Treatment outcome of tuberculosis patients at Gondar University Teaching Hospital, Northwest Ethiopia. A five - year retrospective study

<p>Abstract</p> <p>Background</p> <p>In Gondar University Teaching Hospital standardized tuberculosis prevention and control programme, incorporating Directly Observed Treatment, Short Course (DOTS) started in 2000. According to the proposal of World Health Organization (WHO), treatment outcome is an important indicator of tuberculosis control programs. This study investigated the outcome of tuberculosis treatment at Gondar University Teaching Hospital in Northwest Ethiopia.</p> <p>Methods</p> <p>We analyzed the records of 4000 tuberculosis patients registered at Gondar University Teaching Hospital from September 2003 to May 2008. Treatment outcome and tuberculosis type were categorized according to the national tuberculosis control program guideline. Multivariate analysis using logistic regression model was used to analyse the association between treatment outcome and potential predictor variables.</p> <p>Results</p> <p>From the total of 4000 patients, tuberculosis type was categorized as extrapulmonary in 1133 (28.3%), smear negative pulmonary tuberculosis in 2196 (54.9%) and smear positive pulmonary tuberculosis in 671 (16.8%) cases. Of all patients, treatment outcome was classified as successfully treated in 1181(29.5%), defaulted in 730 (18.3%), died in 403 (10.1%), treatment failed in six (0.2%) and transferred out in 1680 (42.0%) patients. Males had the trend to be more likely to experience death or default than females, and the elderly were more likely to die than younger. The proportion of default rate was increased across the years from 97(9.2%) to 228(42.9%). Being female, age group 15-24 years, smear positive pulmonary tuberculosis and being urban resident were associated with higher treatment success rate.</p> <p>Conclusion</p> <p>The treatment success rate of tuberculosis patients was unsatisfactorily low (29.5%). A high proportion of patients died (10.1%) or defaulted (18.3%), which is a serious public health concern that needs to be addressed urgently.</p

Intestinal parasitosis and shigellosis among diarrheal patients in Gondar teaching hospital, northwest Ethiopia

<p>Abstract</p> <p>Background</p> <p>Diarrheal diseases are the major causes of morbidity and mortality in developing world. Understanding the etiologic agents of diarrheal diseases and their association with socio-demographic characteristics of patients would help to design better preventive measures. Thus, this study was aimed to determine the prevalence of intestinal parasites and enteropathogenic bacteria in diarrheic patients.</p> <p>Methods</p> <p>A cross-sectional study involving 384 consecutive diarrheal patients who visited Gondar teaching hospital, Gondar, Ethiopia from October 2006 to March 2007 was conducted. Stool specimens were collected and examined for intestinal parasites and enteropathogenic bacteria following standard parasitological and microbiological procedures.</p> <p><b><it>Results</it></b></p> <p>Intestinal parasites were diagnosed in 36.5% of the patients. The most frequently encountered protozoan parasite was <it>Entamoeba histolytica/dispar </it>(7.3%) followed by <it>Giardia lamblia </it>(5.0%), C<it>ryptosporidium parvum </it>(1.8%) and <it>Isospora belli </it>(1.3%). The dominant helminthic parasite identified was <it>Ascaris lumbricoides </it>(5.5%) followed by <it>Strongyloides stercoralis </it>and <it>Schistosoma mansoni </it>(3.1% each), hookworm infection (1.8%), and <it>Hymenolepis </it>species (1.3%). Multiple infections of intestinal parasites were also observed in 6.3% of the patients. Among the enteropathogenic bacteria <it>Shigella </it>and <it>Salmonella </it>species were isolated from 15.6% and 1.6%, respectively, of the patients. <it>Escherichia coli O57:H7 </it>was not found in any of the stool samples tested. Eighty eight percent and 83.3% of the <it>Shigella </it>and <it>Salmonella </it>isolates were resistant to one or more commonly used antibiotics, respectively.</p> <p>Intestinal parasitosis was higher in patients who live in rural area, in patients who were washing their hands after visiting toilet either irregularly with soap and without soap or not at all, in patients who used well and spring water for household consumption, and in patients who had nausea (<it>P </it>< 0.05). Statistically significant associations were also observed between Shigella infections and patients who were using well and spring water for household consumption, and patients who had dysentery and mucoid stool (<it>P </it>< 0.05).</p> <p>Conclusions</p> <p>The high prevalence of intestinal parasites and <it>Shigella </it>species in diarrheic patients calls for institution of appropriate public health intervention measures to reduce morbidity and mortality associated with these diseases. The rational use of antibiotics should also be practiced.</p

Keratinocytes as Depository of Ammonium-Inducible Glutamine Synthetase: Age- and Anatomy-Dependent Distribution in Human and Rat Skin

In inner organs, glutamine contributes to proliferation, detoxification and establishment of a mechanical barrier, i.e., functions essential for skin, as well. However, the age-dependent and regional peculiarities of distribution of glutamine synthetase (GS), an enzyme responsible for generation of glutamine, and factors regulating its enzymatic activity in mammalian skin remain undisclosed. To explore this, GS localization was investigated using immunohistochemistry and double-labeling of young and adult human and rat skin sections as well as skin cells in culture. In human and rat skin GS was almost completely co-localized with astrocyte-specific proteins (e.g. GFAP). While GS staining was pronounced in all layers of the epidermis of young human skin, staining was reduced and more differentiated among different layers with age. In stratum basale and in stratum spinosum GS was co-localized with the adherens junction component ß-catenin. Inhibition of, glycogen synthase kinase 3β in cultured keratinocytes and HaCaT cells, however, did not support a direct role of ß-catenin in regulation of GS. Enzymatic and reverse transcriptase polymerase chain reaction studies revealed an unusual mode of regulation of this enzyme in keratinocytes, i.e., GS activity, but not expression, was enhanced about 8–10 fold when the cells were exposed to ammonium ions. Prominent posttranscriptional up-regulation of GS activity in keratinocytes by ammonium ions in conjunction with widespread distribution of GS immunoreactivity throughout the epidermis allows considering the skin as a large reservoir of latent GS. Such a depository of glutamine-generating enzyme seems essential for continuous renewal of epidermal permeability barrier and during pathological processes accompanied by hyperammonemia

Age- and region-dependent distribution of glutamine synthetase in human and rat skin sections.

<p>The cells were labelled with polyclonal antibodies against GS. The intensity of staining was estimated visually as absent (−), weak (+), moderate (++), strong (+++) or very strong (++++).</p

Distribution of GS and β-catenin in normal senile human temple skin.

<p>(A) hematoxiline staining of a skin sample. Stratum basale can be identified by cells with prominent nuclei. (B) GS is localized throughout the viable part of the epidermis. The highest staining intensity can be detected at the interface of stratum granulosum and stratum corneum. (C) Localization of β-catenin in lower parts of the epidermis. β-catenin shows a strong membraneous and cytoplasmic staining in stratum basale and in stratum spinosum. Arrows in (C) point to the presence of catenin in the nucleus of keratinocytes. Scale bar 25 μm.</p

Age-dependent distribution of GS and GFAP in rat scalp.

<p>(A–C) Double labelling of newborn (2–3-day-old) rat scalp. (A) staining for GS (green, pAb), (B) staining for GFAP (red, mAb), (C) merge. (D–F) Double staining of adult rat scalp sections. (D) staining for GS, (E) staining for GFAP, (F) merge. The insert in (C) shows single keratinocytes strongly stained for GS. White arrowheads in the insert point to GS-positive cells migrating towards the outer layer of the skin. The insert in (F) shows the prominent differences in the ratio of GS and GFAP in neighboring regions of the epidermis of adult rat skin evidenced by green, yellow or orange staining. Red arrows in (A–F) point to stratum basale, white arrows to stratum spinosum, magenta arrows to stratum granulosum, yellow arrows to stratum corneum. (G–L) Co-expression of GS and GFAP in adult rat leg skin. (G–I) Double labelling of skin section from the lateral surface of adult rat leg skin. (G) staining for GS (green, pAb), (H) staining for GFAP (red, mAb), (I) merge. (J–L) Double staining of skin section from the medial surface of adult rat leg skin. (J) staining for GS, (K) staining for GFAP, (L) merge. White arrows in (G–L) point to the portion of the skin in which GS can be barely detected, whereas red arrows point to the portion of the skin in which GS is strongly expressed. Binding of specific antibodies was visualized with FITC-conjugated goat anti-rabbit IgG (A, D, G, J) and Cy3-conjugated goat anti-mouse IgG (B, E, H, K). Scale bar: (A–C) 10 μm; (D–F) 20 μm.</p

Regulatory features of GS in HaCaT cells.

<p>(A) Effect of Gln on the specific activity of GS. Cells were cultivated over 96 h with (squares) and w/o (circles) 5 mM Gln. Medium was renewed every day. Each point represents the mean±SD of 3 determinations for a representative culture. (B) Effect of cultivation time on the specific activity of GS. Cells were cultivated for the times indicated and then harvested. Culture medium was exchanged 3 times a week. Each point represents the mean±SD of 3 determinations for a representative culture. (C) Effect of dexamethasone on the specific activity of GS. Cells were incubated with the indicated concentrations of dexamethasone for 24 h. Each point represents the mean±SD of 3 determinations. (D) Effect of ammonium chloride on the specific activity of GS. Cells were incubated for 24 h in the presence of the indicated concentrations of NH₄Cl. Each point represents the mean±SD of 3 determinations for a representative culture. Statistically significant from controls: *, p<0.05; **, p<0.01; ***, p<0.001.</p

Presence of GS in human foreskin of children and regional variations in its distribution revealed in co-localization studies with GFAP, or with SMAA.

<p>(A–D) Expression of GS (A) and GFAP (B) and merged micrograph of GS and GFAP (C) immune reaction in human foreskin sections. (D–F) Expression of GS (D) and SMAA (E) and merged micrograph of GS and SMAA immune reaction (F) in a human skin section. The line connecting the D–F clearly shows strong expression of SMAA (E) in stratum granulosum and its absence of stratum corneum. The latter is strongly stained for GS (D). GS and SMAA merge at the interface of stratum corneum boarder and stratum granulosum (F). Binding of specific antibodies was visualized with FITC-conjugated goat anti-rabbit IgG and Cy3-conjugated goat anti-mouse IgG. Blue arrows point to stratum corneum, magenta arrows to stratum basale white arrows to fibroblasts and yellow arrows to small and middle-sized vessels. Scale bar: A–D, H 200 μm; E–G 100 μm.</p