need for continuing medical education for liver disease management in mongolia

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Low rates of screening and treatment of chronic hepatitis B, C, D (HBV, HCV, HDV), and hepatocellular carcinoma (HCC), associated barriers, and proposed solutions: results of a survey of physicians from all major provinces of Mongolia

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Identification of diarrheagenic Escherichia coli isolated from infants and children in Dar es Salaam, Tanzania

<p>Abstract</p> <p>Background</p> <p>Relatively few studies have been done in Tanzania to detect and classify diarrheagenic <it>Escherichia coli </it>(DEC) strains among children with diarrhea. This study aimed at investigating DEC among children in Dar es Salaam aged less than five years hospitalized due to acute/persistent diarrhea.</p> <p>Methods</p> <p>DEC were isolated from stool samples collected from two hundred and eighty children with acute/persistent diarrhea at Muhimbili National Hospital and Ilala and Mwananyamala Municipal Hospitals in Dar es Salaam. A multiplex PCR system method was used to detect a species specific gene for <it>E.coli </it>and ten different virulence genes for detection of five pathogroups of DEC namely enteroaggregative- (EAEC), enteropathogenic- (EPEC), enterotoxigenic- (ETEC), enteroinvasive- (EIEC) and enterohemorghagic- <it>Escherichia coli </it>(EHEC).</p> <p>Results</p> <p>Sixty-four patients (22.9%) harbored DEC. Forty-one of them (14.6%) were categorized as EAEC. Most of the EAEC (82.9%) were classified as typical EAEC possessing the <it>aggR </it>gene, and 92.6% carried the <it>aat </it>gene. Isolates from thirteen patients were EPEC (4.6%) and most of these (92.3%) were typical EPEC with both <it>eae </it>and <it>bfpA </it>genes. Ten isolates were identified as ETEC (3.6%) with only the heat stable toxin; either <it>st1a </it>or <it>st1b </it>but not both. Age wise, EAEC and EPEC were significantly more prevalent among the age group 0–6 months (p < 0.05). Genes for EHEC (<it>stx</it>₁and <it>stx</it>₂) and EIEC <it>(ial</it>) were not detected in this study group.</p> <p>Conclusion</p> <p>The results show a high proportion of DEC among Tanzanian children with diarrhea, with typical EAEC and typical EPEC predominating. The use of primers for both variants of ST1 (st1a and st1b) increased the sensitivity for detection of ETEC strains.</p

Genomic Characterization of Enteroaggregative Escherichia coli From Children in Mali

Background. Enteroaggregative Escherichia coli (EAEC) is a cause of epidemic and sporadic diarrhea, yet its role as an enteric pathogen is not fully understood

Rapid molecular testing for multi-resistant tuberculosis in Mongolia: A diagnostic accuracy study

Objective: The aim of this study was to assess the performance of a molecular line probe assay, GenoType® MTBDRplus, for rapid detection of rifampicin and isoniazid resistance in the Mongolian situation. The sensitivity and specificity of GenoType® MTBDRplus to detect rifampicin and isoniazid resistance-associated mutations in culture specimens and directly in smear-positive clinical specimens was examined. Method: 218 MDR-TB subjects aged between 14 and 75 years old from eight districts in Ulaanbaatar city (between July 2009 and May 2010) were included in this study .The GenoType Mycobacterium tuberculosis drug resistance first line (MTBDR plus) assay (Hain Life-science, Nehren, Germany) was tested on 109 clinical isolates and directly on 41 sputum specimens for the ability to detect the resistances. Results were compared with conventional culture and drug susceptibility testing on solid medium. Results: The high correlation of the results from GenoType® MTBDRplus and conventional drug susceptibility testing was obtained from this study. The results clearly showed a high performance of GenoType® MTBDRplus with almost 100% accuracy for all the important indicators, such as sensitivity, specificity, positive and negative predictive values and detection of rifampicin resistance. Discrepancies were obtained in comparison with DNA sequencing results. Conclusions: The Genotype174; MTBDRplus assay was demonstrated as a rapid, reliable and highly accurate tool for early detection of MDR-TB through examining smear positive cases

Low liver disease screening and treatment rates in Mongolia: results from a physician survey

This journal suppl. entitled: Conference Abstracts: 25th Annual Conference of APASL, February 20–24, 2016, Tokyo, JapanPoster Presentation: P-0307BACKGROUND: According to Globocan, Mongolia has the highest worldwide HCC incidence (78.1/100,000, 3.59 higher than China). It is unclear if screening and linkage to care for HBV, HCV, HDV, and HCC have been optimal. Our goal was to evaluate these screening rates, antiviral therapy utilization and barriers to care in Mongolia. METHODS: We conducted an anonymous survey of physicians from all major provinces who attended a 2-day CME liver symposium in Ulaanbaatar analyzing their demography, practice setting/patterns, perceptions, and proposed solutions. RESULTS: A total of 70–95 out of 121 (58–79 %) physician attendees responded to each question. Most were female (87 %), age50 (79 %), sub-specialists (76 %) and practiced in urban vs. rural areas (61 vs. 39 %). Most ([80 %) noted that50 % who need hepatitis or HCC screening receive it. The main perceived barriers to screening were inability to pay for diagnostic tests, lack of guidelines, and poor patient awareness (Figure 1). The major HCC screening barrier was also cost (37 %). Hepatitis treatment rates were low; 83 % treated HCV in10 patients in the past year and 86 % treated HBV in10 patients/month. Treatment barriers were multifactorial with medication cost as a principal barrier. Top proposed solutions were universal screening policies (46 %), removal of financial barriers (28 %), and provider education (20 %). CONCLUSIONS: Physicians from all major regions of Mongolia noted low screening for viral hepatitis (50 %) and even lower treatment rates ([80 % treated10 patients/year for HCV10 patients/month for HBV), and the need to remove financial barriers and increase educational efforts

Need for continuing medical education for liver disease management in Mongolia

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