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Biomedical subjects

W A Cutting

Publications and source records attributed to W A Cutting.

At least 19 recordsLinked to original sources

Genetic heterogeneity of HIV type 1 subtypes in Kimpese, rural Democratic Republic of Congo.

A relatively low and stable seroprevalence of HIV-1 was previously reported among pregnant women attending for antenatal care between 1988 and 1993 in Kimpese, a rural town in the Democratic Republic of Congo (DRC, formerly Zaire). To characterize the HIV-1 subtypes circulating in this area, we have examined a 330-bp fragment of the p17 region of the gag gene of HIV-1 strains obtained from 70 patients (55 mothers, 15 children), of whom 61 were epidemiologically unlinked. Phylogenetic analyses revealed the existence of at least seven HIV-1 subtypes within the Kimpese region. Among the 61 epidemiologically unlinked patients, subtype A was predominant and found in 29 (47.5%) individuals. Other subtypes cocirculating in this rural part of DRC include subtypes C (1.6%), D (9.8%), F (3.2%), G (6.5%), H (21.3%), and J (4.9%). Sequences from four patients did not cluster with any of the currently documented HIV-1 subtypes, in analyses of fragments of both the gag (247 to 330 bp, 197 bp, and 310 bp) and env (340 bp) genes. Overall, comparisons of the gag(p17) gene regions revealed high pairwise divergences (mean, 19.9%; range, 1 to 46%). This level of gag(p17) gene variation in the DRC is considerably greater than previously appreciated. These results are relevant for the molecular epidemiology of HIV-1 in Africa and for the design of a future vaccine against HIV-1 in this region.

Adolescent

Zinc and rehabilitation from severe protein-energy malnutrition: higher-dose regimens are associated with increased mortality.

A randomized, double-blind trial was undertaken to measure the effects of zinc supplementation on catch-up growth in severe protein-energy malnutrition, with particular reference to linear growth. One hundred forty-one children between the ages of 6 mo and 3 y were enrolled after admission to a nutritional rehabilitation unit in Dhaka, Bangladesh, and randomly assigned to receive elemental zinc by mouth, 1.5 mg/kg for 15 d, 6.0 mg/kg for 15 d, or 6.0 mg/kg for 30 d, and thereafter they were followed for a total of 90 d. Anthropometric outcome measures included change in knee-heel length, midupper arm circumference, subscapular and triceps skinfold thicknesses, and change in height-for-age, weight-for-age, and weight-for-height z scores. Higher zinc doses were not associated with significant change in any anthropometric measurement, but mortality was significantly greater in children who received high-dose zinc (6.0 mg/kg) initially as opposed to those who received low-dose zinc supplementation (1.5 mg/kg) (Yates-corrected chi-square P value of 0.033 and a risk ratio of 4.53; 95% CI: 1.09 < risk ratio < 18.8). We conclude that there is no benefit to using high-dose zinc supplementation regimens and that they could contribute to increased mortality in severely malnourished children.

Anthropometry

Blood transfusion in developing countries: problems, priorities and practicalities.

The acute medical services could not exist without blood transfusions--life-savers in many situations. But transfusions can also be a quick and easy route for the transmission of infectious agents such as HIV, HBV, HCV and malaria. Infection through blood supply is a major issue in all countries but particularly in those with economic constraints which limit safety. This study was carried out in India (March-May 1997) and involved centres in Delhi, Calcutta and Vellore. It examined many aspects of blood transfusion including donor screening, use of professional donors, blood testing and criteria for blood use. The many problems in Indian blood transfusion services are mirrored in other countries. Here we examine the problems, priorities and practicalities of blood transfusion particularly in developing countries.

Blood Banks

HIV seroprevalence amongst pregnant women in northeastern Zaire.

To assess the seroprevalence of HIV in pregnant women in northeastern Zaire and factors that correlate with seropositivity, sequential blood sampling and interviews were performed on 700 women at antenatal clinics in northeastern Zaire. The seroprevalence of the 3 clinics surveyed varied from 0.3%-5.5%, rates being higher in more urban areas. Seropositivity was associated with greater education (P<0.001) and having a partner whose job involved travelling (P<0.001). No correlation was found with marital status, age, or gravidity. Women in northeastern Zaire are at a greater risk of being infected with HIV if they are well educated or have a husband who travels due to his work. Health education on HIV should be particularly directed at women who are well educated and at men who have 'mobile' jobs.

Democratic Republic of the Congo

How to do it. Participate in an international conference.

Attending an international conference should be instructive and fun. But it can also be alarming and lonely. Although participating in scientific conferences is now almost essential to medical career development, no medical school describes how to make the most of the opportunity as part of its curriculum. Here are some hints on how to get yourself organised so that the experience can be both scientifically productive and enjoyable. In essence, you should travel, see places, meet people, make friends, and identify one or two ideas that you can apply in your own work or research.

Congresses as Topic

A preliminary evaluation of the cognitive and motor effects of pediatric HIV infection in Zairian children.

Fourteen asymptomatic HIV-infected Zairian children under 2 years of age displayed social and motor developmental deficits on the Denver Developmental Screening Test when compared with 20 HIV-negative cohorts born to HIV-infected mothers and 16 control children. In a second study, 11 infected children over 2 years of age had sequential motor and visual-spatial memory deficits on the Kaufman Assessment Battery for Children and motor development deficits on the Early Childhood Screening Profiles. HIV infection affects central nervous system structures mediating motor and spatial memory development, even in seemingly asymptomatic children. Furthermore, maternal HIV infection compromises the labor-intensive provision of care in the African milieu and undermines global cognitive development in even uninfected children.

AIDS Dementia Complex

Breast-feeding and HIV--a balance of risks.

HIV-1 infection may be transmitted by breast-feeding. The risk of vertical transmission varies with the stage of maternal infection, but is 29 per cent if a mother acquires infection during lactation. The risk of infant death by not breast-feeding in a poor and contaminated environment is greater than the risk of HIV-infection when an HIV-positive mother breast-feeds. Vertical transmission can be reduced if women avoid high risk activities during pregnancy and especially lactation.

Africa

AIDS in Africa.

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Acquired Immunodeficiency Syndrome

Rapid HIV tests.

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AIDS Serodiagnosis

Osmotic production of sterile oral rehydration solutions--an economic, low-technology method.

A sterile oral rehydration solution can be produced by immersing in water a semi-permeable cellulose tube containing glucose and salts. Osmotically-driven ultrafiltration excludes all microbes and particulate matter even when the immersion water contains 45 x 10(6) cfu/ml of Pseudomonas aeruginosa, 25 x 10(7) cfu/ml of Staphylococcus aureus or 20 x 10(7) cfu/ml of Escherichia coli. Solutions of consistent composition can be obtained by having a standard amount of glucose-electrolytes in a cellulose tube of appropriate dimensions and immersing this in a fixed volume of water for a minimum period of time. The method is simple, inexpensive, low-technology and requires no external source of power. It has potential for producing sterile solutions for injections and intravenous use in situations with very limited and simple resources, in emergencies and during natural disasters. Further studies are now needed to determine whether the method can be adapted to provide the large quantities of oral rehydration fluid needed in field conditions.

Humans

Effect of a maltodextrin-electrolyte, a maltodextrin-nutrient-electrolyte and a standard electrolyte solution on water and electrolyte fluxes in the secreting rat intestine.

The effects of a maltodextrin (dextrose equivalent 12)-electrolyte solution and a maltodextrin-electrolyte solution with added nutrients on net water and electrolyte transport in the secreting rat intestine was compared with the citrate-World Health Organization oral rehydration solution to determine the need for a clinical trial to evaluate the efficacy of these maltodextrin solutions in acute diarrhoea treatment. Cholera toxin consistently produced net water secretion (-36.5 +/- 9.9 mean +/- SEM microliter/min/g dry weight of intestine). All three solutions reversed the cholera toxin-induced net intestinal water secretion to net absorption. Significantly greater net water absorption occurred from the maltodextrin-electrolyte solution compared to the World Health Organization solution (P < 0.05) but not when compared to the maltodextrin-electrolyte-nutrient solution. Net sodium, potassium and chloride fluxes due to the World Health Organization-solution were not significantly different from the maltodextrin-electrolyte solution. These data provide a rationale for initiating a clinical trial.

Animals