Genetic diversity of circulating rotavirus strains in Tanzania prior to the introduction of vaccination

Background: Tanzania currently rolls out vaccination against rotavirus-diarrhea, a major cause of child illness and death. As the vaccine covers a limited number of rotavirus variants, this study describes the molecular epidemiology of rotavirus among children under two years in Dar es Salaam, Tanzania, prior to implementation of vaccination. Methods: Stool specimens, demographic and clinical information, were collected from 690 children admitted to hospital due to diarrhea (cases) and 545 children without diarrhea (controls) during one year. Controls were inpatient or children attending child health clinics. Rotavirus antigen was detected using ELISA and positive samples were typed by multiplex semi-nested PCR and sequencing. Results: The prevalence of rotavirus was higher in cases (32.5%) than in controls (7.7%, P,0.001). The most common G genotypes were G1 followed by G8, G12, and G4 in cases and G1, G12 and G8 in controls. The Tanzanian G1 variants displayed 94% similarity with the Rotarix vaccine G1 variant. The commonest P genotypes were P[8], P[4] and P[6], and the commonest G/P combination G1 P[8] (n = 123), G8 P[4] and G12 P[6]. Overall, rotavirus prevalence was higher in cool (23.9%) than hot months (17.1%) of the year (P = 0.012). We also observed significant seasonal variation of G genotypes. Rotavirus was most frequently found in the age group of four to six months. The prevalence of rotavirus in cases was lower in stunted children (28.9%) than in non-stunted children (40.1%, P = 0.003) and lower in HIV-infected (15.4%, 4/26) than in HIVuninfected children (55.3%, 42/76, P,0.001). Conclusion: This pre-vaccination study shows predominance of genotype G1 in Tanzania, which is phylogenetically distantly related to the vaccine strains. We confirm the emergence of genotype G8 and G12. Rotavirus infection and circulating genotypes showed seasonal variation. This study also suggests that rotavirus may not be an opportunistic pathogen in children infected with HIV

Symptomatic and asymptomatic secondary transmission of Cryptosporidium parvum following two related outbreaks in schoolchildren

Two related outbreaks (in 2009 and 2012) of cryptosporidiosis in Norwegian schoolchildren during a stay at a remote holiday farm provided us with a natural experiment to investigate possible secondary transmission of Cryptosporidium parvum IIa A19G1R1. After the children had returned home, clinical data and stool samples were obtained from their household contacts. Samples were investigated for the presence of Cryptosporidium oocysts by immunofluorescence antibody test. We found both asymptomatic and symptomatic infections, which are likely to have been secondary transmission. Laboratory-confirmed transmission rate was 17% [4/23, 95% confidence interval (CI) 7·0–37·1] in the 2009 outbreak, and 0% (95% CI 0–16·8) in the 2012 outbreak. Using a clinical definition, the probable secondary transmission rate in the 2012 outbreak was 8% (7/83, 95% CI 4·1–16·4). These findings highlight the importance of hygienic and public health measures during outbreaks or individual cases of cryptosporidiosis. We discuss our findings in light of previous studies reporting varying secondary transmission rates of Cryptosporidium spp

A Standardized Reading Intervention with Three Students with Dyslexia

According to The International Dyslexia Association, it is estimated that 15-20 percent of the world\u27s population experience at least one symptom of dyslexia throughout their lives (International Dyslexia Association, 2022). Dyslexia is an unexpected difficulty in reading in an individual who has the intelligence to be a much better reader (Shaywitz, 2017). It is described as a learning disability in reading and the individual has trouble reading at a good and accurate pace, and without making mistakes when they are reading or spelling text. There are several early predictors of dyslexia that can be identified as early as when the child first starts speaking. There are also several interventions that can help a child with dyslexia become a successful reader, including the Orton-Gillingham Approach to reading. This is a form of structured reading, that is a multi-sensory approach to teaching phonemic and phonological awareness. Within the Orton-Gillingham Approach, is a program called the Barton Reading and Spelling Program. The Barton Reading and Spelling Program is a multi-sensory, direct, explicit, structured, and sequential intense intervention program (Barton, 2021). Even though there is little evidence based data supporting the Barton Reading Program, it has several effective components. The purpose of this capstone project is to analyze the Barton Reading Program with three 3rd grade students within a special education resource room for students specifically who have dyslexia. This capstone was not structured within a scientific research setting, so the findings are not meant to be interpreted in this manner

Giardiasis treatment: an update with a focus on refractory disease

Postponed access: the file will be accessible after 2021.10.01Purpose of review Giardiasis remains a common cause of diarrhea and intestinal enteropathy globally. Here we give an overview of clinical treatment studies and discuss potential mechanisms and molecular targets for in-vitro testing of drug resistance. Recent findings Giardia is a cause of disease both in diarrheal and nondiarrheal cases. The prevalence of treatment refractory giardiasis is increasing. Recent studies reveal 5-nitroimidazole refractory infection occurs in up to 50% of cases. Mechanisms of drug resistance are not known. Placebo controlled studies of drug efficacy, taking the self-limiting course of giardiasis into account, has not been reported. No randomized controlled trials of treatment of refractory infection have been performed the last 25 years. Based on the clinical studies reported, combination treatment with a 5-nitroimidazole and a benzimidazole is more effective than repeated courses of 5-nitroimidazole or monotherapies in refractory cases. Quinacrine is effective in refractory cases, but potentially severe side effects limit its use. Summary A combination of a 5-nitroimidazole and albendazole or mebendazole, and quinacrine monotherapy, are rational choices in nitroimidazole refractory infections, but randomized controlled studies are needed. Further research into more recent clinical isolates is necessary to uncover mechanisms for the increase in metronidazole refractory giardiasis observed during the last decade.acceptedVersio

Human mucosal IgA immune responses against enterotoxigenic escherichia coli

Infection with enterotoxigenic Escherichia coli (ETEC) is a major contributor to diarrheal illness in children in low- and middle-income countries and travelers to these areas. There is an ongoing effort to develop vaccines against ETEC, and the most reliable immune correlate of protection against ETEC is considered to be the small intestinal secretory IgA response that targets ETEC-specific virulence factors. Since isolating IgA from small intestinal mucosa is technically and ethically challenging, requiring the use of invasive medical procedures, several other indirect methods are used as a proxy for gauging the small intestinal IgA responses. In this review, we summarize the literature reporting on anti-ETEC human IgA responses observed in blood, activated lymphocyte assayss, intestinal lavage/duodenal aspirates, and saliva from human volunteers being experimentally infected with ETEC. We describe the IgA response kinetics and responder ratios against classical and noncanonical ETEC antigens in the different sample types and discuss the implications that the results may have on vaccine development and testing.publishedVersio

Client predictors of therapy dropout in a primary care setting

Bakgrunn: Frafall fra terapi representerer en betydelig utfordring. Derfor har det blitt grundig studert hva som kan predikere frafall fra terapi. Dette har hittil ikke blitt undersøkt i primærhelsetjenesten i Norge. Formålet med denne studien var å undersøke hvilke karakteristikker ved klienter som kan predikere frafall fra tjenesten Rask Psykisk Helsehjelp (RPH). Metode: Vi gjennomførte en sekundær analyse av en randomisert kontrollert studie (RCT). Utvalget besto av 526 voksne deltakere som mottok behandling fra Rask Psykisk Helsehjelp i kommunene Sandnes og Kristiansand fra november 2015 til august 2017. Ved bruk av logistisk regresjon undersøkte vi sammenhengen mellom ni klientkarakteristikker og frafall. Resultater: Frafallsraten i studien var 25.3%. Eldre klienter hadde lavere odds ratio (OR) for å falle fra sammenlignet med yngre klienter (OR = 0.44, [95% CI = .27, .71]). Klienter med høyere utdanning hadde lavere odds ratio for å falle fra sammenlignet med klienter med lavere grad av utdanning (OR = .57, 95% CI [.35, .92]). Klienter med dårlig sosial støtte hadde høyere odds ratio for å falle fra sammenlignet med klienter med god sosial støtte (OR = 1.90, [95% CI = 1.20, 2.99]). Karakteristikkene kjønn, innvandrerbakgrunn, arbeidsstatus, funksjonsnivå, symptomtrykk og problemvarighet predikerte ikke frafall. Diskusjon: De predikerende karakteristikkene vi fant i denne prospektive studien kan hjelpe RPH-terapeuter å identifisere klienter i risiko for frafall. Strategier for å forebygge frafall diskuteres.Hovedoppgave psykologprogrammetPROPSY317PRPSY

Development of functional gastrointestinal disorders after Giardia lamblia infection

<p>Abstract</p> <p>Background</p> <p>Functional gastrointestinal disorders (FGID) may occur following acute gastroenteritis. This long-term complication has previously not been described after infection with the non-invasive protozoan <it>Giardia lamblia</it>. This study aims to characterize persistent abdominal symptoms elicited by <it>Giardia </it>infection according to Rome II criteria and symptoms scores.</p> <p>Methods</p> <p>Structured interview and questionnaires 12–30 months after the onset of <it>Giardia </it>infection, and at least 6 months after <it>Giardia </it>eradication, among 82 patients with persisting abdominal symptoms elicited by the <it>Giardia </it>infection. All had been evaluated to exclude other causes.</p> <p>Results</p> <p>We found that 66 (80.5%) of the 82 patients had symptoms consistent with irritable bowel syndrome (IBS) and 17 (24.3%) patients had functional dyspepsia (FD) according to Rome II criteria. IBS was sub classified into D-IBS (47.0%), A-IBS (45.5%) and C-IBS (7.6%). Bloating, diarrhoea and abdominal pain were reported to be most severe. Symptoms exacerbation related to specific foods were reported by 45 (57.7%) patients and to physical or mental stress by 34 (44.7%) patients.</p> <p>Conclusion</p> <p>In the presence of an IBS-subtype pattern consistent with post-infectious IBS (PI-IBS), and in the absence of any other plausible causes, we conclude that acute <it>Giardia </it>infection may elicit functional gastrointestinal diseases with food and stress related symptoms similar to FGID patients in general.</p

Cause of death in patients with tuberculosis: A study based on epidemiological and autopsy records of Western Norway 1931-47

Background Without treatment, nearly 50 % of tuberculosis (TB) patients die. World Health Organization’s definition of TB deaths does not take into consideration whether the cause of death was TB or other non-TB co-morbid conditions. We aimed to improve our knowledge of the causes of death in patients with TB. Methods Single-center retrospective study conducted at Gade Institute of Pathology, Haukeland University Hospital, Bergen, Norway. Autopsy data of 269 patients with TB was collected from autopsy journals, and epidemiological data was collected from Norwegian Official Statistics books for period 1931–1947. Results Of all TB deaths reported in epidemiological reports, pulmonary TB accounted for 81 % and extrapulmonary TB for 19 %. However, in autopsy records, only 21 % of cases with active pulmonary TB died because of TB. Extrapulmonary involvement was significantly associated with higher mortality (OR EPTB as compared to PTB; 3.27, CI 1.91 – 5.61) and constituted 79 % of deaths attributable to TB. A significant burden of extrapulmonary TB was found in autopsy records (63 %), while in epidemiological records, only 4 % of cases were reported. Conclusions Extrapulmonary involvement was a predictor of mortality due to TB in hospitalized TB patients. The contribution of extrapulmonary TB to TB mortality seems to be underestimated because extrapulmonary TB largely remains underdiagnosed and underreported in epidemiological data.publishedVersio

A study of the experience of Norwegian IVF physicians in evaluating the parenting capacity of patients

Research question: How do Norwegian fertility doctors assess the parenting capacity of applicants, and how do they experience and evaluate the assessment practice? Design: Qualitative interview study with 14 Norwegian fertility doctors. Interviews were analysed with systematic text condensation, a qualitative analysis framework. Results: Norwegian fertility doctors deem parenting capacity assessments of applicants to be straightforward and simple in most cases. Yet, some cases of doubt pose difficulties. Physicians can then draw on resources such as colleagues, physicians from other specialties who know the patient and patient records. All the participating physicians agreed with the principle of parenting capacity assessment for patients seeking fertility treatment. The assessment enabled physicians to refuse patients whom they thought should definitely not have responsibility for children. The physicians' main argument was their own felt responsibility for the future child. Even though assessments could be challenging, the participants all thought of themselves as competent to perform them. Indeed, some thought that delegating the assessments would imply abdicating a responsibility that was properly theirs. Although national guidelines might aid decision-making, the physicians would not want guidelines to curtail the significant discretion that they exercised. Conclusions: Whether societies should assess applicants' capacity for parenthood before fertility treatment is an ethical and political question. Although sometimes a difficult task, Norwegian fertility doctors see it as important, and as something they are competent and suited to undertake.A study of the experience of Norwegian IVF physicians in evaluating the parenting capacity of patientspublishedVersio