HIV Incidence Prior to,during, and after Violent Conflict in 36 Sub-Saharan African Nations, 1990-2012: An Ecological Study

Objectives

The aim of this study was to determine the association between violent conflict and HIV incidence within and across 36 sub-Saharan Africa countries between 1990 and 2012.

Methods

We used generalized linear mixed effect modeling to estimate the effect of conflict periods on country-level HIV incidence. We specified random intercepts and slopes to account for across and within country variation over time. We also conducted a sub-analysis of countries who experienced conflict to assess the effect of conflict intensity on country-level HIV incidence. All models controlled for level of economic development, number of refugees present in the country, and year.

Results

We found that, compared to times of peace, the HIV incidence rate increased by 2.1 per 1000 infections per year (95%CI: 0.39, 3.87) in the 5 years prior to conflict. Additionally, we found a decrease of 0.7 new infections per 1000 people per year (95%CI: -1.44, -0.01) in conflicts with 25 to 1000 battle-related deaths and a decrease of 1.5 new infections per 1000 people per year (95%CI:-2.50, -0.52) for conflict with more than 1000 battle-related deaths, compared to conflicts with less than 25 battle-related deaths

Conclusions

Our results demonstrate that HIV infection rates increase in the years immediately prior to times of conflict; however, we did not identify a significant increase during and immediately following periods of violent conflict. Further investigation, including more rigorous data collection, is needed, as is increased aid to nations at risk of violent conflict to help in the fight against HIV/AIDS in sub-Saharan Africa.     

The acute phase response of cod (Gadus morhua L.): expression of immune response genes

An acute phase response (APR) was experimentally induced in Atlantic cod (Gadus morhua L.) by intramuscular injection of turpentine oil. The change in the expression of immune related genes was monitored in the anterior kidney and the spleen over a period of 7 days. The genes examined were two types of pentraxins, apolipoprotein A1 (ApoA-I), the complement component C3, interleukin-1β (IL-1β), transferrin, cathelicidin, and hepcidin. All genes were constitutively expressed in both organs and their expression amplified by the turpentine injection. A pattern of response was observed both with respect to the organ preference and to the timing of a maximum response. The increased gene expression of the pentraxins, ApoA-I and C3 was restricted to the anterior kidney, the gene expression of IL-1β, cathelicidin, and transferrin increased in both organs, while hepcidin gene expression was only significantly increased in the spleen. The pentraxins and ApoA-I appear to be early mediators of APR in cod, possibly stimulating C3 and IL-1β response, while the antimicrobial peptides may play a minor role. The increase in transferrin gene expression in both organs, and apparent indifference to cortisol release associated with the turpentine injection, suggests that this could be a typical acute phase protein in cod.     

The acute phase response of Atlantic cod (Gadus morhua): humoral and cellular response

Intra-muscular injection of turpentine oil was used to induce acute phase response (APR) in Atlantic cod (Gadus morhua L.). The effects on the serum cortisol, total protein, IgM and pentraxin concentration were examined as well as the effects on natural antibody, anti-trypsin and leukocyte respiratory burst activity. The turpentine injection resulted in a 26 fold increase in the cortisol level after 72 h. Slightly reduced serum protein level in both groups was attributed to the restricted feeding during the experimental period. The IgM serum concentration was significantly reduced after 168 h in the turpentine treated fish while the natural antibody activity was not affected. The anti-trypsin activity was initially suppressed but recovered to normal levels at the end of the experiment. The turpentine injection had little effect on the serum level of the pentraxins, CRP-PI and CRP-PII. The respiratory burst activity was significantly suppressed after 72 h. It is concluded that 1) cod shows a relatively slow humoral and cellular response to APR induction, 2) the increase in serum cortisol level may be the key modulator of the mainly suppressive effects on the immune parameters and 3) pentraxins are not typical acute phase proteins in cod.     

Early supported discharge after stroke in Bergen (ESD Stroke Bergen): three and six months results of a randomised controlled trial comparing two early supported discharge schemes with treatment as usual

Background

Stroke causes lasting disability and the burden of stroke is expected to increase substantially during the next decades. Optimal rehabilitation is therefore mandatory. Early supported discharge (ESD) has previously shown beneficial, but all major studies were carried out more than ten years ago. We wanted to implement and study the results of ESD in our community today with comparisons between ESD and treatment as usual, as well as between two different ESD models.

Methods

Patients with acute stroke were included during a three year period (2008–11) in a randomised controlled study comparing two different ESD models to treatment as usual. The two ESD models differed by the location of treatment: either in a day unit or in the patients’ homes. Patients in the ESD groups were followed by a multi-disciplinary ambulatory team in the stroke unit and discharged home as early as possible. The ESD models also comprised treatment by a multi-disciplinary community health team for up to five weeks and follow-up controls after 3 and 6 months. Primary outcome was modified Rankin Scale (mRS) at six months.

Results

Three-hundred-and-six patients were included. mRS scores and change scores were non-significantly better in the two ESD groups at 3 and 6 months. Within-group improvement from baseline to 3 months was significant in the ESD 1 (p?=?0.042) and ESD 2 (p?=?0.001) groups, but not in the controls. More patients in the pooled ESD groups were independent at 3 (p?=?0.086) and 6 months (p?=?0.122) compared to controls and there also was a significant difference in 3 month change score between them (p?=?0.049). There were no differences between the two ESD groups. Length of stay in the stroke unit was 11 days in all groups.

Conclusions

Patients in the ESD groups tended to be more independent than controls at 3 and 6 months, but no clear statistically significant differences were found. The added effect of supported discharge and improved follow-up seems to be rather modest. The improved stroke treatment of today may necessitate larger patient samples to demonstrate additional benefit of ESD.

Clinical trial registration

Unique identifier: NCT00771771

     

Immunological Control of Fish Diseases

All metazoans possess innate immune defence system whereas parameters of the adaptive immune system make their first appearance in the gnathostomata, the jawed vertebrates. Fish are therefore the first animal phyla to possess both an innate and adaptive immune system making them very interesting as regards developmental studies of the immune system. The massive increase in aquaculture in recent decades has also put greater emphasis on studies of the fish immune system and defence against diseases commonly associated with intensive fish rearing. Some of the main components of the innate and adaptive immune system of fish are described. The innate parameters are at the forefront of immune defence in fish and are a crucial factor in disease resistance. The adaptive response of fish is commonly delayed but is essential for lasting immunity and a key factor in successful vaccination. Some of the inherent and external factors that can manipulate the immune system of fish are discussed, the main fish diseases are listed and the pathogenicity and host defence discussed. The main prophylactic measures are covered, including vaccination, probiotics and immunostimulation. A key element in the immunological control of fish diseases is the great variation in disease susceptibility and immune defence of different fish species, a reflection of the extended time the present day teleosts have been separated in evolution. Future research will probably make use of molecular and proteomic tools both to study important elements in immune defence and prophylactic measures and to assist with breeding programmes for disease resistance.     

Notes on feeding ecology of macrourid fishes from the mid-Atlantic Ridge, North Atlantic

At least 16 macrourid fishes (Gadiformes, Macrouridae) inhabit the mid-Atlantic Ridge of the North Atlantic. To investigate the roles of macrourids in the food-web and compare feeding patterns of the most frequent co-occurring species, diet information on five of the species were described and compared. Pelagic and benthopelagic copepods were the most numerous prey but did not contribute much on a weight basis. Cephalopods were by far the most important prey of the small grenadiers, while shrimps and fish became increasingly significant with increasing size. Previous studies from other areas have also found pelagic prey to be important, but in contrast to this study, cephalopods were more important on the mid-Atlantic Ridge than in continental margin locations.     

Microbial,Immunological and Toxicological Aspects of Canine Pyometra

There is agreement that uterine infection is necessary for the development of the varied picture of clinical pyometra which includes changes in the kidneys and other organs (Børresen 1975). Some important clinical manifestations of the pyometra syndrome have been explained in terms of an endotoxinaemia (Asheim 1964, Schalm 1965).