilizing the public sector were price sensitive, and therefore any attempt to improve accessibility to health care services in Jordan should take this into consideration.

Time Trends in Breast Cancer Among Indian Women Population: An Analysis of Population Based Cancer Registry Data.

BACKGROUND: The trends observed in cancer breast among Indian women are an indication of effect of changing lifestyle in population. To draw an appropriate inference regarding the trends of a particular type of cancer in a country, it is imperative to glance at the reliable data collected by Population Based Cancer Registries over a period of time. OBJECTIVE: To give an insight of changing trends of breast cancer which have taken place over a period of time among women in Cancer Registries of India. Breast Cancer trends for invasive breast cancer in women in Indian Registries have varied during the selected period. Occurrence of breast cancers has also shown geographical variation in India. MATERIALS AND METHODS: This data was collected by means of a 'Standard Core Proforma' designed by NCRP conforming to the data fields as suggested by International norms. The Proforma was filled by trained Registry workers based on interview/ hospital medical records/ supplementing data by inputs from treating surgeons/radiation oncologists/involved physicians/pathologists. The contents of the Proforma are entered into specifically created software and transmitted electronically to the coordinating center at Bangalore. The registries contributing to more number of years of data are called as older registries, while other recently established registries are called newer registries. RESULTS: While there has been an increase recorded in breast cancer in most of the registries, some of them have recorded an insignificant increase. Comparison of Age Adjusted Rates (AARs) among Indian Registries has been carried out after which trends observed in populations covered by Indian Registries are depicted. A variation in broad age groups of females and the proneness of females developing breast cancer over the period 1982 to 2010 has been shown. Comparisons of Indian registries with International counterparts have also been carried out. CONCLUSIONS: There are marked changes in incidence rates of cancer breast which have occurred in respective registries in a developing country like India. A steady increase in AARs in most of the registries of India including the newly established registries is indicative of the fact that cancer breast poses a threat to women in India.