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Human immunodeficiency virus (HIV) risk perception remains an effective determinant of HIV transmission. Although higher educational attainment has been associated with increased HIV risk perception, this predictor remains to be assessed among Nigerian military personnel (NMP). In a prospective cohort of 2,213 NMP, the effects of education and other factors on HIV risk perception were assessed at baseline by using the χ^sup 2^ statistic and unconditional logistic regression. There was an inverse correlation between higher educational attainment and HIV risk perception in the univariate model (prevalence odds ratio, 0.64; 95% confidence interval, 0.52-0.79). This association persisted after adjustment for relevant covariates in the multivariate model (prevalence odds ratio, 0.70; 95% confidence interval, 0.56-0.88). Similarly, there was a direct correlation between use of alcohol and marijuana and HIV risk perception (p 0.05). This study indicates an inverse correlation between educational attainment and HIV risk perception, as well as a direct correlation between alcohol and marijuana use and HIV risk perception, among NMP. Therefore, HIV prevention interventions targeted at NMP need to include multiple factors that may affect risk perception regardless of the educational status of the participants.

Introduction

Nigeria is the second-most human immunodeficiency vims (HIV)-affected country in sub-Saharan Africa, representing 14% of HIV/acquired immunodeficiency syndrome (AIDS) cases in that region.1 Although the first HIV case was reported in Nigeria in 1986, the HIV infection prevalence increased from 1.8% in 1991 to 4.5% in 1996 to 5.8% in 2001, with a slight decrease to 5.0% in 2003.2 The prevalence varied according to occupation and across state boundaries, with previous studies of 2,300 subjects from five states in Nigeria demonstrating prevalence rates of >60% among commercial sex workers, 8% among male clients of commercial sex workers, 9% among truck drivers, and 21% among patients with sexually transmitted infections.3 HIV prevalence among Nigerian military personnel (NMP) has been reported to be higher than that in the general population,4 because of their mobile lifestyle and distance from their spouses while on U.N. peacekeeping missions.5″9

There are variables associated with HIV risk perception that have been studied in the general population but have yet to be fully investigated among NMP. Examples include the association between HIV risk perception and educational attainment, as well as the relationship between HIV risk perception and knowledge of HIV risk factors.1011 An epidemiological study showed that conventional HIV risks, such as multiple sex partners, drug use, and inconsistent condom use, were lesser determinants of HIV infection, compared with HIV risk perception.12 The associations between higher educational attainment and increased knowledge of HIV risk factors and between education and HIV risk perception have been well documented across studies in most developed countries but not among military personnel in sub-Saharan Africa.13″15

Behavioral and epidemiological factors leading to HIV infection and AIDS morbidity remain to be fully explored, particularly among mobile populations at heightened risk of HIV infection. Increasing HIV risk perception may enhance HIV-related protective behaviors, thus decreasing the propensity for HIV infection.16″18 In this sample of NMP, HIV risk perception may be influenced by multiple factors, including educational attainment, subjective norms, actual risk, income, and marital status. Although the relationship between HIV risk perception and educational attainment has been studied in U.S. populations and other civilian-based populations, to our knowledge no study has examined the influence of educational status on individuals’ HIV infection risk perception among NMP. We hypothesized that, among NMP, higher education might be associated with HIV risk perception and higher educational attainment might directly correlate with HIV risk perception. This study represents the first published cross-sectional investigation of educational attainment as a predictor of HIV risk perception among NMP.

Methods

Study Participants

Study participants were NMP, namely, Army, Navy, and Air Force personnel. The study sample consisted of a cohort of 2,213 men and women, 18 to 55 years of age, who were recruited in 2003 for an HIV educational intervention. Of the 2,213 participants, 13.3% were women and 86.7% were men, 43.9% had less than high school education, and 56.1% had high school and some college education. The details of the methods are available elsewhere.5619

Study Design

A cross-sectional design was used to assess the association between HIV risk perception as the outcome variable and educational status, as well as other potential predictors. Two cantonments stationed in the area of Lagos, the largest city in Africa, were selected for intervention. Data were collected between June and December 2003.

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Knowing the names of the prescription drugs you are taking is central to a person’s medical history–crucial when consulting a new doctor or making a visit to the emergency room. Yet a study of 119 people on anti-hypertension drugs found that about one-third of them could not accurately name the drugs they were on. Answers were compared with the drugs listed on the patients’ medical charts. The study’s author, Stephen Persell, MD, was shocked to see that some of his own patients who participated in this study had continued taking a prescription drug, though they had been told to stop and take another.

Journal of General Internal Medicine, November 2007

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For everything you need to know about women and the cholesterol-lowering drugs, known as statins (Lipitor, Zocor, Mevacor, Crestor, Pravachol, Le-scol), go to the Web site of Women and Health Protection, sponsored by the Canadian Women’s Health Network. This report is a thorough assessment of all statin studies that included women.

http://www.whp_apsf.ca/pdf/statinsEvidenceCaution.pdf

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Context.-Hodgkin lymphoma is a neoplastic disease in which the immune system plays a major role in its pathogenesis. Interleukin 10 (IL-10), an immunosuppressive cytokine actively produced in patients with Hodgkin lymphomas, favors the survival of the Hodgkin/Reed-Sternberg cells. Individual variations in IL-10 levels may be due, in part, to the presence of single nucleotide polymorphisms in the IL10 gene promoter.

Objective.-To evaluate whether particular single nucleotide polymorphisms in the IL10 gene are found more frequently in Hodgkin lymphoma cases associated with Epstein- Barr virus infection.

Design.-The identification of single nucleotide polymorphisms at positions -1082 and -819/-592 in the IL10 gene was performed by polymerase chain reaction and restriction length fragment polymorphisms analysis in 65 cases of Hodgkin lymphoma and 50 cases of reactive benign follicular lymphoid hyperplasia (non-Hodgkin lymphoma control group).

Results.-The frequency of the genotype GG at position -1082 was found to be significantly higher in patients with Epstein-Barr virus-positive Hodgkin lymphoma compared with Epstein-Barr virus-negative cases.

Conclusions.-The results suggest that the presence of specific single nucleotide polymorphisms in the IL10 gene, notably those associated with high IL-10 production, may play a role in the susceptibility to Epstein-Barr virus-positive Hodgkin lymphoma development.

(Arch Pathol Lab Med. 2007;131:1691-1696)

Hodgkin lymphoma (HL) is a B-cell malignant neoplasia in which the neoplastic component, the Hodgkin/Reed-Sternberg cells (H-RS), accounts for less than 2% of the tumor.1-4 Morphologically, HL cases are classi- fied into 2 main categories: classical HL and nodular lymphocyte- predominant HL. Classical HL is further subdivided into 4 subgroups: nodular sclerosis HL, mixed cellularity HL, lymphocyte-rich HL, and lymphocyte-depleted HL.5 Overall, Epstein-Barr virus (EBV) is detected within the H-RS cells in roughly half of all cases of classical HL, mainly in the mixed cellularity subtype in patients from developing countries.6 Geographic variability in EBV positivity in HL is observed: The virus is found in 40% to 50% of cases from Western countries7 and in up to 95% of HL cases from developing countries.8 Moreover, HL occurring in childhood, particularly in those younger than 10 years, would appear to be a predominantly EBVpositive disease in both developed and developing countries.9 It has recently been suggested that non-EBV-associated HL is unlikely to be associated with other oncogenic viruses and its etiology remains to be elucidated.10,11

Cytokines produced by H-RS cells are thought to contribute to HL pathogenesis by acting as autocrine growth factors, as well as by initiating and sustaining the reactive inflammatory infiltrate within the tumor. Alternatively, cytokines produced by the inflammatory cells may also support the proliferation and survival of H-RS cells.12,13

Interleukin 10 (IL-10) is a pleiotropic cytokine with strong immunosuppressive properties. IL-10 is mainly produced by activated T cells, activated monocytes/macrophages, stimulated B cells, and mast cells. IL-10 changes the TH1-TH2 balance toward the humoral (TH2) profile, therefore inhibiting cytotoxic T cells and stimulating the proliferation and differentiation B cells.14 Some proximal single nucleotide polymorphisms (SNPs) in the promoter region of the IL10 gene (-1082G/A, -819C/T, and -591C/A) form 3 distinct haplotypes found in whites (GCC, ACC, and ATA).15,16 A fourth haplotype (GTA) was described in southern Chinese patients with systemic lupus erythematosis.17

Some studies reported that the haplotypes defined by SNPs in the IL10 gene promoter (SNPs/IL10) may be associated with different levels of IL-10 production. Indeed, the haplotype combination GCC/GCC was associated with high IL-10 expression; GCC/ATA, GCC/ACC, and GTA/ACC were associated with intermediate IL-10 expression; and ATA/ATA, ATA/ACC, and ACC/ACC were associated with low IL-10 expression.18 In 2003, Myhr et al19 reported that the GCC/GCC genotype was clearly associated with high production of IL-10 in patients with the Guillain-Barre syndrome, both at mRNA and at protein levels. Some authors suggested that the -1082G allele is the most important genetic factor in the regulation of high constitutive IL-10 production.20,21

The observation that some individuals may be genetically predisposed to produce different levels of IL-10, which to some degree may account for susceptibility to EBV infection, could shed some light on the understanding and management of HL. Therefore, the aim of the present study was to evaluate the frequencies of SNPs at the IL10 gene promoter in patients with HL and compare the different groups identified in respect to age, gender, EBV status, and HL subtype. Considering that the alleles at positions -819 and -592 of the IL10 gene promoter exhibit linked transmission,16,17,22 these were analyzed together.

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The hepatitis E virus (HEV) is thought to be endemic throughout much of the world, particularly where sanitary infrastructure remains inadequate. HEV has been considered a military health threat and has been reported in several military environments. This study determined HEV seroconversion (defined by a 4-fold increase in antibody titers) occurring in Thai soldiers deployed to the HEV-endemic areas of East Timor, Afghanistan, and Iraq, as part of the U. N. multinational forces. With an average deployment of 6.4 months, the annualized seroconversion rates after deployments to East Timor, Afghanistan, Burundi, and Iraq were 1.9%, 4.6%, 4.6%, and 3.9%, respectively.

Introduction

Hepatitis E virus (HEV) causes large epidemics of acute hepatitis, as well as sporadic hepatitis, in southeast and central Asia, the Middle East, and parts of Africa and Mexico and is considered a threat to military forces. Serological studies suggest that HEV may also be endemic in the United States, Europe, and Japan, although it rarely causes overt disease in these countries.1 Recent outbreaks of HEV have been reported in refugee and internally displaced persons camps in Sudan, Chad, and Iraq.2 HEV infection may lead to death attributable to fulminant hepatitis, with associated mortality rates ranging from 1 to 2% in the general population to 15 to 20% among pregnant women. The virus spreads through the fecal-oral route, usually through contaminated water. With the advent of vaccines for hepatitis A and B, HEV is the leading form of hepatitis for which there is no prophylaxis. However, a clinical trial of an efficacious recombinant vaccine composed of a truncated capsid protein was recently concluded in Nepal.3

Several outbreaks of HEV have been reported in military environments, in Chad,4 Djibouti,5 Nepal,6 and Ethiopia7 and among Bangladeshi soldiers serving with the United Nations forces in Haiti.8 French and Italian soldiers serving in Somalia were reported to suffer from HEV illness.9 Outbreaks also occurred in military and paramilitary forces in India,10 as well as in military units in Sargodha11 and Abbottabad12 in Pakistan. In most of those outbreaks, contaminated drinking water was implicated. High attack rates in HEV-endemic areas and lengthy convalescent periods, lasting ≥6 weeks, significantly contribute to loss of soldier duty days6 and seriously affect military operations.

Methods

Between October 1999 and May 2006, Thai soldiers were deployed to East Timor (9 deployments; n = 5,140), Afghanistan (1 deployment; n = 109), Burundi (2 deployments; n = 349), and Iraq (2 deployments; n = 879) as part of United Nations multinational forces. Outbreaks of HEV in Afghanistan and Iraq were reported,213 and Soviet soldiers deployed to Afghanistan during the 1980s were reported to be ill with HEV.14 Data for HEV in East Timor are not available, but HEV is reported to be endemic in adjacent Indonesia. Consequently, although effective disease surveillance does not exist in any of these countries, these areas can be regarded as high risk for contracting HEV. The objective of this study was to determine the seroconversion rates by comparing titers of antibodies to HEV in predeployment and postdeployment sera.

The presence and quantity of total HEV immunoglobulin to the recombinant HEV antigen were assessed by using the Walter Reed Army Institute of Research enzyme immunoassay.15 The antigen was the putative capsid protein of HEV, Sargodha 1987 strain, expressed in Spodoptemfrugiperdia (SF9) cells by a recombinant baculovirus. Seroconversion was defined by a 4-fold increase in antibody titer to a level of ≥20 U/ml. Past infection was defined by antibody levels of ≥20 U/ml. Sera were tested in duplicate wells, with all specimens from a single subject tested on the same plate. The study was performed with 13% of randomly selected, paired sera from troops deployed to East Timor (n = 646), 99% of sera from troops deployed to Burundi (n = 347) and Iraq (n = 869), and 100% of sera from troops deployed to Afghanistan (n = 109). Sera were not examined for hepatitis A, B, and C markers. Predeployment serum samples were collected a few weeks before deployment at the predeployment physical examination, and postdeployment serum samples were collected immediately after return. Assessments were made by the medical officers of all battalions regarding demographic factors and medical history, with a focus on hepatitis, food and water supplies, and environmental sanitation. To our knowledge, this is the first study to detect HEV seroconversion in predeployment and postdeployment sera from military deployments.

Prevalence was calculated as the percentage positive at a specific time point (point prevalence). The seroconversion rate is an incidence, i.e., the number seroconverting over the time of deployment. Those who exhibited seroconversion before deployment were not considered in the latter calculation.

Results

The ages of deployed troops ranged from 21 to 55 years; 97% of troops were male. The average period of deployment for all troops was 6.4 months. No clinical cases of HEV were reported during the deployments to any of these regions.

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Background & objectives: Dengue virus (DV) has caused severe epidemics of dengue fever (DF) and dengue haemorrhagic fever (DHF) and is endemic all over India. We have earlier reported that exposure of mice to hexavalent chromium [Cr(VI)] compounds increased the severity of dengue virus infection. Trivalent chromium picolinate (CrP) is used worldwide as micronutrient and nutritional supplement. The present study was therefore, carried out to investigate the effects of CrP on various haematological parameters during DV infection of mice.

Methods: The Swiss Albino smice were inoculated with dengue virus (1000 LD^sub 50^, intracerebrally) and fed with chromium picolinate (CrP) in drinking water (100 and 250 mg/l) for 24 wk. Peripheral blood leucocytes and other haematological parameters, and spleens were studied on days 4 and 8 after virus inoculations and the findings were compared with those given only CrP and the normal control age matched mice.

Results: CrP in drinking water for 24 wk had no significant effects on peripheral blood cells of mice. On the other hand, there was significant decrease in different haematological parameters following inoculation of normal mice with DV. In CrP fed mice the effects of DV infection were abolished on most of the haematological parameters.

Interpretation & conclusions: The findings of present study showed that the adverse effects of DV infection, specially on platelets and leucocytes, were abrogated by pretreatment of mice with CrP. The therapeutic utility of CrP in viral infections including dengue needs to be studied in depth.

Key words Blood cells - chromium picolinate - dengue virus - haematological indices - leucopenia - thrombocytopoenia

Dengue virus (DV) produces a benign self-limiting illness, the dengue fever (DF) or a life-threatening serious illness, the dengue haemorrhagic fever (DHF). Dengue virus is endemic in India with frequent epidemics of DF and DHF1′6. The dengue disease is characterized by leucopenia, thrombocytopenia, bone marrow suppression, increased haematocrit value and increased capillary permeability, which may result in haemorrhage and shock79. Immunopathological mechanisms appear to be responsible for the pathogenesis of DHF. A rapid increase in the levels of cytokines and chemical mediators apparently induced by a unique cytokine, cytotoxic factor (CF), plays a key role in inducing plasma leakage, shock and haemorrhagic manifestations1611.

Pollution of environment by chromium (Cr) is common in industrialized areas as a consequence of effluent discharge from tanneries and otiier industries, which include metal plating, manufacturing industries and ferrochrome production. This poses serious problem for environmental quality. In aqueous environments chromium has two oxidation states: hexavalent chromium (Cr-VI) and trivalent chromium (Cr-HI). Cr (VI) compounds are generally soluble over a wide pH range and have been shown to exert toxic and carcinogenic effects in humans and experimental animals, also induce DNA damage such as DNA singlestrand breaks and DNA-protein crosslinks in vivo and in cultured cells. On the otiier hand, Cr (HI) compounds are mainly non-toxic1215.

DV infection is endemic all over India, so is die occupational and non occupational exposure to Cr (VI). The effect of chromium compromises the immune response of the host1617. It is, therefore, possible that the chromium toxicity may adversely affect the disease process during DV infection. In our earlier study we tave reported tiiat Cr (VI) in the form of potassium dichromate drinking led to reduction in lymphocytes, haemoglobin and the haematocrit values while the granulocyte, monocyte and platelet counts were increased. The most significant finding of these experiments was that the DV-induced reduction of platelet counts was cancelled in Cr (Vl)-fed mice18.

Chromium picolinate monohydrate, (CrP) is a synthetic Cr (in) compound that has widespread use as a nutritional supplement. It promotes a variety of beneficial health effects including weight loss, serum cholesterol reduction, treatment of diabetes, and increased muscle mass19. CrP administered to mice in the diet for 3 months up to the maximal possible dose (approximately 20,000-30,000 times that of the average daily human supplement 200 - 400 u,g) to show any adverse effects20″23. No effects of CrP exposure on clinical chemistry or haematology parameters, gross lesions, or microscopic findings have been observed24″26. We, therefore, undertook this study to investigate the effects of dengue virus infection in mice fed with non toxic trivalent chromium in the from of chromium picolinate (CrP).

Material & Methods

Animals: The study was carried out on Swiss Albino mice weighing 25-30 g, aged 6-8 wk obtained from me animal breeding facility of die Industrial Toxicology Research Centre (ITRC), Lucknow. Study protocol was approved by the Animal Ethical Committee of the ITRC, Lucknow. Mice were maintained on pellet diet supplied by local supplier.

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Vaccines and anti-viral drugs will not be enough to stop the spread of respiratory viruses if and when an epidemic breaks out. What else is there? That is the subject of a new Cochrane review that found handwashing, surgical face masks, gloves and isolating the infected person are all useful ways to block the transmission. Frequent handwashing with normal soap and water is effective and recommended especially in households with young children. Using soap with antiseptics or virus-killing substances is "of uncertain benefit." This review is based on the results of 51 studies.

Interventions for the Interruption or Reduction of the Spread of Respiratory Viruses, Cochrane review, October 2007

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Antioxidant vitamins and minerals are heavily promoted for "eye health" and "natural vision improvement." But a new review of all relevant studies found that there is "insufficient evidence" to show that these supplements prevent age-related macular degeneration, which is the loss of central vision. The best way to prevent macular degeneration: stop smoking.

British Medical Journal, October 12, 2007

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Do your knees give way without warning? Sudden knee buckling is fairly common in middle-aged and older people, according to a new study that looked at its prevalence. More than 2,300 people, aged 36 to 94 years, participated in the study (median age: 63 years) and 12% reported that they had had a knee buckling incident in the past three months, nearly 13% of them said they fell at the time–most often when going up or down stairs. Testing of the study participants showed that over half of those who had fallen showed no evidence of arthritis on x-ray examination or magnetic resonance imaging of the knee. Those who reported knee buckling were more likely to have knee pain and they tended to be in worse physical condition. Weakness of the quadriceps (thigh muscles) was identified as the main reason for buckling. Strengthening these muscles is currently thought to be a solution.

Annals of Internal Medicine, October 16,2007

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About one in five women with a diagnosis of minimal breast cancer were treated with mastectomy in 2004, the most recent year for statistics. Surgical removal of the breast appears to be therapeutic overkill for women whose cancers are smaller than 1 cm (about 3/8 of an inch) and have no evidence of disease in the lymph nodes. This finding, from the National Cancer Data Base, illustrates the real-world treatment of breast cancer. It may also demonstrate how slowly it takes for a "new" idea like breast conservation to catch on. The proportion of women treated with breast conservation therapy (removal of the tumor but not the breast) increased steadily from 1993 (61%) to 2004 (78%). The authors of this study expressed concern that "mastectomy rates may still be considered high given the small size of tumors … and the percent of patients eligible for breast conservation."

Annals of Surgical Oncology October 2007

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