Clinical Predictors of Drug Resistance and Mortality Among Tuberculosis Patients in a Rural South African Hospital: A Case-Control Study

The recent discovery of a high prevalence of multidrug-resistant (MDR-TB) and extensively drug-resistant tuberculosis (XDR-TB) in rural South Africa, where HIV is rampant, has provoked alarms about the future of tuberculosis control in the region. Little is known about the clinical manifestations of MDR-TB in general, and XDR-TB in particular, in the high HIV prevalence settings of Sub-Saharan Africa. We performed a retrospective, case-control study of patients diagnosed with tuberculosis at a rural hospital in KwaZulu Natal, South Africa, where large numbers of MDR-TB and XDRTB cases have been identified. All MDR-TB and XDR-TB patients who began treatment for TB between June 1, 2005 and August 31, 2006 and whose charts were available were included in the study. A comparison group of patients without resistance to both isoniazid and rifampicin (non- MDR-TB), matched 1:1 with the size of the MDR-TB and XDR-TB groups, was created. Clinical and laboratory data were obtained through review of hospital records, clinic registers, and the laboratory system. We compared clinical characteristics to identify risk factors for MDRTB, XDR-TB, and mortality. Bivariate and multivariate analyses were performed. A total of 170 patients were enrolled in the study: 52 MDR-TB, 61 XDR-TB and 57 non-MDR-TB. Greater than 75% of patients from all groups were tested for HIV; HIV prevalence among those tested was 94% in the non-MDR group, 93% in the MDR group, and 100% in the XDR-TB group (P=1.000 for MDR versus non-MDR; p=0.089 for XDR versus non-MDR). Forty percent of MDR-TB patients and 57% of XDR-TB patients had no previous history of TB treatment, strongly suggesting transmitted drug resistance. Significant associations and risk factors for MDR-TB and XDR-TB in bivariate analysis included positive sputum smear (P=0.015, P=0.005), TB treatment in the past year (P\u3c0.0001, P\u3c0.001), and hospitalization in the past two years (P=0.007, P=0.004). In multivariate logistic regression, positive sputum smear remained a significant risk factor for XDR-TB (adjusted odds ratio (AOR) 2.79, 1.20-6.47), and TB treatment in the past year remained a risk factor for both MDR-TB and XDR-TB (AOR 8.33, 95% CI 1.64-42.33; AOR 7.19, 95% CI 1.35-38.17). Mortality for the non-MDR, MDR and XDR groups was 36.8%, 73.1% and 85.3%, respectively (P= 0.0001 for MDR versus non MDR; P\u3c0.0001 for XDR versus non-MDR; P=0.109 for XDR versus MDR); median survival from TB diagnosis was 199 days, 103 days, and 92 days, respectively (P\u3c0.001). In Cox Proportional Hazards model, positive sputum smear (P=0.003), MDR-TB (P=0.028), XDR-TB (P=0.002), and CD4 cell count less than 200 cells/mm3 (P=0.037) were significant risk factors for mortality. Forty of the 170 patients had sputum isolates with differing resistance patterns, and 18 moved from a lower to a higher resistance category; this increasing drug resistance appeared to be more likely the result of super-infection than amplification. A significant proportion of MDR-TB and all XDR-TB appear to be due to primary resistance, with nosocomial transmission playing a critical role. MDR-TB and XDR-TB carry extraordinarily high mortality rates in this setting; previous hospitalization, previous TB treatment, positive sputum smear and low CD4 count may be used to target drug susceptibility testing for patients at high risk of drug resistant TB and mortality

Diagnosis of Influenza from Lower Respiratory Tract Sampling after Negative Upper Respiratory Tract Sampling

In this retrospective cohort study, we demonstrate that PCR-confirmed diagnoses of influenza were made solely by lower respiratory sampling in 6.9% of cases, as traditional upper respiratory tract tests were negative, indeterminate or not performed. Clinical features of these cases are presented. Clinicians should consider lower respiratory tract sampling in select cases of influenza-like illness for diagnosis

Suicide in Brazilian indigenous communities: clustering of cases in children and adolescents by household

OBJECTIVE: To estimate age and sex-specific suicide rates, compare suicide rates between indigenous communities, and quantify the frequency of intrafamilial suicide clustering. METHODS: We performed a retrospective cohort study involving 14,666 indigenous individuals in reservations in Dourados, state of Mato Grosso do Sul, Brazil, from 2003 through 2013 using national and local census. RESULTS: The overall suicide rate was 73.4 per 100,000 person-years. Adolescent males aged 15–19 and girls aged 10–14 had the highest rates for each sex at 289.3 (95%CI 187.5–391.2) and 85.3 (95%CI 34.9–135.7), respectively. Comparing the largest reservations, Bororo had a higher suicide rate than Jaguapiru (RR = 4.83, 95%CI 2.85–8.16) and had significantly lower socioeconomic indicators including income and access to electricity. Nine of 19 suicides among children under 15 occurred in household clusters. Compared with adult suicides, a greater proportion of child (OR = 5.12, 95%CI 1.89–13.86, p = 0.001) and adolescent (OR = 3.48, 95%CI 1.29–9.44, p = 0.017) suicides occurred within household clusters. CONCLUSIONS: High rates of suicide occur among children and adolescents in these indigenous reservations, particularly in poor communities. Nearly half of child suicides occur within household clusters. These findings underscore the need for broad public health interventions and focused mental health interventions in households following a suicide

Finishing the euchromatic sequence of the human genome

The sequence of the human genome encodes the genetic instructions for human physiology, as well as rich information about human evolution. In 2001, the International Human Genome Sequencing Consortium reported a draft sequence of the euchromatic portion of the human genome. Since then, the international collaboration has worked to convert this draft into a genome sequence with high accuracy and nearly complete coverage. Here, we report the result of this finishing process. The current genome sequence (Build 35) contains 2.85 billion nucleotides interrupted by only 341 gaps. It covers ∼99% of the euchromatic genome and is accurate to an error rate of ∼1 event per 100,000 bases. Many of the remaining euchromatic gaps are associated with segmental duplications and will require focused work with new methods. The near-complete sequence, the first for a vertebrate, greatly improves the precision of biological analyses of the human genome including studies of gene number, birth and death. Notably, the human enome seems to encode only 20,000-25,000 protein-coding genes. The genome sequence reported here should serve as a firm foundation for biomedical research in the decades ahead

Nolanville Comprehensive Plan 2021-2041

Nearly five years after the completion of the 2015 Comprehensive Plan, TxTC partnered with the City of Nolanville again in 2019 with the ENDEAVR project. ENDEAVR (Envisioning the Neo-traditional Development by Embracing the Autonomous Vehicles Realm)— is an ambitious project to re-envision ”smart” city solutions in small towns with students from a wide range of university degree programs in urban planning, landscape architecture, visualization, computer science, and civil, electrical and mechanical engineering. ENDEAVR launched in 2018 with a $300,000 grant from the Keck Foundation, which supports projects that promote inventive educational approaches. The City of Nolanville sought to explore “smart” city solutions to make efficient and prudent improvements to traffic flow, public safety, optimize utility systems, high-bandwidth digital networks, and foster autonomous vehicles. Additionally, TxTC included these “smart” city solutions to update its 2015 comprehensive plan. The new 2020 comprehensive plan embeds “smart” city solutions into its priorities and capital improvement projects to foster diversity and continue to make Nolanville “A Great Place to Live”

The Cambridge History of Welsh Literature

This is the first comprehensive, single-volume history of the literature of Wales. The volume contains chapters covering the whole range of Welsh literature, from post-Roman Britain to post-devolution Wales, with many of the later chapters providing holistic accounts of literature in Welsh and literature in English within a single genre or a single period of literary production