Rationing tests for drug-resistant tuberculosis - who are we prepared to miss?

BACKGROUND: Early identification of patients with drug-resistant tuberculosis (DR-TB) increases the likelihood of treatment success and interrupts transmission. Resource-constrained settings use risk profiling to ration the use of drug susceptibility testing (DST). Nevertheless, no studies have yet quantified how many patients with DR-TB this strategy will miss. METHODS: A total of 1,545 subjects, who presented to Lima health centres with possible TB symptoms, completed a clinic-epidemiological questionnaire and provided sputum samples for TB culture and DST. The proportion of drug resistance in this population was calculated and the data was analysed to demonstrate the effect of rationing tests to patients with multidrug-resistant TB (MDR-TB) risk factors on the number of tests needed and corresponding proportion of missed patients with DR-TB. RESULTS: Overall, 147/1,545 (9.5%) subjects had culture-positive TB, of which 32 (21.8%) had DR-TB (MDR, 13.6%; isoniazid mono-resistant, 7.5%; rifampicin mono-resistant, 0.7%). A total of 553 subjects (35.8%) reported one or more MDR-TB risk factors; of these, 506 (91.5%; 95% CI, 88.9-93.7%) did not have TB, 32/553 (5.8%; 95% CI, 3.4-8.1%) had drug-susceptible TB, and only 15/553 (2.7%; 95% CI, 1.5-4.4%) had DR-TB. Rationing DST to those with an MDR-TB risk factor would have missed more than half of the DR-TB population (17/32, 53.2%; 95% CI, 34.7-70.9). CONCLUSIONS: Rationing DST based on known MDR-TB risk factors misses an unacceptable proportion of patients with drug-resistance in settings with ongoing DR-TB transmission. Investment in diagnostic services to allow universal DST for people with presumptive TB should be a high priority

Un análisis exploratorio de la relación entre pobreza multidimensional y conflicto armado : el caso de Antioquia en Colombia

RESUMEN: Este artículo analiza la relación entre pobreza y conflicto armado en Antioquia, Colombia. El análisis de la pobreza está enmarcado en el enfoque de las capacidades de Sen, el cual conforma la base conceptual del índice de pobreza multidimensional (IPM) desarrollado por Alkire y Foster. El IPM es calculado con información derivada de la base de datos Sisbén, la cual se utiliza para seleccionar la población atendida por los programas de asistencia social del Gobierno colombiano. Este artículo consideró tres dimensiones de pobreza: estándares de vida, salud, y educación. El conflicto armado fue medido por medio de datos de conteo acerca de la ocurrencia de eventos de violencia registrados entre 1996 y 2010 en cada municipalidad de Antioquia. Luego, la relación entre la pobreza y el conflicto armado se analizó mediante métodos exploratorios y no paramétricos como las distribuciones kernel. Los resultados sugieren que el IPM es robusto con respecto a la elección del umbral de pobreza multidimensional. Los mapas de caja y bigotes sugieren que los pobres están localizados en las regiones periféricas de Antioquia. Las distribuciones kernel muestran que las áreas más afectadas por el conflicto, usualmente, tienen altos niveles de pobreza multidimensional.ABSTRACT: This paper analyses the relationship between poverty and armed conflict in Antioquia, Colombia. The poverty analysis it uses is framed according to Sen’s capability approach, which constitutes the conceptual basis for the Multidimensional Poverty Index (MPI) subsequently developed by Alkire and Foster. The MPI is measured employing data from the government database SISBEN, which is used by the Colombian authorities to identify beneficiaries of social assistance programmes. The paper considers three poverty dimensions: living standards, health, and education. Armed conflict is measured using count data on violent events recorded for every municipality in the Department of Antioquia between 1996 and 2010. The relationship between poverty and armed conflict is then analysed using exploratory and non-parametric methods such as kernel distributions. Results suggest that the MPI is robust when compared multidimensional cutoffs. The MPI box-plot maps suggest that poor people are located in Antioquia’s peripheral areas. Kernel distributions show that areas most affected by conflict tend to show higher levels of multidimensional poverty

A social and ecological assessment of tropical land uses at multiple scales: the Sustainable amazon network

Science has a critical role to play in guiding more sustainable development trajectories. Here, we present the Sustainable Amazon Network (Rede Amazônia Sustentável, RAS): a multidisciplinary research initiative involving more than 30 partner organizations working to assess both social and ecological dimensions of land-use sustainability in eastern Brazilian Amazonia. The research approach adopted by RAS offers three advantages for addressing land-use sustainability problems: (i) the collection of synchronized and co-located ecological and socioeconomic data across broad gradients of past and present human use; (ii) a nested sampling design to aid comparison of ecological and socioeconomic conditions associated with different land uses across local, landscape and regional scales; and (iii) a strong engagement with a wide variety of actors and non-research institutions. Here, we elaborate on these key features, and identify the ways in which RAS can help in highlighting those problems in most urgent need of attention, and in guiding improvements in land-use sustainability in Amazonia and elsewhere in the tropics. We also discuss some of the practical lessons, limitations and realities faced during the development of the RAS initiative so far

Genetic characterization of 12 heterologous microsatellite markers for the giant tropical tree Cariniana legalis (Lecythidaceae)

Twelve microsatellite loci previously developed in the tropical tree Cariniana estrellensis were genetically characterized in Cariniana legalis. Polymorphisms were assessed in 28 C. legalis individuals found between the Pardo and Mogi-Guaçu River basins in the state of São Paulo, Brazil. Of the 12 loci, 10 were polymorphic and exhibited Mendelian inheritance. The allelic richness at each locus ranged from 2-11, with an average of 7 alleles per locus, and the expected heterozygosity ranged from 0.07-0.88. These loci showed a high probability of paternity exclusion. The characteristics of these heterologous microsatellite markers indicate that they are suitable tools for investigating questions concerning population genetics in C. legalis

Intraovarian injection of mesenchymal stem cells improves oocyte yield and in vitro embryo production in a bovine model of fertility loss.

Valuable female cattle are continuously subject to follicular puncture (ovum pick-up - OPU). This technique is commonly used for in-vitro embryo production, but may result in ovarian lesion. Mesenchymal stem cells (MSC) ameliorate the function of injured tissues, but their use to treat ovarian lesions in cattle has not been established. We investigated whether a local injection of MSC would reduce the negative efects of repeated OPU under acute and chronic scenarios in bovines. First, we performed four OPU sessions and injected 2.5×106 MSCs immediately after the 4th OPU procedure (n=5). The treated organs (right ovary) were compared to their saline-treated counterparts (left), and presented superior production of oocytes and embryos in the three following OPU sessions (P<0.05). Then, cows with progressive fertility loss went through three OPU sessions. Animals received MSC, saline, or MSC+FSH in both ovaries after the frst OPU. In the two following OPU sessions, the MSC and MSC&#8201;+FSH - treated groups failed to present any signifcant alteration in the number of oocytes and embryos compared to saline-treated animals. Thus, MSC have benefcial efects on the fertility of OPUlesioned cows, but not in cows with cystic ovarian disease and chronic ovarian lesions