Indian agriculture, air pollution, and public health in the age of COVID.

Emerging evidence supports the intuitive link between chronic health conditions associated with air pollution and the vulnerability of individuals and communities to COVID-19. Poor air quality already imposes a highly significant public health burden in Northwest India, with pollution levels spiking to hazardous levels in November and early December when rice crop residues are burned. The urgency of curtailing the COVID-19 pandemic and mitigating a potential resurgence later in the year provides even more justification for accelerating efforts to dramatically reduce open agricultural burning in India.

Ethnobotanical approach versus random approach in the search for new bioactive compounds: support of a hypothesis.

CONTEXT: Whether natural product drug discovery programs should rely on wild plants collected "randomly" from the natural environment, or whether they should also include plants collected on the basis of use in traditional medicine remains an open question. OBJECTIVE: This study analyzes whether plants with ethnomedical uses from Vietnam and Laos have a higher hit rate in bioassay testing than plants collected from a national park in Vietnam with the goal of maximizing taxonomic diversity ("random" collection). MATERIALS AND METHODS: All plants were extracted and subjected to bioassay in the same laboratories. Results of assays of plant collections and plant parts (samples) were scored as active or inactive based on whether any extracts had a positive result in a bioassay. Contingency tables were analyzed using χ(2) statistics. RESULTS: Random collections had a higher hit rate than ethnomedical collections, but for samples, ethnomedical plants were more likely to be active. Ethnomedical collections and samples had higher hit rates for tuberculosis, while samples, but not collections, had a higher hit rate for malaria. Little evidence was found to support an advantage for ethnomedical plants in HIV, chemoprevention and cancer bioassays. Plants whose ethnomedical uses directly correlated to a bioassay did not have a significantly higher hit rate than random plants. DISCUSSION: Plants with ethnomedical uses generally had a higher rate of activity in some drug discovery bioassays, but the assays did not directly confirm specific uses. CONCLUSIONS: Ethnomedical uses may contribute to a higher rate of activity in drug discovery screening.

Prevalence and risk factors for tuberculosis infection among personnel in two hospitals in Viet Nam.

SETTING: Two general hospitals in Viet Nam. OBJECTIVE: To assess the risk of tuberculosis (TB) infection associated with hospital employment. DESIGN: During October-December 2009, we performed a cross-sectional study of hospital personnel and, for community comparison groups, staff from nearby schools. We tested for TB infection using the tuberculin skin test; an induration ≥ 10 mm indicated TB infection. RESULTS: Of 956 hospital personnel, 380 (40%) had TB infection compared to 40 (26%) of 155 school personnel. Hospital personnel had twice the odds of TB infection compared with school personnel (OR 2.0, 95%CI 1.3-3.0) after adjustment for age and sex. Compared to hospital administrative staff, the odds of TB infection were similar among clinical staff (OR 1.0, 95%CI 0.6- 1.3), clinical support staff (OR 0.9, 95%CI 0.5-1.6) and auxiliary staff (OR 1.1, 95%CI 0.6-2.0) at the hospitals. No additional infection risk was detected in high-risk departments (OR 1.1, 95%CI 0.6-2.0). CONCLUSIONS: Hospital personnel are at increased risk of TB infection. Among hospital personnel, risk was independent of job or department, suggesting that personnel are commonly at risk and that improvements in infection control are needed throughout hospitals.

Drug resistance and HIV co-infection among pulmonary tuberculosis patients in Haiphong City, Vietnam.

SETTING: Vietnam is one of the 22 countries with the highest burden of tuberculosis (TB). Although its National Tuberculosis Programme (NTP) is effective, there is no ongoing surveillance of drug resistance. OBJECTIVE: To establish the first step of a surveillance programme on anti-tuberculosis drug resistance in Haiphong, the third largest city in Vietnam. DESIGN: A regional survey using proportionate cluster sampling in 2006, and recording patients' characteristics, including human immunodeficiency virus (HIV) co-infection. RESULTS: There was a high prevalence of HIV co-infection (14.2%) among culture-positive pulmonary TB patients. The prevalence of drug resistance was high, and it was much higher among previously treated cases than among new cases (52.5% vs. 25.6%), with resistance to streptomycin being the most prevalent. The prevalence of multidrug resistance was high among new cases (4.4%), but was relatively low among previously treated cases (10%). HIV co-infection was related to resistance to rifampicin alone among new cases, but was not a risk factor for any other resistance pattern. CONCLUSION: These results suggest a high prevalence of anti-tuberculosis drug resistance and of HIV co-infection among TB patients in Haiphong. Ongoing surveillance to assess resistance trends is needed, and the NTP needs to coordinate HIV and TB programmes to address the growing issue of TB and HIV co-infection.

Survival and relapse rate of tuberculosis patients who successfully completed treatment in Vietnam.

SETTING: Reported tuberculosis (TB) cure rates are high in Vietnam with the 8-month short-course chemotherapy regimen. However, long-term treatment outcomes are unknown. OBJECTIVE: To assess survival and relapse rates among patients successfully treated for new smear-positive pulmonary tuberculosis (PTB). METHODS: A cohort of patients treated in 32 randomly selected districts in northern Vietnam were followed up 12-24 months after reported cure or treatment success for survival and bacteriologically confirmed relapse. Measurements included sputum smear examination, culture and interview for recent treatment history. RESULTS: Of 304 patients included in the study, no information was available for 31 (10%) and 19 (6%) had died. Bacteriology results were available for 244 (80%). The median interval between treatment completion and follow-up was 19 months. Relapse was recorded in 21/244 (8.6%, 95%CI 5.4-13), including 9 (4%) with positive sputum smears, 3 (1%) with negative smears but positive culture and 9 (4%) who had started TB retreatment. Four of 12 culture-positive relapse cases (33%) had multidrug-resistant strains. If the definition of relapse was extended to include death, reportedly due to TB, the relapse proportion was 26/263 (9.9%, 95%CI 6.6-14). CONCLUSION: A substantial proportion of patients (15%) had died or relapsed after being successfully treated for TB in northern Vietnam.

Prevalence of asthma and asthma-like symptoms in Dalat Highlands, Vietnam.

INTRODUCTION: No data has been reported on the prevalence of asthma in highland rural areas of Vietnam. We attempt to determine the prevalence of asthma and asthma-like symptoms in Dalat, a Vietnamese city at 1,500 m altitude, and to learn about environmental influences, patient attitudes toward diagnosis and treatment, and the prevalent general knowledge about asthma. METHODS: Investigators were trained in the use of formal questionnaires. After an extensive publicity campaign by local television, the investigators randomly selected homes for interviews in 12 districts. When physician-diagnosed asthma or asthma-like symptoms were identified, all parts of the questionnaire were completed and a more detailed visit was arranged with the patients, for clinical examination, spirometry and skin tests for important allergens. RESULTS: 9,984 individuals were interviewed, of whom 243 were identified as having asthma or asthma-like symptoms, giving a prevalence of 2.4 percent. Average age was 48 +/- 27 years, age at onset of asthma was 25 +/- 22 years. Hospitalisation had been required in 18.3 percent of patients during 2003. Daily asthma treatment was used by only 17 percent of patients. 34 percent used inhalers and 6 percent used nebulisation. 52.3 percent had associated atopic features. Polyvalent positive prick tests were prevalent, but no one reacted to a pollen mixture. General knowledge about asthma was lacking. CONCLUSION: The prevalence of asthma and asthma-like symptoms in Dalat is low. Allergic cutaneous reactions to house mites predominate. Diagnosis and treatment of those afflicted with asthma appears to be suboptimal. The study highlights the need for further patient education and for preventative interventions for asthma sufferers in this region.

Ethnobotany/ethnopharmacology and mass bioprospecting: issues on intellectual property and benefit-sharing.

Ethnobotany/ethnopharmacology has contributed to the discovery of many important plant-derived drugs. Field explorations to seek and document indigenous/traditional medical knowledge (IMK/TMK), and/or the biodiversity with which the IMK/TMK is attached, and its conversion into a commercialized product is known as bioprospecting or biodiversity prospecting. When performed in a large-scale operation, the effort is referred to as mass bioprospecting. Experiences from the mass bioprospecting efforts undertaken by the United States National Cancer Institute, the National Cooperative Drug Discovery Groups (NCDDG) and the International Cooperative Biodiversity Groups (ICBG) programs demonstrate that mass bioprospecting is a complex process, involving expertise from diverse areas of human endeavors, but central to it is the Memorandum of Agreement (MOA) that recognizes issues on genetic access, prior informed consent, intellectual property and the sharing of benefits that may arise as a result of the effort. Future mass bioprospecting endeavors must take heed of the lessons learned from past and present experiences in the planning for a successful mass bioprospecting venture.

The UIC ICBG (University of Illinois at Chicago International Cooperative Biodiversity Group) Memorandum of Agreement: a model of benefit-sharing arrangement in natural products drug discovery and development.

The Convention on Biodiversity mandates a new approach to the discovery of natural product drugs, one that incorporates concepts of national ownership of genetic resources, intellectual property rights in traditional knowledge, and sharing of economic benefits with countries that are the source of new natural products. The International Cooperative Biodiversity Group (ICBG) program was established to support experimentation in implementation of the Convention through development and execution of international agreements for bioprospecting. The agreement of one such ICBG program, between the University of Illinois at Chicago and institutions in Vietnam and Laos, is presented here. The core elements contained in the single, five-way Memorandum of Agreement are the arrangements for intellectual property rights, treatment of informed consent, and plans for benefit-sharing (including the sharing of short- and long-term royalty benefits, capacity building, and community reciprocity). Program participants were able to develop a practical and flexible agreement that satisfies the wishes of all institutions that are parties to it.

Investigations into the safety and immunogenicity of a killed oral cholera vaccine developed in Viet Nam.

OBJECTIVE: To evaluate a killed oral cholera vaccine produced in Viet Nam, and to compare the Vietnamese vaccine with one that is licensed internationally. METHOD: Two-dose regimens of a locally produced, bivalent, anti-O1, anti-O139 killed oral whole-cell cholera vaccine (biv-WC) and of a commercially available, monovalent (anti-O1) oral recombinant B subunit-killed whole-cell cholera vaccine (rBS-WC) were compared in two trials in Viet Nam. In the first trial, 144 adults were randomized to biv-WC with or without buffer, rBS-WC with buffer, or placebo without buffer. In the second, 103 children aged 1-12 years were randomized to biv-WC without buffer, rBS-WC with buffer, or placebo without buffer. FINDINGS: No regimen was associated with significant side-effects. In adults, ca 60% of recipients of either vaccine exhibited at least fourfold serum anti-O1 vibriocidal antibody responses and ca 40% of recipients of biv-WC demonstrated anti-O139 vibriocidal responses. Both anti-O1 (ca 90% in each vaccine groupand anti-O139 (68% in the biv-WC group) vibriocidal responses occurred more frequently in children. The responses to biv-WC were unaffected by the receipt of buffer. CONCLUSION: It was concluded that biv-WC was safe and immunogenic, that it could be administered without buffer, and that it could elicit robust immune responses even in children, for whom the risk of endemic cholera is highest.

Development of a routine analytical procedure for nonylphenol polyethyoxylates and their biodegradation products in sludge from sewage treatment plants.

A method of quantitative analysis of nonylphenol polyethoxylates (NPnEOs) and their biodegration products (NPE-BDPs) in sewage sludge, which is effective, economical, and applicable to a high performance liquid chromatography was developed and actual sludge samples collected from Japanese sewage treatment plants (STPs) were analyzed using the method to confirm its effectiveness. Soxhlet extraction showed better recovery in a spike and recovery test than shaking extraction. Among the four pretreatments for Soxhlet extraction tested, the condition in which samples were freeze-dried, ultrasonicated, and extracted with methanol showed the best recovery efficiency. Quantitative analysis of NPE-BDPs in STP sludge resulted in 6.1 microg/g, 4.3 microg/g, and 8. microg/g in average concentration for NPnEOs (n=1-3), NPnEOs (n=4-18), and nonylphenol ethoxycarboxylates (NPnECs (n=1-3)), respectively, and the values of concentration were 100-1000 times higher than those in effluent at Japan's STPs. The results implied importance of quantitation of NPE-BDPs in sewage sludge to assess the risk to the environment.