28 research outputs found
Mortality of drug-resistant tuberculosis in high-burden countries: comparison of routine drug susceptibility testing with whole-genome sequencing
Background: Drug-resistance threatens global tuberculosis control. We examined mortality in patients with tuberculosis from high-burden countries, according to concordance or discordance of results from drug susceptibility testing done locally and whole-genome sequencing (WGS). Methods: We collected pulmonary Mycobacterium tuberculosis isolates and clinical data from adult tuberculosis patients from Côte d'Ivoire, Democratic Republic of the Congo, Kenya, Nigeria, South Africa, Peru, and Thailand, stratified by HIV status and drug resistance, from 2013 to 2016. Sites tested drug susceptibility using routinely available methods. WGS was done on Illumina HiSeq 2500 in the USA and Switzerland, and TBprofiler used to analyse the genomes. We analysed mortality in multivariable logistic regression models adjusted for sex, age, HIV-status, history of tuberculosis, and sputum positivity. Findings: We included 582 tuberculosis patients. The median age was 33 years (interquartile range 27-43 years), 225 (39%) were female, and 247 (42%) were HIV-positive. Based on WGS, 339 (58%) isolates were pan- susceptible, 35 (6%) monoresistant, 146 (25%) multidrug-resistant, and 24 (4%) pre-/ extensively drug-resistant (pre-XDR/XDR). The local results were discordant with the WGS results in 130/582 (22%) of patients. All testing methods identified isoniazid and rifampicin resistance with a high agreement. Resistance to ethambutol, pyrazinamide, and second-line drugs was rarely tested locally. Of 576 patients with known treatment, 86 (15%) patients received inappropriate treatment according to WGS results and the World Health Organization (WHO) treatment guidelines. The analysis of mortality was based on 530 patients; 63 (12%) died, and 77 patients (15%) received inappropriate treatment. Mortality ranged from 6% in patients with pan-susceptible tuberculosis (18/310) to 39% in patients with pre-XDR/XDR tuberculosis (9/23). The adjusted odds ratio for mortality was 4.92 (95% CI 2.47-9.78) among under-treated patients, compared to appropriately treated cases. Interpretation: In seven high-burden tuberculosis countries, we observed discrepancies between drug resistance patterns obtained locally and WGS. The under-diagnosis of drug resistances resulted in inappropriate treatment and higher mortality. WGS can provide accurate and detailed drug resistance information required to improve the outcomes of drug-resistant tuberculosis in high-burden settings. Our results support the WHO's call for point-of- care tests based on WGS
Post-imperial crises and liminal masculinity in Orhan Kemal’s My Father’s House–The Idle Years
Due to copyright restrictions, the access to the full text of this article is only available via subscription.My Father’s House–The Idle Years is an autobiographical novel by Orhan Kemal, one of the giants of Turkish literature. The novel’s explicit focus is on a boy who grows up pursuing self-realization in a working-class atmosphere. The story takes place during a period of abrupt transformation when the Republic of Turkey, newly born out of the ashes of the collapsed Ottoman Empire, is adapting to oppressive conditions introduced by a burgeoning capitalism. Scholarship on Orhan Kemal has extensively uncovered and charted his socialist realism and unorthodox look at the history of Turkey, but it has not concerned itself enough with the issue of masculinity, which is an indisputable part of Kemal’s view of labour and political power. This paper is an initial attempt to approach Kemal’s autobiographical novels with theories of masculinity. I argue that My Father’s House–The Idle Years explores rites of passages into manhood in what can be referred to as a crisis of imperial loss: the boy grows in an attempt to restore his father’s victimized manhood, in a symbolic parallel to the transformation of the disintegrated Ottoman Empire into self-governed nation-states. Kemal handles the loss metaphorically, using the instability generated by the gender anxieties of a young boy who fails to be like his father to represent the instability generated by the disintegration of the Ottoman Empire. I examine My Father’s House–The Idle Years as the Oedipalized story of post-Ottoman Turkey
Design and establishment of a biobank in a multicenter prospective cohort study of elderly patients with venous thromboembolism (SWITCO65+).
In the field of thrombosis and haemostasis, many preanalytical variables influence the results of coagulation assays and measures to limit potential results variations should be taken. To our knowledge, no paper describing the development and maintenance of a haemostasis biobank has been previously published. Our description of the biobank of the Swiss cohort of elderly patients with venous thromboembolism (SWITCO65+) is intended to facilitate the set-up of other biobanks in the field of thrombosis and haemostasis. SWITCO65+ is a multicentre cohort that prospectively enrolled consecutive patients aged ≥65 years with venous thromboembolism at nine Swiss hospitals from 09/2009 to 03/2012. Patients will be followed up until December 2013. The cohort includes a biobank with biological material from each participant taken at baseline and after 12 months of follow-up. Whole blood from all participants is assayed with a standard haematology panel, for which fresh samples are required. Two buffy coat vials, one PAXgene Blood RNA System tube and one EDTA-whole blood sample are also collected at baseline for RNA/DNA extraction. Blood samples are processed and vialed within 1 h of collection and transported in batches to a central laboratory where they are stored in ultra-low temperature archives. All analyses of the same type are performed in the same laboratory in batches. Using multiple core laboratories increased the speed of sample analyses and reduced storage time. After recruiting, processing and analyzing the blood of more than 1,000 patients, we determined that the adopted methods and technologies were fit-for-purpose and robust