Reduction of Post-Harvest Injuries Caused by Drosophila suzukii in Some Cultivars of Sweet Cherries Using a High Carbon Dioxide Level and Cold Storage.

Efficient strategies are required in sweet cherry fruits to control the spotted wing drosophila (SWD), Drosophila suzukii, due to its adverse economic effect on farmers. Cold storage (CS) and storage with elevated carbon dioxide (CO2) are environmentally safe approaches for the pest control of stored fresh fruit. These strategies are effective in controlling a wide variety of insect species, without allowing toxic compounds to accumulate. The purpose of this study was to assess the effectiveness of a post-harvest application of CO2 treatment at 50%, cold treatment at 4 °C (CT), and a combination of both (CO2-CT) in controlling the early stages of SWD within four cultivars of freshly harvested cherry fruit, namely "Burlat-Bigarreau", "Giorgia", "Ferrovia", and "Lapins". In addition, an evaluation of the quality attributes of the cherries (skin firmness, berry firmness, strong soluble material, and titratable acidity) was carried out at harvest and after 10 and 20 days of storage. All treatments significantly reduced the rate of emergence of SWD when compared to the control (untreated cherry at 24 °C), and 100% SWD mortality was obtained in Burlat-Bigarreau (CO2-CT). In addition, over the entire storage time, the quality parameters were preserved in the samples stored at 4 °C and in the samples with combined treatments in comparison with the control.

A cross-sectional analysis of clinical presentations of and risk factors for enteric protozoan Infections in an Active Duty Population during Operation Iraqi Freedom.

BACKGROUND: Infectious travelers' diarrhea (TD) is a well-appreciated problem among service members serving abroad, particularly where infrastructure is limited due to ongoing combat operations, and efforts at sanitation and hygiene may not be considered an immediate priority. Bacterial and viral causes of travelers' diarrhea are well-described among deployed service members, however, gastrointestinal protozoan infections among deployed service members are less well documented. This study's purpose was to identify potential risk factors for, and clinical presentations of, enteric protozoan infections in an active duty military population deployed to combat operations in the Southwest Asia. METHODS: A cross-sectional study of enteric protozoan infections among US service members deployed in Al-Asad Air Base, Iraq in support of Operation Iraqi Freedom (OIF) was conducted in summer 2004. Subjects were obtained through a randomized sector sampling scheme, and through presentations for care at the air base medical facilities. All study participants provided a stool sample, either diarrhea or solid, upon study entry and completed a questionnaire documenting demographic information, clinical symptoms of any prior diarrheal episodes, and health risk behaviors. Basic diagnostic microscopy for protozoa was conducted to include acid-fast and modified trichrome staining. RESULTS: Four hundred thirty-seven subjects were included in the analysis, and 75 (17.1 %) subjects were found to have enteric protozoan infections as identified by diagnostic stool microscopy. Blastocystis hominis (n = 36), Entamoeba coli (n = 25), Endolimax nana (n = 20), and Entamoeba histolytica (n = 5) were the predominant organisms isolated. Crude incidence of prior episodes of diarrhea was greater among subjects from whom enteric protozoa were isolated compared to those without (IRR 1.66, 95 % CI 1.47-1.87). Bivariate analysis of health risk and hygiene behaviors found increased odds for presence of Blastocystis hominis among those service members who reported off base ice (OR 3.61, 95 % CI 1.40-9.28) and raw vegetable consumption (OR 8.18, 95 % CI 1.40-47.5). CONCLUSIONS: This study suggests that US service members deployed to the early stages of OIF were at greater risk of acquiring enteric protozoa than previously understood. The noted prevalence of enteric protozoa among US service members in this study is higher than in prior reports, approaching prevalence expected in the general host nation population, suggesting that US service members operating at Al-Asad Air Base in early OIF were exposed to greater degrees of fecally contaminated food and water, and poor hygienic and sanitation practices. Consumption of food and water prepared by host nation parties in Southwest Asia may place US service members at risk for acquiring intestinal protozoa.

Perceived risk of watery diarrhea and dysentery and intended compliance with chemoprophylaxis among a deployed military population.

BACKGROUND: Infectious diseases are a leading cause of morbidity among travelers to resource-limited regions and primary prevention is a cornerstone to risk reduction. Chemoprophylaxis has been successfully utilized for specific diseases. METHODS: We assessed self-reported compliance to daily chemoprophylaxis among deployed US military personnel. A 21 item self-completed questionnaire was completed by military personnel during mid-deployment. RESULTS: The perception of high disease risk was associated with an increased likelihood of compliance with daily chemoprophylaxis. However, 60 % of respondents stated they would not comply with a daily regimen. CONCLUSIONS: These data highlight the complexity of perceived risk and the difficulties with prophylactic interventions.

A cross-sectional household cluster serosurvey of hepatitis C virus antibodies in an urban slum of Cairo, Egypt in 2004.

BACKGROUND: Hepatitis C Virus (HCV) continues to be a burden to the Egyptian population and its economy. Despite all efforts, the prevalence of infection continues to be one of the highest in the world. The high national prevalence has been attributed to unintentional, nosocomial spread during an anti-schistosomiasis campaign conducted in the 1970's, but that does not fully explain the persistent infection rates. Work is needed to further clarify risk associations. A serosurvey was performed in Manshiet Nasser, a slum in Cairo sometimes referred to as Mokattem Hills where a primary occupation is garbage collection and sorting, to characterize potential risk factors for infection. METHODS: Following a detailed mapping and census of the area, a cluster sampling was performed and demographic and risk behavior data and a blood sample were collected from subjects older than 6 months. Blood samples were tested using 4th generation anti-HCV EIA kit. RESULTS: The slum was estimated to house 45,000 residents. Blood samples were obtained from 2169 subjects. The age adjusted anti-HCV seroprevalence was 9.1 %. Participants with HCV antibodies were more likely to be male, heads of households, subjects without formal education, and those with a lower standard of living. After adjustment of all prevalence ratios (aPR) for age, the following risk factors were significantly associated with higher risk of HCV infection: Garbage collection (aPR 1.5), history of blood transfusion (aPR 2.0), tattooing (aPR 1.4), history of schistosomiasis (aPR 1.5), and use of traditional latrines (aPR 2.0) or pits for sanitation (aPR 1.3). The results of the multivariate analysis indicated that age (p < 0.01), history of schistosomiasis (p < 0.05), garbage sorting (p = 0.05), blood transfusions (<0.001), and the use of traditional latrines for sanitation (p < 0.01) were significantly associated with infection. CONCLUSION: While HCV prevalence among those over 30 could be attributed to anti-schistosomiasis injections, the prevalence in younger age indicates ongoing transmission. Although specific behavioral risks were not identified, HCV infection appears to be an occupational hazard of garbage collection and sorting in this environment. Given the large reservoir of HCV infection in the population, further effort needs to be made to identify and mitigate new infections.

The epidemiological and clinical characteristics of diarrhea associated with enteropathogenic, enteroaggregative and diffuse-adherent Escherichia coli in Egyptian children.

A total of 220 enteroadherent Escherichia coli were identified from 729 Egyptian children with diarrhea using the HEp-2 adherence assay. Enteropathogenic E.coli (EPEC = 38) was common among children <6 months old and provoked vomiting, while diffuse-adhering E.coli (DAEC = 109) induced diarrheal episodes of short duration, and enteroaggregative E.coli (EAEC = 73) induced mild non-persistent diarrhea. These results suggest that EPEC is associated with infantile diarrhea in Egyptian children.

Effects of pre-deployment loperamide provision on use and travelers' diarrhea outcomes among U.S. military personnel deployed to Turkey.

OBJECTIVE: This study assessed the efficacy of education and self-treatment with loperamide on diarrhea morbidity and healthcare utilization in a deployed military setting. METHOD: In this prospective, controlled study, volunteers from military personnel deployed to Incirlik Air Base received either travelers' diarrhea education (non-loperamide group) or education plus a supply of loperamide (loperamide group). Volunteers were surveyed to determine frequency and outcomes of diarrheal illness. RESULTS: 109 deployed personnel were enrolled with 48 assigned to the loperamide group, and 61 to the non-loperamide group. Overall, 41 (38%) service members had at least one diarrheal episode. Only 10 (9%) service members sought treatment from a healthcare provider and the distribution was similar in both groups. Loperamide use for self-treatment was more common in the loperamide group (85%) vs. (57%), [p = 0.02]) but use of antibiotics was similar in both groups (loperamide (30%) vs. non-loperamide (20%). CONCLUSIONS: Provision of loperamide and education did not significantly affect healthcare utilization or antibiotic use to manage diarrheal episodes, when compared to education alone. Further prospective studies will either need a very large patient population to power them or should use other primary end points such a functional assessment in addition to seeking care.

Two new flavonol glycosides and biological activities of Diplotaxis harra (Forssk.) Boiss.

Two new flavonol glycosides, isorhamnetin 3-O-ß-glucopyranoside-4'-O-ß-xylopyranoside (1) and kaempferol 3-O-ß-glucopyranoside -4'-O-ß-xylopyranoside (2), were isolated from the defatted aqueous methanol extract of the whole plant Diplotaxis harra along with 12 known flavonols (3-14). They were characterised by chemical and spectral methods. The 70% aqueous methanol, chloroform and defatted aqueous methanol plant extracts exhibited significant antioxidant effects (nitroblue tetrazolium reduction method). Their cytotoxic activity was carried out against 11 tumour cell lines (sulphorhodamine B assay). The three extracts expressed the greatest antiproliferative activity against colon 38, P388 and MKN-28 with GI50 (0.45, 0.4, 0.07 µg/mL) and against P388 [3-(4,5-dimethylthiazol-2yl)-2,5-diphenyltetrazolium bromide assay] with IC50 (0.26, 0.24, 0.25 µg/mL), respectively. The chloroform extract showed the highest activity as eukaryotic DNA topoisomerase II inhibitors of P388 with IC50 0.24 µg/mL. Antiviral screening of the extracts and the pure compounds against foot-and-mouth disease virus types A and O revealed a prominent inhibition of its cytopathic effect.

Willingness to receive a hypothetical avian influenza vaccine among US military personnel in mid-deployment.

Though no avian influenza vaccine currently exists, development efforts have increased. Given recent reports of suboptimal vaccination rates among US military personnel, we sought to assess factors associated with a willingness to receive a hypothetical avian influenza vaccine. A self-administered questionnaire was completed by US military personnel during mid-deployment to Iraq, Afghanistan, and surrounding regions. Respondents were predominately male (86.2%), Army (72.1%), and enlisted (86.3%) with a mean age of 29.6 y. The majority (77.1%) agreed to receive an avian influenza vaccine if available. Exploratory factor analysis (EFA) identified two factors, vaccine importance and disease risk, that best described the individual perceptions and both were associated with an increased willingness to receive the hypothetical vaccine (OR: 8.2 and 1.6, respectively). Importantly, after controlling for these factors differences in the willingness to receive this hypothetical vaccine were observed across gender and branch of service. These results indicated that targeted education on vaccine safety and efficacy as well as disease risk may modify vaccination patterns in this population.

Enteric viral infections as potential risk factors for intussusception.

INTRODUCTION: We aimed to identify potential risk factors for intussusception (ISS) among children presenting to two pediatric hospitals in Egypt. METHODOLOGY: In this case-control study,  enrolled children < 3 years old with ISS (confirmed radiologically and/or surgically) were  matched by age and gender to controls admitted with acute non-abdominal surgical illnesses. Stool samples were collected and tested for various enteric bacteria, rotavirus, enteric adenoviruses (EA, 40 and 41) and astroviruses using commercially available ELISA diagnostic kits. RESULTS: From December 2004 to May 2009, 158 cases and 425 matched controls were enrolled. A history of diarrhoea and cough over the preceding four weeks of interview were more common in cases than controls, respectively. Children with mothers who had secondary education and above were 2.2 times more likely to have ISS than those whose mothers had a lower level of education. In spite of the low detection rate of EA infection (regardless of diarrhoea history) and asymptomatic rotavirus infection, they were detected in higher frequencies in cases than controls; however, infection with astrovirus and bacterial pathogens did not appear to be associated with increased risk of ISS. CONCLUSIONS: History of diarrhoea and cough over the four weeks preceding the study and maternal education above secondary level were potential risk factors for ISS. EA and asymptomatic rotavirus infection were detected in higher frequencies among cases than controls; however, association with ISS cannot be confirmed. Additional research is needed to confirm these findings and evaluate the pathogenesis which may link such infections with ISS.

Viral gastroenteritis associated with genogroup II norovirus among U.S. military personnel in Turkey, 2009.

The present study demonstrates that multiple NoV genotypes belonging to genogroup II contributed to an acute gastroenteritis outbreak at a US military facility in Turkey that was associated with significant negative operational impact. Norovirus (NoV) is an important pathogen associated with acute gastroenteritis among military populations. We describe the genotypes of NoV outbreak occurred at a United States military facility in Turkey. Stool samples were collected from 37 out of 97 patients presenting to the clinic on base with acute gastroenteritis and evaluated for bacterial and viral pathogens. NoV genogroup II (GII) was identified by RT-PCR in 43% (16/37) stool samples. Phylogenetic analysis of a 260 base pair fragment of the NoV capsid gene from ten stool samples indicated the circulation of multiple and rare genotypes of GII NoV during the outbreak. We detected four GII.8 isolates, three GII.15, two GII.9 and a sole GII.10 NoV. Viral sequences could be grouped into four clusters, three of which have not been previously reported in Turkey. The fact that current NoV outbreak was caused by rare genotypes highlights the importance of norovirus strain typing. While NoV genogroup II is recognized as causative agent of outbreak, circulation of current genotypes has been rarely observed in large number of outbreaks.

Assessment of leukemia inhibitory factor and glycoprotein 130 expression in endometrium and uterine flushing: a possible diagnostic tool for impaired fertility.

BACKGROUND: Uterine receptivity and implantation are complex processes requiring coordinated expression of molecules by zygote and uterus. Our objective was to evaluate the role of the endometrial expression of leukemia inhibitory factor (LIF) and its glycoprotein 130 (gp130) receptor molecules and their secretion in uterine flushing during the window of implantation in cases of primary unexplained infertility CASE PRESENTATION: The study was conducted on 25 infertile women with unexplained infertility for at least two years and 10 normal fertile women as a control group . Endometrial tissue and uterine flushing were obtained. Each tissue specimen was divided into two pieces; one piece was used for histological dating of the endometrium and for immunostaining of progesterone receptors, and the second was used for RNA extraction and PCR assay of LIF and gp130 mRNA expression. Serum estrogen and progesterone were measured for all subjects. LIF mRNA was expressed in the endometrium of all normal fertile women but significantly decreased in infertile women. LIF was not detectable in 88% of infertile women while it was fairly detectable in 12% of them. Gp130 mRNA was hardly detectable in both fertile and infertile women with no difference between them. Infertile women secreted significantly less LIF and gp130 molecules in the uterine flushing compared with normal fertile women. CONCLUSIONS: Expression of LIF mRNA in endometrium could be used as a molecular marker of unexplained infertility. Assessment of secreted LIF and gp130 molecules in uterine flushing could be another useful and safe method for predicting successful implantation as well as for diagnosing and eventually treating women with impaired fertility using recombinant human LIF.

Epidural analgesia during labor vs no analgesia: A comparative study.

BACKGROUND: Epidural analgesia is claimed to result in prolonged labor. Previous studies have assessed epidural analgesia vs systemic opioids rather than to parturients receiving no analgesia. This study aimed to evaluate the effect of epidural analgesia on labor duration compared with parturients devoid of analgesia. METHODS: One hundred sixty nulliparous women in spontaneous labor at full term with a singleton vertex presentation were assigned to the study. Parturients who request epidural analgesia were allocated in the epidural group, whereas those not enthusiastic to labor analgesia were allocated in the control group. Epidural analgesia was provided with 20 mL bolus 0.5% epidural lidocaine plus fentanyl and maintained at 10 mL for 1 h. Duration of the first and second stages of labor, number of parturients receiving oxytocin, maximal oxytocin dose required for each parturient, numbers of instrumental vaginal, vacuum-assisted, and cesarean deliveries and neonatal Apgar score were recorded. RESULTS: There was no statistical difference in the duration of the active-first and the second stages of labor, instrumental delivery, vacuum-assisted or cesarean delivery rates, the number of newborns with 1-min and 5-min Apgar scores less than 7 between both groups and number of parturients receiving oxytocin, however, the maximal oxytocin dose was significantly higher in the epidural group. CONCLUSION: Epidural analgesia by lidocaine (0.5%) and fentanyl does not prolong labor compared with parturients without analgesia; however, significant oxytocin augmentation is required during the epidural analgesia to keep up the aforementioned average labor duration.

Self-reported incidence of skin and soft tissue infections among deployed US military.

The incidence of skin and soft tissue infections has steadily increased over the past decade, and military populations, particularly recruits, have been affected. However, the epidemiology of skin and soft tissue infections in deployed personnel has not previously been described. We conducted a cross-sectional study of United States military personnel in mid-deployment using self-reported questionnaire data containing 11 demographic questions and 20 questions related to skin and soft tissue infections. The primary outcome was self-reported incident SSTI. Descriptive analyses were conducted and incidence estimates calculated. Multivariable regression models were developed to evaluate the association between SSTI and important covariates. Self-reported treatment modalities and effect on work performance were also assessed. The study was approved by the Institutional Review Board. 2125 questionnaires were completed over 12 months using convenience sampling. 110 personnel (5%) reported one or more skin and soft tissue infection during their most recent employment, for an incidence of 52 cases per 100,000 person-days. The majority reported a single infection. A higher proportion of individuals reporting skin and soft tissue infection were female, reported antibiotic use in the 6 months prior to completing the survey, had a family member in the healthcare occupation, and were senior enlisted or officers. 40 (36%) were treated with antibiotics and 24 (22%) underwent incision and drainage. Less than 5% (3 patients) required admission. Eighty eight respondents (81%), reported no days of lost job performance. There is a higher than expected incidence of skin and soft tissue infections in deployed military personnel. Although fewer than 20% of patients report missing at least one day of work, this can have a significant impact on the military mission. Further study should be conducted into how to prevent skin and soft tissue infections in military populations.

Pre-deployment vaccinations and perception of risk among US military personnel.

BACKGROUND: Vaccination programs have significantly reduced the incidence of numerous infectious diseases; however, public attitudes toward immunization oftentimes remain contentious. Concerns over vaccine safety and effectiveness, compounded with reduced perceived risk of disease, influence decision making and frequently override public health recommendations. Although vaccinations are compulsory for US military personnel, their concerns mirror the general population, resulting in sub-optimal coverage. RESULTS: Demographics of the 1,757 respondents: 83.3% male, 71.1% Army, 87.5% enlisted, mean age of 29.2 years (standard deviation: 8.3). The majority (89.3%) reported receiving all pre-deployment vaccines; 17.1% stated they would decline if given the opportunity. Factors associated with an increased likelihood of declining vaccines included a perception that the vaccines were not safe (odds ratio [OR]: 3.7; p < 0.001) and rarely/never believing information from the military command (OR: 2.2; p < 0.001). Those with a perceived risk for the diseases targeted by the vaccines were less likely to decline (OR: 0.6; p < 0.001). DISCUSSION: In US military personnel, negative perceptions of pre-deployment vaccines exist. These attitudes appear to be associated with negative perceptions of vaccine safety and low perceived disease risk. Targeted interventions, focusing on the drivers of negative perceptions toward vaccines, and accounting for the source of the educational material, may influence attitudes and improve vaccination perceptions. METHODS: A self-administered questionnaire was completed by a convenience sample of US military personnel deployed to Iraq, Afghanistan and surrounding regions. Questions solicited demographic information and assessed agreement with statements in an attempt to identify factors associated with declining pre-deployment vaccines.

A randomized, double-blind, placebo-controlled study evaluating the efficacy and safety of rifaximin for the prevention of travelers' diarrhea in US military personnel deployed to Incirlik Air Base, Incirlik, Turkey.

BACKGROUND: Infectious diarrhea is an important problem among travelers and deployed US military overseas causing substantial morbidity due to acute illness and may result in burdensome postinfectious sequelae. METHODS: The nonsystemic antibiotic rifaximin was evaluated for prevention of travelers' diarrhea (TD) in a US military and civilian adult beneficiary population in a randomized, double-blind, placebo-controlled clinical trial. In all, 100 volunteers deployed to Incirlik Air Base, Turkey, received rifaximin 1,100 mg once daily or placebo for 2 weeks, and participants were followed daily for 2 weeks. RESULTS: In an intention to treat analysis (n = 95), TD (based on subjects meeting case definition or early treatment) developed in 6.3% (3 of 48) of the rifaximin group compared with 19.2% (9 of 47) in the placebo group (Fisher's exact test p = 0.07). Rifaximin provided 67% (95% confidence interval, -13% to 91%, p = 0.07) protection against TD. Rifaximin 1,100 mg once daily was well tolerated with no observed differences in adverse events, whether solicited or unsolicited among the two treatment groups. CONCLUSIONS: Rifaximin may represent an option among military personnel on deployment for prevention of TD with supportive future studies that consider deployment length, settings, and operational situations where widespread use of chemoprophylaxis may increase force health protection without undue risk during critical deployments.

Epidural analgesia during labor--0.5% lidocaine with fentanyl vs. 0.08% ropivacaine with fentanyl.

BACKGROUND: Although lidocaine is a cheap and globally available local anesthetic, yet it is not a popular drug for labor analgesia. This is claimed to its higher intensity of motor block, possibility of transient neurological symptoms (TNS) and its placental transfer with probable drawbacks on fetal well-being. However, these effects could be concentration dependent and, the evidence linking them to lidocaine is still lacking. This study was designed to evaluate the efficacy and safety of 0.5% epidural lidocaine plus fentanyl during labor. METHODS: One hundred and twenty healthy full term nulliparous women in early labor with a single fetus presented by the vertex were enrolled in this randomized, double-blind clinical trial. Parturient were assigned to receive epidural analgesia either with lidocaine 0.5% plus fentanyl 2 microg(-1 mL) (LF), or ropivacaine 0.08% plus fentanyl 2 microg(-1 ml) (RF) when their cervix was dilated to 4 centimeters. Analgesia was provided with 20 ml bolus of the study solution and maintained at 10 ml(-1) h. Upper level of sensory loss to cold, Visual Analogue Pain Score (VAPS), motor block (modified Bromage score), the duration of the first and second stages of labor, numbers of instrumental vaginal and cesarean deliveries, the neonatal apgar score, patient satisfaction and side effects, were recorded. RESULTS: There were no significant differences in sensory level, pain scores, duration of the first and second stages of labor, numbers of instrumental and cesarean deliveries, the neonatal apgar scores, patient satisfaction or side effect between groups. Although motor block was significantly high in lidocaine group compared to ropivacaine group (p < 0.05), all parturient were moving satisfactorily in bed. CONCLUSIONS: Dilute epidural lidocaine (0.5%) with fentanyl effectively and safely initiates epidural analgesia clinically indistinguishable from 0.08% epidural ropivacaine with fentanyl. Although it induces significant motor block compared to ropivacaine, it still preserves maternal ability to move satisfactorily in bed. Whether further reduction in lidocaine concentration could trim down the motor block, remains to be investigated.

Retrospective study of maternal mortality in a tertiary hospital in Egypt.

BACKGROUND: Making efforts to decrease maternal mortality rate is a moral, economic and human rights related issue. This issue could not be handled without investigation of maternal mortality related factors. The role of anesthesia in maternal mortality in developing countries is obscure. The aim of the study is to estimate the prevalence, causes and risk factors of maternal mortality related to anesthesia. PATIENTS AND METHODS: An observational retrospective study was carried out in our university hospital from January 2004 till December 2008. RESULTS: The study revealed that maternal mean age of death was 34.9 years, 59% of women came from rural areas and 41% from urban ones, 65% delivered inside the hospital while 35% delivered outside, 71% were multiparous, 65% had no antenatal care and 29.7% irregular one, 12% were complaining of concomitant diseases, 77.5% labored with cesarean section, 17% died before labor, 36% during and 47% after labor. Causes of death are given in the order of the most leading cause of death to the least as follows: postpartum hemorrhage, eclampsia, pre-eclampsia, postpartum eclampsia, ruptured uterus, amniotic fluid embolism, accidental hemorrhage, anesthesia and at last unexplained causes. CONCLUSIONS: Maternal mortality was 953 per 100,000 cases and the greatest number of deaths took place among women considered to be at low risk. Anesthesia was responsible for about 8% of the causes of death. Difficult airway management during general anesthesia was the major anesthetic reason for maternal mortality.

Past trends and current status of self-reported incidence and impact of disease and nonbattle injury in military operations in Southwest Asia and the Middle East.

OBJECTIVES: To evaluate the evolutional changes in disease and nonbattle injury in a long-term deployment setting, we investigated trends of selected disease and nonbattle injury (NBI) incidence among US military personnel deployed in ongoing military operations in Southwest Asia and the Middle East. METHODS: Participants completed an anonymous questionnaire concerning diarrhea, acute respiratory illness (ARI), and NBIs. We compared incidence, morbidity, and risk associations of disease and NBI incidence with historical data. We analyzed a clinic screening form to describe trends in diarrhea incidence over a 3-year period. RESULTS: Between April 2006 and March 2007, 3374 troops completed deployment questionnaires. Incidence of diarrhea was higher than that of ARI and NBI (12.1, 7.1, and 2.5 episodes per 100 person-months, respectively), but ARI and NBI resulted in more-frequent health system utilization (both P < .001) and decreased work performance (P < .001 and P = .05, respectively) than did diarrhea. Compared with historical disease and NBI incidence rates, diarrhea and NBI incidence declined over a 4-year period, whereas ARI remained relatively constant. CONCLUSIONS: Diarrhea, ARI, and NBI are important health concerns among deployed military personnel. Public health and preventive measures are needed to mitigate this burden.

Role of IL-13 in the pathogenesis of bronchial asthma.

Asthma is a chronic inflammatory disease of the lung. Although it is multifactorial in origin, the inflammatory process is believed to be a result of inappropriate immune responses to common aeroallergens in genetically susceptible individuals. As such, it has been reported that Th2 cytokines play a pivotal role in the pathogenesis of disease. The aim of this study was to evaluate the role of IL-13 in the pathogenesis of bronchial asthma. The study was carried out on 71 subjects out of which 54 were asthmatic patients and 17 were normal controls. Patients with bronchial asthma were further classified according to the National Asthma Education and Prevention Program (NAEPP) into 4 groups: intermittent, mild persistent, moderate persistent and severe persistent. IL-13 serum levels were estimated in patients and controls by ELISA. Asthmatic patients showed a statistical significant elevation of serum IL-13 levels (mean = 78.5 +/- 64.5 pg/ml) as compared to controls (mean = 51.8 +/- 24.9 pg/ml). When patients with different degrees of severity were compared, a significant increase in serum IL-13 was found in patients with intermittent asthma (mean = 106 +/- 105 pg/ml) as compared to those with mild (mean = 63.6 +/- 14.7 pg/ml) and severe persistent asthma (mean = 64.9 +/- 29.1 pg/ml). Only patients with intermittent asthma showed a highly significant increase in serum IL-13 than controls. No statistically significant difference was found between patients not on steroids, patients on inhaled steroids and those on systemic steroids. A statistically significant increase in IL-13 serum levels was observed in patients not on steroids compared to normal controls. A significant increase in blood eosinophil counts was found in patients during acute asthmatic attacks as compared to those who were stable. In conclusion, IL-13 is a key cytokine with critical role in the immunopathogenesis of bronchial asthma. Steroids can downregulate IL-13, but inhaled steroids alone might not be able to abolish the airway remodeling process in asthmatics. Although patients with intermittent asthma are asymptomatic in between exacerbations, inflammation and remodeling are ongoing in their lungs.