Incidence and Predictors of Tuberculosis Among Adult PLWHA at Public Health Facilities of Hawassa City

Tuberculosis (TB) is the most frequently diagnosed opportunistic infection (OI) and disease in people living with HIV/AIDS (PLWHA), world-wide. This study aimed at determining the incidence and predictors of tuberculosis among people living with HIV.A Six year retrospective follow up study was conducted among adult PLHIV. The Cox proportional hazards model was used to identify predictors.A total of 554 patients were followed and produced 1830.3 person year of observation. One hundred sixty one new TB cases occurred during the follow up period. The overall incidence density of TB was 8.79 per 100 person-year (PY). It was high (148.71/100 PY) in the first year of enrolment. The cumulative proportion of TB free survival was 79% and 67% at the end of first and sixth years, respectively. Not having formal education(AHR=2.68, 95%CI: 1.41, 5.11 ), base line WHO clinical stage IV (AHR = 3.22, 95% CI=1.91-5.41), CD4 count <50 cell/ul (AHR=2.41, 95%CI=1.31, 4.42), Being bed redden (AHR= 2.89, 95%CI=1.72, 3.78), past TB history (AHR=1.65, 95% CI = 1.06,2.39), substance use (AHR=1.46, 95% CI=1.03,2.06) and being on pre ART (AHR=1.62, 95%CI:1.03-2.54 ) were independently predicted tuberculosis occurrence. Advanced WHO clinical stage, limited functional status, past TB history, addiction and low CD4 (<50cell/ul) count at enrollment were found to be the independent predictor of tuberculosis occurrence. Therefore early initiation of treatment and intensive follow up is important

Perspectives of Protocol Based Breaking Bad News among Medical Patients and Physicians in a Teaching Hospital, Ethiopia

BACKGROUND፡ Discussing potentially bad outcomes is a standard communication task in clinical care. Physicians’ awareness on ways to communicate bad news is considered low. SPIKES protocol is the most popular strategy used by physicians, but its practice and patients' perception are not known. This study attempted to fill the knowledge gap on protocol implementation, patient preference and physician effects.METHODS: Hospital-based descriptive cross-sectional study was conducted at SPHMMC from May 1 to June 30 using structured interviews administered to patients and physicians. Three hundred and sixty patients and 111 physicians were included. Assessment of SPIKES performance, patient satisfaction, patient preference, and physician awareness, attitude and effects were studied.RESULTS: Performance of SPIKES protocol was setting (74.5%), perception (51.1%), invitation (56.3%), knowledge (15.9%), emotion (22.3%) and summary (10.1%). Only 30.6% of the patients were entirely satisfied with the interaction, and 19.2% with knowledge attained. Patient satisfaction was associated with physician asking how much information they like (P=0.025). Patient desire and report showed variation. Eighty-two percent of the physicians were not aware of the protocol, and 83.8% had no training. Half of the physicians feel depressed after disclosure.CONCLUSIONS: Patient satisfaction with communication process and knowledge is poor, as is performance of SPIKES components. Satisfaction is related to being asked how much patients want to know. Patients’ desires on how to be told news is different from how it is done. Breaking bad news increases feeling of depression. Awareness and training on the protocol are deficient; medical schools should incorporate it into their studies and implement proper follow-up.&nbsp

Inhibition of fatty acid oxidation as a therapy for MYC-overexpressing triple-negative breast cancer.

Expression of the oncogenic transcription factor MYC is disproportionately elevated in triple-negative breast cancer (TNBC), as compared to estrogen receptor-, progesterone receptor- or human epidermal growth factor 2 receptor-positive (RP) breast cancer. We and others have shown that MYC alters metabolism during tumorigenesis. However, the role of MYC in TNBC metabolism remains mostly unexplored. We hypothesized that MYC-dependent metabolic dysregulation is essential for the growth of MYC-overexpressing TNBC cells and may identify new therapeutic targets for this clinically challenging subset of breast cancer. Using a targeted metabolomics approach, we identified fatty acid oxidation (FAO) intermediates as being dramatically upregulated in a MYC-driven model of TNBC. We also identified a lipid metabolism gene signature in patients with TNBC that were identified from The Cancer Genome Atlas database and from multiple other clinical data sets, implicating FAO as a dysregulated pathway that is critical for TNBC cell metabolism. We found that pharmacologic inhibition of FAO catastrophically decreased energy metabolism in MYC-overexpressing TNBC cells and blocked tumor growth in a MYC-driven transgenic TNBC model and in a MYC-overexpressing TNBC patient-derived xenograft. These findings demonstrate that MYC-overexpressing TNBC shows an increased bioenergetic reliance on FAO and identify the inhibition of FAO as a potential therapeutic strategy for this subset of breast cancer

1,5-Anhydro-3,6-di-O-benzyl-2-de­oxy-1,2-C-dichloro­methyl­ene-d-glycero-d-gulo-hexitol

In the title compound, C21H22Cl2O4, the pyranosyl ring adopts a twist-boat conformation with the O-benzyl groups in equatorial positions. In the crystal, O—H⋯O hydrogen bonding results in infinite chains of mol­ecules along [100]. The structure is further consolidated by weak C—H⋯O, C—H⋯Cl and C—H⋯π inter­actions. The absolute structure was determined

Внутригодовые (сезонные) изменения общего содержания биогенных элементов и кислорода в различных районах Севастопольской бухты

Для каждого месяца в период май 1998 г. – май 1999 г. рассчитано абсолютное содержание биогенных элементов и кислорода в пяти различных районах Севастопольской бухты и для всей бухты в целом. Показано, что наиболее чистый (возле входа в бухту) и наиболее грязный (Южная бухта) районы отличаются по динамике накопления и расходования биогенных элементов. Максимальный запас неорганических форм азота, фосфора, и кремнекислоты во всех районах Севастопольской бухты, за исключением района Инкерманской бухты, приходится на январь.Total content of biogenic elements and oxygen in five different areas of the Sevastopol Bay and for the whole bay in general is estimated for each month starting from May, 1998 up to May, 1999. It is shown that the purest (near the bay entrance) and the dirtiest (the Southern Bay) areas are distinguished for dynamics of biogenic elements accumulation and expense. Maximum storage of inorganic forms of nitrogen, phosphorus and silicic acid in all the areas of the Sevastopol Bay, excepting the Inkerman Bay area, falls on January

Boron-Rich Benzene and Pyrene Derivatives for the Detection of Thermal Neutrons

A synthetic methodology is developed to generate boron rich aromatic small molecules based on benzene and pyrene moieties for the detection of thermal neutrons. The prepared aromatic compounds have a relatively high boron content up to 7.4 wt%, which is important for application in neutron detection as 10B (20% of natural abundance boron) has a large neutron induced reaction cross-section. This is demonstrated by preparing blends of the synthesized molecules with fluorescent dopants in poly(vinyltoluene) matrices resulting in comparable scintillation light output and neutron capture as state-of-the art commercial scintillators, but with the advantage of much lower cost. The boron-rich benzene and pyrene derivatives are prepared by Suzuki conditions using both microwave and traditional heating, affording yields of 40-93%. This new procedure is simple and straightforward, and has the potential to be scaled up

Pragmatism in practice: lessons learned during screening and enrollment for a randomised controlled trial in rural northern Ethiopia

Background. We use the example of the Gojjam Lymphoedema Best Practice Trial (GoLBeT), a pragmatic trial in a remote rural setting in northern Ethiopia, to extract lessons relevant to other investigators balancing the demands of practicality and community acceptability with internal and external validity in clinical trials. Methods. We explain in detail the preparation for the trial, its setting in northern Ethiopia, the identification and selection of patients (inclusion and exclusion criterion, identifying and screening of patients at home, enrollment of patients at the health centres and health posts), and randomisation. Results. We describe the challenges met, together with strategies employed to overcome them. Conclusions. Examples given in the previous section are contextualised and general principles extracted where possible. We conclude that it is possible to conduct a trial that balances approaches that support internal validity (e.g. careful design of proformas, accurate case identification, control over data quality and high retention rates) with those that favour generalisability (e.g. ‘real world’ setting and low rates of exclusion). Strategies, such as Rapid Ethical Assessment, that increase researchers’ understanding of the study setting and inclusion of hard-to-reach participants are likely to have resource and time implications, but are vital in achieving an appropriate balance

Quantum Phase Transition in a Resonant Level Coupled to Interacting Leads

An interacting one-dimensional electron system, the Luttinger liquid, is distinct from the "conventional" Fermi liquids formed by interacting electrons in two and three dimensions. Some of its most spectacular properties are revealed in the process of electron tunneling: as a function of the applied bias or temperature the tunneling current demonstrates a non-trivial power-law suppression. Here, we create a system which emulates tunneling in a Luttinger liquid, by controlling the interaction of the tunneling electron with its environment. We further replace a single tunneling barrier with a double-barrier resonant level structure and investigate resonant tunneling between Luttinger liquids. For the first time, we observe perfect transparency of the resonant level embedded in the interacting environment, while the width of the resonance tends to zero. We argue that this unique behavior results from many-body physics of interacting electrons and signals the presence of a quantum phase transition (QPT). In our samples many parameters, including the interaction strength, can be precisely controlled; thus, we have created an attractive model system for studying quantum critical phenomena in general. Our work therefore has broadly reaching implications for understanding QPTs in more complex systems, such as cold atoms and strongly correlated bulk materials.Comment: 11 pages total (main text + supplementary

Lymphoedema management to prevent acute dermatolymphangioadenitis in podoconiosis northern Ethiopia (GoLBeT): a pragmatic randomised controlled trial in

Background Podoconiosis (endemic, non-filarial elephantiasis) affects ~4 million subsistence farmers in tropical Africa. Limited awareness of the condition and lack of evidence for treatment mean that no endemic-country government yet offers lymphoedema management for podoconiosis patients. Among patients with filarial lymphoedema, trials suggest that limb care is effective in reducing the most disabling sequelae: acute dermatolymphangioadenitis (ADLA) episodes. Methods We conducted a pragmatic randomised controlled trial to test the hypothesis that a simple, inexpensive lymphoedema management package would reduce the incidence of ADLA in adult podoconiosis patients in northern Ethiopia. Patients were individually randomised to a package comprising instruction in foot hygiene, skin care, bandaging, exercises, use of socks and shoes, with support by lay Community Podoconiosis Agents at monthly meetings; or no intervention. The primary outcome was incidence of ADLA, measured using a validated patient-held pictorial diary. Assignment was not masked, but those performing the primary analysis were. The trial was registered at the International Standard Randomised Controlled Trials Number Register, number ISRCTN67805210. Findings A total of 350 patients were randomised to the intervention and 346 to the control group, with 93.4% follow-up at one year. During the 12 months of follow up, 16,550 new episodes of ADLA occurred during 765.2 person years observed. The incidence of ADLA was 19.4 (95% CI 18.9 to 19.9) and 23.9 (95% CI 23.4 to 24.4) episodes per person year in the intervention and control groups respectively; incidence rate ratio 0.81 (95% CI 0.69 to 0.96, p=0.02), rate difference -4.5 (95% CI -5.1 to -3.8) episodes per person year. No important adverse events related to the intervention were reported. Interpretation A simple, inexpensive package of lymphoedema self-care is effective in reducing frequency and duration of ADLA. We recommend its implementation by endemic-country governments