Knowledge of tuberculosis-treatment prescription of health workers: a systematic review

Treating tuberculosis (TB) patients with inappropriate treatment regimens can lead to treatment failure and, thus, patients who have not been cured and/or to the development of (multi)-drug resistance. A systematic review was performed to assess the knowledge of appropriate TB drug regimens among all categories of healthcare workers (HCWs)

Which Fishers are Satisfied in the Caribbean? A Comparative Analysis of Job Satisfaction Among Caribbean Lobster Fishers

Lobster fishing (targeting the spiny lobster Panulirus argus) is an important economic activity throughout the Wider Caribbean Region both as a source of income and employment for the local population as well as foreign exchange for national governments. Due to the high unit prices of the product, international lobster trade provides a way to improve the livelihoods of fisheries-dependent populations. The specie harvested is identical throughout the region and end market prices are roughly similar. In this paper we wish to investigate to which extent lobster fishers’ job satisfaction differs in three countries in the Caribbean and how these differences can be explained by looking at the national governance arrangements

controlling the disease

Surveillance and outbreak reports Surveillance of extensively drug-resistant tuberculosis in Europe, 2003-2007 15 by I Devaux, D Manissero, K Fernandez de la Hoz, K Kremer, D van Soolingen, on behalf of the EuroTB network Analysis of tuberculosis treatment outcomes in the European Union and European Economic Area: efforts needed towards optimal case management and control 21 by D Manissero, V Hollo, E Huitric, C Ködmön, A Amato-Gauci Risk of developing tuberculosis from a school contact: retrospective cohort study

Association of mutation patterns in gyrA/B genes and ofloxacin resistance levels in Mycobacterium tuberculosis isolates from East China in 2009

<p>Abstract</p> <p>Background</p> <p>This study aimed to analyze the association of mutation patterns in <it>gyrA </it>and <it>gyrB </it>genes and the ofloxacin resistance levels in clinical <it>Mycobacterium tuberculosis </it>isolates sampled in 2009 from East China.</p> <p>Methods</p> <p>The quinolone resistance-determining region of <it>gyrA/B </it>were sequenced in 192 <it>M. tuberculosis </it>clinical isolates and the minimal inhibitory concentrations (MICs) of 95 ofloxacin-resistant <it>M. tuberculosis </it>isolates were determined by using microplate nitrate reductase assays.</p> <p>Results</p> <p>Mutations in <it>gyrA </it>(codons 90, 91 and 94) and in <it>gyrB </it>(G551R, D500N, T539N, R485C/L) were observed in 89.5% (85/95) and 11.6% (11/95) of ofloxacin-resistant strains, respectively. The <it>gyrB </it>mutations G551R and G549D were observed in 4.1% (4/97) of ofloxacin-susceptible strains and no mutation was found in <it>gyrA </it>in ofloxacin-susceptible strains. The MICs of all ofloxacin-resistant strains showed no significant difference among strains with mutations at codons 90, 91 or 94 in <it>gyrA </it>(F = 1.268, <it>p </it>= 0.287). No differences were detected among strains with different amino acid mutations in the quinolone resistance-determining region of <it>gyrA </it>(F = 1.877, <it>p </it>= 0.123). The difference in MICs between ofloxacin-resistant strains with mutations in <it>gyrA </it>only and ofloxacin-resistant strains with mutations in both <it>gyrA </it>and <it>gyrB </it>genes was not statistically significant (F = 0.549, <it>p </it>= 0.461).</p> <p>Conclusions</p> <p>Although <it>gyrA/B </it>mutations can lead to ofloxacin resistance in <it>M. tuberculosis</it>, there were no associations of different mutation patterns in <it>gyrA/B </it>and the level of ofloxacin resistance in <it>M. tuberculosis </it>isolates from East China in 2009.</p

The History of Makassan Trepang Fishing and Trade

The Malayan term trepang describes a variety of edible holothurians commonly known as sea cucumbers. Although found in temperate and tropical marine waters all over the world, the centre of species diversity and abundance are the shallow coastal waters of Island Southeast Asia. For at least 300 years, trepang has been a highly priced commodity in the Chinese market. Originally, its fishing and trade was a specialized business, centred on the town of Makassar in South Sulawesi (Indonesia). The rise of trepang fishing in the 17th century added valuable export merchandize to the rich shallow seas surrounding the islands of Southeast Asia. This enabled local communities to become part of large trading networks and greatly supported their economic development. In this article, we follow Makassan trepang fishing and trading from its beginning until the industrialization of the fishery and worldwide depletion of sea cucumbers in the 20th century. Thereby, we identify a number of characteristics which trepang fishing shares with the exploitation of other marine resources, including (1) a strong influence of international markets, (2) the role of patron-client relationships which heavily influence the resource selection, and (3) the roving-bandit-syndrome, where fishermen exploit local stocks of valuable resources until they are depleted, and then move to another area. We suggest that understanding the similarities and differences between historical and recent exploitation of marine resources is an important step towards effective management solutions

Pre-Existing Isoniazid Resistance, but Not the Genotype of Mycobacterium Tuberculosis Drives Rifampicin Resistance Codon Preference in Vitro

Both the probability of a mutation occurring and the ability of the mutant to persist will influence the distribution of mutants that arise in a population. We studied the interaction of these factors for the in vitro selection of rifampicin (RIF)-resistant mutants of Mycobacterium tuberculosis. We characterised two series of spontaneous RIF-resistant in vitro mutants from isoniazid (INH)-sensitive and -resistant laboratory strains and clinical isolates, representing various M. tuberculosis genotypes. The first series were selected from multiple parallel 1 ml cultures and the second from single 10 ml cultures. RIF-resistant mutants were screened by Multiplex Ligation-dependent Probe Amplification (MLPA) or by sequencing the rpoB gene. For all strains the mutation rate for RIF resistance was determined with a fluctuation assay. The most striking observation was a shift towards rpoB-S531L (TCG→TTG) mutations in a panel of laboratory-generated INH-resistant mutants selected from the 10-ml cultures (p<0.001). All tested strains showed similar mutation rates (1.33×10−8 to 2.49×10−7) except one of the laboratory-generated INH mutants with a mutation rate measured at 5.71×10−7, more than 10 times higher than that of the INH susceptible parental strain (5.46–7.44×10−8). No significant, systematic difference in the spectrum of rpoB-mutations between strains of different genotypes was observed. The dramatic shift towards rpoB-S531L in our INH-resistant laboratory mutants suggests that the relative fitness of resistant mutants can dramatically impact the distribution of (subsequent) mutations that accumulate in a M. tuberculosis population, at least in vitro. We conclude that, against specific genetic backgrounds, certain resistance mutations are particularly likely to spread. Molecular screening for these (combinations of) mutations in clinical isolates could rapidly identify these particular pathogenic strains. We therefore recommend that isolates are screened for the distribution of resistance mutations, especially in regions that are highly endemic for (multi)drug resistant tuberculosis