The prevalence of helminth and malaria infections and the effects of de-worming on disease progression markers in HIV-1 infected pregnant women on antiretroviral therapy in Rwanda

thesis submitted to the Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa, in fulfilment of the requirements for the award of the degree of Doctor of Philosophy (PhD) August 15th, 2017.Background: Helminth and malaria co-infections have been hypothesized to be factors driving the HIV-1 epidemic in Africa, and the fact that both cause anaemia highlights the importance of addressing the interactions between HIV/AIDS, malaria and intestinal helminthic infections in pregnancy for individuals in resource limited settings. Aims: The aims of this thesis were to determine the prevalence and risk factors for malariahelminthic dual infections among HIV positive pregnant women on antiretroviral therapy in Rwanda. The second aim was to determine the effect of deworming on immune markers of HIV/AIDs disease progression among HIV-infected pregnant women on antiretroviral therapy (ART), and to elucidate the benefits of deworming, specifically in targeted versus untargeted deworming. Methods: A cross-sectional study was carried out in 328 HIV-positive pregnant women receiving ART. We determined the prevalence of helminth and malaria dual infections and the effects of ART on these infections were also examined. This cross sectional study acted as a pilot study for a deworming intervention, which took the form of a longitudinal study of targeted and untargeted deworming in which 980 HIV-infected pregnant women were randomized to ‘targeted’ and ‘untargeted’ arms with albendazole therapy. The effects of deworming on the prevalence of helminth infection and CD4 counts, viral load and haemoglobin levels were measured over time at 4 visits. Measurements were at baseline and every 3 months thereafter. The presence of Plasmodium falciparum was tested at each visit and anti-malarial therapy (Coartem: artemether-lumefantrine) was administered to all subjects who tested positive for P. falciparum. Baseline data was used to determine the risk factors for helminth infection. Helminthic infection was diagnosed using the Kato Katz method, whilst the presence of P. falciparum was identified from blood smears. The CD4 counts and viral load levels were also determined using standard laboratory methods. Results: Within the pilot study of 328 women residing in rural (n=166) and peri-urban (n=162) locations, 38% of those tested harboured helminths, 21% had malaria and 10% were infected with both. The most prevalent helminth species were Ascaris lumbricoides (20.7%), followed by Trichiuris trichiura (9.2%), Ancylostoma duodenale and Necator Americanus (1.2%). Helminth infections were characterized by low haemoglobin levels and low CD4 E. Ivan PhD thesis Page iii counts. Subjects treated with a d4T-3TC-NVP regimen had a reduced risk of Trichuris trichiura infection (OR, 0.27; 95% CIs, 0.10-0.76; p<0.05) and malaria-helminth dual infection (OR, 0.29; 95% CI, 0.11-0.75; p<0.05) compared to those receiving AZT-3TC-NVP therapy. Within the longitudinal study of deworming in 980 pregnant, HIV-infected females, analysis of the baseline data showed that education and employment reduced the risk of all types of infection whilst hand washing protected against helminth infection (0.29 [0.19-0.46]; p<0.0005). Logistic regression analysis, at baseline (odds ratio [95% CIs]), demonstrated that TDF-3TC-NVP (3.47 [2.21-5.45]; p<0.0005), D4T-3TC-NVP (2.47 [1.27-4.80]; p<0.05) and AZT-NVP (2.60 [1.33-5.08]; p<0.05) regimens each yielded higher helminth infection rates than the AZT-3TC-NVP regimen. Anti-retroviral therapy had no effect on the risk of malaria. The prevalence of P. falciparum infection was similar at all-time points for the targeted and non-targeted anti-helminth treatment arms, with a significant fall in helminth prevalence in both arms by visit 2. Albendazole therapy was associated with favourable changes in haemoglobin levels, CD4 counts and viral loads, in those subjects with helminth infections. Haemoglobin levels were similar in both arms at all study visits, rising significantly from visit 1 to visit 2 in both groups and peaking by visit 3. Thereafter, levels fell significantly (p<0.0005 for both comparisons) by visit 4. Conclusions: The prevalence of helminth infection in HIV infected pregnant women on antiretroviral therapy is common in rural and peri-urban settings in Rwanda. This study clearly shows that, albendazole treatment is associated with an increase in CD4 counts, a fall in viral loads and an increase in haemoglobin levels. The effects of albendazole are mediated by the eradication of helminth infection. The study also shows that treatment with albendazole using a targeted or non-targeted regimen is equally effective. The mechanism by which certain ART regimens reduce the risk of helminth infection warrants further study.LG201

Bedeviling Quijano De Manila’s Discourses of the Devil’s Advocate

Using a Marxist framework, this paper looks at Nick Joaquin’s conduct of history writing and uses this analysis to comment on the general practice of writing on history. The paper first assesses the extent by which a strand of dialectical thought operates in Discourses. Second, typical assertions of history as “narrativized” discourse are put into test. The ideas of Linda Hutcheon and Edel Garcellano are utilized to bring in the larger sociality where textual discourses take place, thereby shunning the supposed primacy of texts and positing the dynamic ties between history writing and society. Third, the relationship between oral and written discourses and how these types of sources figured in the book are examined. Following this, the potentials of oral sources for alternative practices of history writing and interpretation—more dispersed, refusing the singularity of the “official”—are hailed. Toward the end, a call for reflexivity is reaffirmed. This is done to counter both the pretentiously grand claims of History and the flirtations with liberal tendencies of history writing that opens itself to multiple sources. What is espoused is history writing that is open precisely because of its awareness of its location in the complexity of the societal whole

On a Two-Dimensional Search Problem

In this article we explore the so-called two-dimensional tree− search problem. We prove that for integers m of the form m = (2^(st) − 1)/(2^s − 1) the rectangles A(m, n) are all tight, no matter what n is. On the other hand, we prove that there exist infinitely many integers m for which there is an infinite number of n’s such that A(m, n) is loose. Furthermore, we determine the smallest loose rectangle as well as the smallest loose square (A(181, 181)). It is still undecided whether there exist infinitely many loose squares

Lives Away from Home and Precarious Writing as Life: Reading Bienvenido Santos’s Postscript to Saintly Life

Towards the end of his writing career, Bienvenido Santos published two autobiographies, Memory’s Fictions and Postscript to Saintly Life—a departure in a writing life mostly devoted to penning fictional works. This paper focuses on the last autobiography which mainly looks at Santos’s experiences as a pensionado in America. It pays attention to how Santos writes about his Philippine home while in exile, taking part in a program that is part of the American colonial period. The range of Santos’s emotions—with shame and pride on both ends—while abroad is also examined. How these emotions were manifested in the book served as springboard to analyze Santos’s thoughts about his pensionado experience and locate hints of his insights regarding the fraught post-colonial relationship between the host-land America, and his homeland Philippines. The paper takes off from, and engages the postulations of Timothy Bewes about shame in postcolonial writing, and of Dylan Rodriquez about the violence inhering in the US–Philippine relations. The paper concludes by highlighting how Santos reaffirms the material force of writing, especially in the context of an exiled writer ceaselessly conjuring his native land, and pining for his return

Laparascopic-assisted endoscopic mucosal resection of a polyp in sigma and laparoscopic right hemicolectomy for adenocarcinoma in colon ascendens - case report

Today, endoscopic polypectomy has become a daily-performed routine procedure in the operating room. Almost every polyp in the colon can be removed endoscopically, but there are some problematic adenomas which are either large in size or difficult to approach. We present 80 years old white woman with a tubulo­villous adenoma with high-grade dysplasia on a flat surface located in sigma with 4 x 5cm in size and also synchronously found in colon ascendens a well differentiated G1 adenocarcinoma with 2 x 2cm in size on a flat surface. The abdominal ultrasound did not find any liver metastases. Because of the difficult location and the size of the two lesions in the right and left colon, we make a decision for a laparoscopic-assisted en­doscopic mucosal resection (piece-meal) of the polyp in sigma and for the adenocarcinoma in colon ascen­dens the procedure was followed by laparoscopic right hemicolectomy in one step approach. The both inter­ventions were performed without complications and good postoperative period. Hybrid endoscopic and lap­aroscopic interventions are very effective approach that can resect large tubulovillous polyps and adenocar­cinoma of the colon, with a lesser risk of complications. Combining the methods in one surgery save time, make endoscopy more easy to perform and can save one-half of the colon in cases of synchronous lesions of the colon. Scr Sci Med 2017; 49(3): 49-5

Induced crystallization of glass-forming melts : Part 1. Heterogeneous nucleation. Effect of noble metal microcrystals on the crystallization of calcium metaphosphate glasses

The possibilities of initiating crystallization in glass-forming melts are analyzed, using experimental evidence, obtained with several model glass-forming systems. In the present Part 1 of the investigation the process of heterogeneous nucleation, catalyzed by insoluble crystallization cores is studied, using a new theoretieal thermodynamie model. The nucleation activity coefficient, Φ, of the aubstrates is described by the adhesion energy, β, at the interface crystallization core/overgrowing crystal. Lattice disregistry is accounted for as an additional correlation factor, influencing the thermodynamie work of adhesion. The crystallization of calcium metaphosphate glass-forming melts, initiated by noble metal microerystals (Ag, Au, Pd, Pt, Rh, Ru, Ir, Os), is studied by differential thermal analysis, optical and scanning electron microseopy. Ir microerystals show highest nucleation activity promoting intensive bulk crystallization in the Ca(PO3)2 systems investigated. The activity of other crystallization cores decreases in the following sequence: Ru > Rh > Os > Pt > Pd > Au > Ag. The above outlined thermodynamic theory of nucleation activity is used to correlate experimental data and to calculate activity coefficients, Φ, in dependence on the properties of the substrates employed. Under tangential stress, applied by pressure in extrusion experiments, the metal microcrystals in the glass samples are stratified in concentric rings with particle density increasing towards the sample surface. Thus a new method of formation of pre-oriented glass-ceramic materials is indicated. In Part 2 of the investigation the effect of soluble oxide additives on nucleation and crystallization in glass-forming melts is considered

CASE REPORT OF PATIENTS WITH LEPTOSPIROSIS HOSPITALIZED IN THE DEPARTMENT OF INFECTIOUS DISEASES AT GENERAL HOSPITAL MURSKA SOBOTA IN THE YEAR 2002 – THE SIGNIFICANCE OF BLOOD CULTURE

Background. Leptospirosis is a zoonosis with worldwide distribution. In Slovenia, Pomurje is an endemic area. Manifestations of leptospirosis may be observed as different types of disease. The range from a short-lived febrile state to a severe disease with renal failure, liver impairment, hemorrhage and fulminant course.Patients and methods. Until year 2001 in the Department of infectious diseases at General Hospital Murska Sobota, only serological methods in diagnosis of leptospirosis had been used. Only in 2002 isolation of leptospires from blood was used. Four cases of confirmed leptospirosis hospitalized in our Department in 2002 were presented with broad spectrum of clinical courses and the significance of cultivation of leptospires from blood in the diagnosis.Conclusions. Because of the protean manifestations of leptospirosis, microbiological tests are essential for confirmatory diagnosis. In case of epidemiological data, clinical course and laboratory markers suggesting the diagnosis of leptospirosis, it is advisible to obtain blood cultures.</p