Enhancing Maternal and Perinatal Health in Under-Served Remote Areas in Sub-Saharan Africa: A Tanzanian Model

Background

In Tanzania, maternal mortality ratio (MMR), unmet need for emergency obstetric care and health inequities across the country are in a critical state, particularly in rural areas. This study was established to determine the feasibility and impact of decentralizing comprehensive emergency obstetric and neonatal care (CEmONC) services in underserved rural areas using associate clinicians.

Methods

Ten health centres (HCs) were upgraded by constructing and equipping maternity blocks, operating rooms, laboratories, staff houses and installing solar panels, standby generators and water supply systems. Twenty-three assistant medical officers (advanced level associate clinicians), and forty-four nurse-midwives and clinical officers (associate clinicians) were trained in CEmONC and anaesthesia respectively. CEmONC services were launched between 2009 and 2012. Monthly supportive supervision and clinical audits of adverse pregnancy outcomes were introduced in 2011 in these HCs and their respective district hospitals.

Findings

After launching CEmONC services from 2009 to 2014 institutional deliveries increased in all upgraded rural HCs. Mean numbers of monthly deliveries increased by 151% and obstetric referrals decreased from 9% to 3% (p = 0.03) in HCs. A total of 43,846 deliveries and 2,890 caesarean sections (CS) were performed in these HCs making the mean proportion of all births in EmONC facilities of 128% and mean population-based CS rate of 9%. There were 190 maternal deaths and 1,198 intrapartum and very early neonatal deaths (IVEND) in all health facilities. Generally, health centres had statistically significantly lower maternal mortality ratios and IVEND rates than district hospitals (p < 0.00 and < 0.02 respectively). Of all deaths (maternal and IVEND) 84% to 96% were considered avoidable.

Conclusions

These findings strongly indicate that remotely located health centres in resource limited settings hold a great potential to increase accessibility to CEmONC services and to improve maternal and perinatal health.     

Frequent alteration of MLL3 frameshift mutations in microsatellite deficient colorectal cancer

Background

MLL3 is a histone 3- lysine 4 methyltransferase with tumor-suppressor properties that belongs to a family of chromatin regulator genes potentially altered in neoplasia. Mutations in MLL3 were found in a whole genome analysis of colorectal cancer but have not been confirmed by a separate study.

Methods and Results

We analyzed mutations of coding region and promoter methylation in MLL3 using 126 cases of colorectal cancer. We found two isoforms of MLL3 and DNA sequencing revealed frameshift and other mutations affecting both isoforms of MLL3 in colorectal cancer cells and 19 of 134 (14%) primary colorectal samples analyzed. Moreover, frameshift mutations were more common in cases with microsatellite instability (31%) both in CRC cell lines and primary tumors. The largest isoform of MLL3 is transcribed from a CpG island-associated promoter that has highly homology with a pseudo-gene on chromosome 22 (psiTPTE22). Using an assay which measured both loci simultaneously we found prominent age related methylation in normal colon (from 21% in individuals less than 25 years old to 56% in individuals older than 70, R = 0.88, p<0.001) and frequent hypermethylation (83%) in both CRC cell lines and primary tumors. We next studied the two loci separately and found that age and cancer related methylation was solely a property of the pseudogene CpG island and that the MLL3 loci was unmethylated.

Conclusions

We found that frameshift mutations of MLL3 in both CRC cells and primary tumor that were more common in cases with microsatellite instability. Moreover, we have shown CpG island-associated promoter of MLL3 gene has no DNA methylation in CRC cells but also primary tumor and normal colon, and this region has a highly homologous of pseudo gene (psiTPTE22) that was age relate DNA methylation.     

Amyloidosis and periodic peritonitis (familial mediterranean Fever)

Some reports indicate that amyloidosis is a rare occurrence in persons with periodic peritonitis (familial Mediterranean fever), while others seem to show it occurs relatively frequently. Two cases were seen among 80 patients in Iraq. Twenty-one consecutive rectal biopsies were negative for amyloidosis. The variation in reported incidence is partly real and partly apparent. Amyloidosis occurs frequently in certain ethnic groups, and it is possible that there are two traits, one for periodic peritonitis and the other for amyloidosis.     

Optimisation of rhamnolipids produced byPseudomonas aeruginosa 181 using Response Surface Modeling

This work investigated the optimisation of the fermented culture medium for maximisation of rhamnolipids production produced byPseudomonas aeruginosa 181 using Response Surface Modeling (RSM). A two full factorial central composite experimental design was used in the design of experiments and in the analysis of results. This procedure limited the number of actual experiments performed while allowing for possible interactions between the parameters (pH, stirring rate, casamino acid concentration and incubation period) on the production of biosurfactants. Production carried out at larger volumes of one litre using Bioreactor under RSM-optimised conditions yielded 3.61 g l^?1 of products after purification by acid precipitation.     

Chemokine-like receptor 1 regulates skeletal muscle cell myogenesis

The chemokine-like receptor-1 (CMKLR1) is a G protein-coupled receptor that is activated by chemerin, a secreted plasma leukocyte attractant and adipokine. Previous studies identified that CMKLR1 is expressed in skeletal muscle in a stage-specific fashion during embryogenesis and in adult mice; however, its function in skeletal muscle remains unclear. Based on the established function of CMKLR1 in cell migration and differentiation, we investigated the hypothesis that CMKLR1 regulates the differentiation of myoblasts into myotubes. In C(2)C(12) mouse myoblasts, CMKLR1 expression increased threefold with differentiation into multinucleated myotubes. Decreasing CMKLR1 expression by adenoviral-delivered small-hairpin RNA (shRNA) impaired the differentiation of C(2)C(12) myoblasts into mature myotubes and reduced the mRNA expression of myogenic regulatory factors myogenin and MyoD while increasing Myf5 and Mrf4. At embryonic day 12.5 (E12.5), CMKLR1 knockout (CMKLR1(-/-)) mice appeared developmentally delayed and displayed significantly lower wet weights and a considerably diminished myotomal component of somites as revealed by immunolocalization of myosin heavy chain protein compared with wild-type (CMKLR1(+/+)) mouse embryos. These changes were associated with increased Myf5 and decreased MyoD protein expression in the somites of E12.5 CMKLR1(-/-) mouse embryos. Adult male CMKLR1(-/-) mice had significantly reduced bone-free lean mass and weighed less than the CMKLR1(+/+) mice. We conclude that CMKLR1 is essential for myogenic differentiation of C(2)C(12) cells in vitro, and the CMKLR1 null mice have a subtle skeletal muscle deficit beginning from embryonic life that persists during postnatal life.     

Influence of selenium on toxicity of some heavy metals in the green algaScenedesmus obliquus

The green alga Scenedesmus obliquus was incubated with heavy metals (Cd2+, Zn2+, Mn2+, Ni2+) with and without selenium. S. obliquus exhibited higher rates of growth and some metabolic activities in cultures containing 0.1 mmol/L Se than those only containing the heavy metals. The positive effect of Se was found with all metals but was negligible with Mn2+.     

Effects of the inoculation of cyanobacteria on the microstructure and the structural stability of a tropical soil

Cyanobacteria are widespread photosynthetic microorganisms among which some are able to fix atmospheric nitrogen. We investigated the impact of indigenous cyanobacteria strains (Nostoc) inoculation on physical characteristics of poorly aggregated soils from Guquka (Eastern Cape, South Africa). The soil aggregates (3–5 mm) were arranged into a layer of 10–20 mm thick, and sprayed with cyanobacteria solution. Subsequently the inoculated and un-inoculated samples were incubated (30°C, 80% humidity, continuous illumination at 100 μmol m⁻² s⁻¹). Their micromorphological characteristics and aggregate stability were investigated, after 1, 2, 3, 4 and 6 weeks of incubation, by using high resolution Cryo-SEM and aggregate breakdown tests. Micromorphological investigations revealed that the surface of un-inoculated samples remained uncovered, while the inoculated samples were partially covered by cyanobacteria material after one week of incubation. A dense superficial network of cyanobacterial filaments and extracellular polymer secretions (EPS) covered their surface after 4 and 6 weeks of incubation. Organo-mineral aggregates comprising cyanobacterial filaments and EPS were observed after 6 weeks of incubation. The results of aggregate breakdown tests showed no significant difference between un-inoculated samples after 1, 2, 3, 4 or 6 weeks, while they revealed improvement of aggregate stability for inoculated samples. The improvement of aggregate stability appeared in a short while following inoculation and increased gradually with time and cyanobacteria growth. The increase in aggregate stability is likely related to the changes induced in micromorphological characteristics by cyanobacterial filaments and EPS. It reflects the effect of coating, enmeshment, binding and gluing of aggregates and isolated mineral particles by cyanobacteria material. Our study presents new data demonstrating the improvement of soil physical quality in a few weeks after cyanobacteria inoculation. The interaction of the inocula and other biotic components is worthy of study before field application of cyanobacteria.     

Covalent trimers of the internal N-terminal trimeric coiled-coil of gp41 and antibodies directed against them are potent inhibitors of HIV envelope-mediated cell fusion

We have engineered two soluble, covalently linked, trimeric polypeptides, N35CCG-N13 and N34CCG comprising only the internal trimeric coiled-coil of the ectodomain of HIV-1 gp41. Both trimers inhibit human immunodeficiency virus, type 1 (HIV-1) envelope (Env)-mediated cell fusion at nanomolar concentrations by targeting the exposed C-terminal region of the gp41 ectodomain in the prehairpin intermediate state. The IC50 values for N35CCG-N13 and N34CCG are approximately 15 and approximately 95 nM, respectively, in a quantitative vaccinia virus-based reporter gene assay for HIV-1 Env-mediated cell fusion using Env from the T cell tropic strain LAV. Polyclonal antibodies were raised against N35CCG-N13 and a tightly binding fraction of anti-N35CCG-N13 inhibits T cell and macrophage tropic HIV-1 Env-mediated cell fusion with respective IC50 values of approximately 0.5 and approximately 1.5 microg/ml at 37 degrees C. The tightly binding anti-N35CCG-N13 antibody fraction targets the exposed internal trimeric coiled-coil in the prehairpin intermediate state of gp41 in a manner analogous to peptides derived from the C region of the gp41 ectodomain. The potency of the tightly binding anti-N35CCG-N13 antibody fraction in the fusion assay is comparable with that of the broadly neutralizing monoclonal antibody 2G12. These results indicate that N35CCG-N13 is a potential anti-HIV therapeutic agent and represents a suitable immunogen for the generation of neutralizing monoclonal antibodies targeted to the internal trimeric coiled-coil of gp41. The data on the tightly binding anti-N35CCG-N13 antibody fraction demonstrate that the internal trimeric coiled-coil of gp41 in the prehairpin intermediate state is accessible to antibodies and that access is not restricted by either antibody size or the presence of a kinetic barrier.