Obesity and HIV: a compounding problem

Objectives: A cross-sectional study was undertaken at Lancers Road Clinic, Durban, South Africa to determine body composition, haemoglobin, serum albumin and serum high sensitivity C-reactive protein (hs-CRP) levels in asymptomatic ART-naive HIV positive adults. Methods: All eligible adults attending the clinic were sampled. Body composition was assessed using deuterium dilution. Descriptive statistics, Wilcoxon rank-sum test, chi-square test, Fisher’s exact test and Spearman’s rank correlation coefficient were used for data analysis. Results: A total of 84 participants (CD4 count: 542.5 ± 145 cell/mm3) enrolled. The mean body mass index (BMI) was 29.5 (± 6.4) kg/m2 and the mean fat mass percentage was 44.9 (± 18.7). The prevalence of overweight (26.2%, 22/84) and obesity (46.4%, 39/84) was high. Mean haemoglobin (Hb) levels were 12.0 ± 1.6 g/dl. Mild, moderate and severe anaemia was present in 21.4% (18/84), 20.2% (17/84) and 1.2% (1/84) of patients, respectively. Mean albumin levels (36.2 ± 3.8 g/l) were on the borderline low range of normal with mildly depleted albumin levels being present in a third (32.1%, 27/84) of patients. The mean hs-CRP levels (5.5 ± 7.2 mg/l) were high. Conclusion: In this cohort of patients, wasting was not associated with HIV as the prevalence of overweight/obesity was high and followed the population trend in SA. This seemingly well, asymptomatic population of people living with HIV was at an increased risk of morbidity, progression and death due to the compounding factors of overweight/obesity, hypoalbuminemia, raised hs-CRP levels and anaemia

Development of a Teaching Performance Assessment in Australia: What did we learn?

Following increasing criticism of the variability in graduate teachers’ readiness to enter the profession, the Australian Institute for Teaching and School Leadership (AITSL) introduced a program accreditation requirement that all initial teacher education (ITE) providers must implement a Teaching Performance Assessment (TPA) in the final year of their teacher education programs. AITSL were not prescriptive in how ITE providers must meet the program standard which has resulted in 12 TPAs being implemented across 42 ITE providers. This paper outlines the development and implementation of one endorsed TPA designed to measure the readiness of graduating teachers, whilst taking into consideration the learnings from well-known TPAs and our own experiences. With this being one of the earlier unfunded TPAs in Australia to have been approved through the accreditation endorsement process, the paper offers some insights into meeting the additional accreditation program requirements and raises some longer-term considerations associated with implementing TPAs

Routinely available cotrimoxazole prophylaxis and occurrence of respiratory and diarrhoeal morbidity in infants born to HIV-infected mothers in South Africa

Objectives. To examine the influence of cotrimoxazole (CTM) prophylaxis on incidence of lower  respiratory tract infections (LRTis) and diarrhoea.Design. A prospective observational cohort study. Morbidity and feeding data on infants born to HN-infected mothers were collected routinely at. clink visits at 1 week, 6 weeks and 3 months, and 3-monthly thereafter, with blood drawn for determining HIV status.Setting. Two hospitals in Durban, South Africa. In one hospital (King Edward VIII Hospital), infants born to HIVinfected mothers recieved CTM prophylaxis and in the other (McCord Hospital) infants did not  receive CTM prophylaxis,Subjects. Infants born to HIV-infected mothers.Outcome measures. Incidence of .LRTI and diarrhoea.Results, Ill. multivariate analysis controlling for breast-feeding status, number of clinic visits and HN infection status, HIVinfected infants with access to C1M prophylaxis had a significantly lower incidence of LRTI (82%) than those without access to prophylaxis. However in HIV-uninfected infants, this was not the case, CTM prophylaxis was associated with a non-significant increased risk for diarrhoea in both infected (odds ratio (OR) 1.58, p = 0.45) aud uninfected infants (OR 1.52, p = 0.10).Conclusions, This observational study .confirms current thinking that CTM prophylaxis is protective  against LRTis in HIV-infected children. However, because of a possible association between CTM prophylaxis and an increased risk of diarrhoea, HIV status of infants should be determined as early as possible in order to prevent tmnecessary exposure of uninfected infants to CTM prophylaxis, while further studies to quantify both beneficial and adverse effects. of CTM prophylaxis are undertaken

PIMATM point-of-care testing for CD4 counts in predicting antiretroviral initiation in HIV-infected individuals in KwaZulu-Natal, Durban, South Africa

Introduction: Limited information is available on the usefulness of the PIMATM analyser in predicting antiretroviral treatment eligibility and outcome in a primary healthcare clinic setting in disadvantaged communities in KwaZulu-Natal, South Africa.Materials and methods: The study was conducted under the eThekwini Health Unit, Durban, KwaZulu-Natal. Comparison of the enumeration of CD4+ T-cells in 268 patients using the PIMATM analyser and the predicate National Health Laboratory Services (NHLS) was undertaken during January to July 2013. Bland-Altman analysis to calculate bias and limits of agreement, precision and levels of clinical misclassification at various CD4+ T-cell count thresholds was performed.Results: There was high precision of the PIMATM control bead cartridges with low and normal CD4+ T-cell counts using three different PIMATM analysers (%CV < 5). Under World Health Organization (WHO) guidelines (≤ 500 cells/mm3), the sensitivity of the PIMATM analyser was 94%, specificity 78% and positive  predictive value (PPV) 95%. There were 24 (9%) misclassifications, of which 13 were false-negative in whom the mean bias was 149 CD4+ T-cells/mm3. Most (87%) patients returned for their CD4 test result but only 67% (110/164) of those eligible (≤ 350 cells/mm3) were initiated on antiretroviral therapy (ART) with a time to treatment of 49 days (interquartile range [IQR], 42–64 days).Conclusion: There was adequate agreement between PIMATM analyser and  predicate NHLS CD4+ T-cell count enumeration (≤ 500 cells/mm3) in adult  HIV-positive individuals. The high PPV, sensitivity and acceptable specificity of the PIMATM analyser technology lend it as a reliable tool in predicting eligibility and rapid linkage to care in ART programmes

Single-grain TT-OSL bleaching characteristics: Insights from modern analogues and OSL dating comparisons

Previous assessments of thermally transferred optically stimulated luminescence (TT-OSL) signal resetting in natural sedimentary settings have been based on relatively limited numbers of observations, and have been conducted primarily at the multi-grain scale of equivalent dose (De) analysis. In this study, we undertake a series of single-grain TT-OSL bleaching assessments on nineteen modern and geological dating samples from different sedimentary environments. Daylight bleaching experiments performed over several weeks confirm that single-grain TT-OSL signals are optically reset at relatively slow, and potentially variable, rates. Single-grain TT-OSL residual doses range between 0 and 24 Gy for thirteen modern samples, with >50% of these samples yielding weighted mean De values of 0 Gy at 2σ. Single-grain OSL and TT-OSL dating comparisons performed on well-bleached and heterogeneously bleached late Pleistocene samples from Kangaroo Island, South Australia, yield consistent replicate age estimates. Our results reveal that (i) single-grain TT-OSL residuals can potentially be reduced down to insignificant levels when compared with the natural dose range of interest for most TT-OSL dating applications; (ii) the slow bleaching properties of TT-OSL signals may not necessarily limit their dating applicability to certain depositional environments; and (iii) non-trivial differences may be observed between single-grain and multi-grain TT-OSL bleaching residuals in some modern samples. Collectively, these findings suggest that single-grain TT-OSL dating may offer advantages over multi-grain TT-OSL dating in certain complex depositional environments

Autoantibodies Produced at the Site of Tissue Damage Provide Evidence of Humoral Autoimmunity in Inclusion Body Myositis

Inclusion body myositis (IBM) belongs to a group of muscle diseases known as the inflammatory myopathies. The presence of antibody-secreting plasma cells in IBM muscle implicates the humoral immune response in this disease. However, whether the humoral immune response actively contributes to IBM pathology has not been established. We sought to investigate whether the humoral immune response in IBM both in the periphery and at the site of tissue damage was directed towards self-antigens. Peripheral autoantibodies present in IBM serum but not control serum recognized self-antigens in both muscle tissue and human-derived cell lines. To study the humoral immune response at the site of tissue damage in IBM patients, we isolated single plasma cells directly from IBM-derived muscle tissue sections and from these cells, reconstructed a series of recombinant immunoglobulins (rIgG). These rIgG, each representing a single muscle-associated plasma cell, were examined for reactivity to self-antigens. Both, flow cytometry and immunoblotting revealed that these rIgG recognized antigens expressed by cell lines and in muscle tissue homogenates. Using a mass spectrometry-based approach, Desmin, a major intermediate filament protein, expressed abundantly in muscle tissue, was identified as the target of one IBM muscle-derived rIgG. Collectively, these data support the view that IBM includes a humoral immune response in both the periphery and at the site of tissue damage that is directed towards self-antigens