A description of patients with recurrence of pulmonary tuberculosis in TB hospital, Ermelo

Thesis (MMed)--Stellenbosch University, 2015.South Africa is one of the high burden countries for TB in Sub Sahara in Africa with Mpumalanga as one of the provinces with a high burden of disease. Data available on tuberculosis in Msukaligwa indicate the following: Cure Rate 40%; Smear conversion at the end of intensive phase 35% and Defaulter Rate 27.5%. The problem of TB is made worse by the twin epidemic of HIV, with a prevalence of 38.9% in our district -the highest among the 3 districts in the province. Retreatment TB carries the risk of developing TB drug resistance with severe consequences for the patient and the population. Understanding the characteristics of these patients will help in designing interventions to prevent the problem, promote a high cure rate for patients with TB in our health care system and reduce to minimum the burden of re-treatment pulmonary TB on our health care facilities and community. One critical precondition for Retreatment TB is non adherence to TB treatment. Factors responsible for non adherence could be classified as individual patient factors; Co-morbid conditions; Health system; treatment related and Community factors. The outcomes of Retreatment TB could be, cure, and death and failure of treatment leading to drug resistance. The Setting of this study is the 58-bedded TB hospital in Ermelo. The Aim of the study was to describe the occurrence, characteristics and management outcome of Retreatment Pulmonary Tuberculosis in patients in the Ermelo TB hospital. The specific Objectives were to describe the socio-demographic, behavioural and clinical factors related to recurrence of the TB in patients; to determine the contribution of non adherence to treatment on recurrence of TB in the study population; to identify the prevalence of resistance to TB medication among patients with Retreatment TB ; to identify treatment outcomes in patients who have been followed up for the duration of Retreatment TB and finally to make recommendations to the Department of Health, Mpumalanga towards minimizing Retreatment TB and improving the overall TB programme. The Study design is cross sectional and descriptive; the study population comprised of patients admitted with TB at Ermelo TB hospital aged 15 years and older between 1 January 2005 and 31 December 2007.No specific probability sampling was applied in the selection of the patients. Data Collection involved visits to the TB hospital during the period and extracting the relevant information from the patient medical records and the TB register using a predesigned data collection form. Data analysis was done by the statistician from the Centre for Statistical Consultation, University of Stellenbosch. Being a descriptive study, the data analysis expresses the prevalence of various factors associated with retreatment TB. This study met the Ethical approval of the University of Stellenbosch as well as the Research Ethics Committee of the Department of Health & Social Services, Mpumalanga. Findings All the three hundred and eighty eight patient records with retreatment TB forming 19.6% of TB patients admitted between 2005 and 2007 were reviewed. The distributions of the patients were: males 66%; mean age of 41.4 years; females 34%; mean age 35.3 years. They were mostly unemployed; primary education 93%; unmarried 43% and married 34%.Retreatment TB was diagnosed with sputum smear microscopy in 71% with bacilli load of 3+ in 45%.The sources of referral to TB hospital were: public hospital 71 %; private doctors 2%. 74% of the patients have had TB 1-3 years before the episode under study. Retreatment TB categories were: after treatment completed 69%; default 19%; after cure 8% and treatment failure 4%. 98% of patients tested had +ve HIV status; the median CD4 cell count was 106 cells/µl at the time of retreatment; very few (5%) were on ART. Drug resistance to primary TB drugs was as follows: Rifampicin 16%; Isoniazid 29%; Ethambutol 19% and Streptomycin 23%. The treatment outcomes for those whom data were available were: successful 49.1%, death 23.8%; treatment default 22.9%. MDR-TB complicated 3.3% of the patients. Conclusion: Majority of the retreatment TB patients were males with an average age of 41years and unemployed. More than two thirds of the patient had completed TB treatment previously and default on treatment accounted for less than one quarter of retreatment categories. The process of care was better in terms of diagnosis of TB with sputum smear. Improvement in the documentation of key factors like smoking, alcohol, drug use among patients and co-morbidity as well as counselling and testing for HIV and provision of ARTs is required. Treatment outcomes with regards to successful outcome need to be monitored and improved upon.AFRIKAANSE OPSOMMING: Geen opsomming beskikbaa

Pre-existing virus-specific CD8+ T-cells provide protection against pneumovirus-induced disease in mice

Pneumoviruses such as pneumonia virus of mice (PVM), bovine respiratory syncytial virus (bRSV) or human (h)RSV are closely related pneumoviruses that cause severe respiratory disease in their respective hosts. It is well-known that T-cell responses are essential in pneumovirus clearance, but pneumovirus-specific T-cell responses also are important mediators of severe immunopathology. In this study we determined whether memory- or pre-existing, transferred virus-specific CD8 + T-cells provide protection against PVM-induced disease. We show that during infection with a sublethal dose of PVM, both natural killer (NK) cells and CD8 + T-cells expand relatively late. Induction of CD8 + T-cell memory against a single CD8 + T-cell epitope, by dendritic cell (DC)-peptide immunization, leads to partial protection against PVM challenge and prevents Th2 differentiation of PVM-induced CD4 T-cells. In addition, adoptively transferred PVM-specific CD8 + T-cells, covering the entire PVM-specific CD8 + T-cell repertoire, provide partial protection from PVM-induced disease. From these data we infer that antigen-specific memory CD8 + T-cells offer significant protection to PVM-induced disease. Thus, CD8 + T-cells, despite being a major cause of PVM-associated pathology during primary infection, may offer promising targets of a protective pneumovirus vaccine

Extreme Ultra-Violet Spectroscopy of the Lower Solar Atmosphere During Solar Flares

The extreme ultraviolet portion of the solar spectrum contains a wealth of diagnostic tools for probing the lower solar atmosphere in response to an injection of energy, particularly during the impulsive phase of solar flares. These include temperature and density sensitive line ratios, Doppler shifted emission lines and nonthermal broadening, abundance measurements, differential emission measure profiles, and continuum temperatures and energetics, among others. In this paper I shall review some of the advances made in recent years using these techniques, focusing primarily on studies that have utilized data from Hinode/EIS and SDO/EVE, while also providing some historical background and a summary of future spectroscopic instrumentation.Comment: 34 pages, 8 figures. Submitted to Solar Physics as part of the Topical Issue on Solar and Stellar Flare

Pneumocystis Pneumonia in HIV-positive Adults, Malawi1

In a prospective study of 660 HIV-positive Malawian adults, we diagnosed Pneumocystis jirovecii pneumonia (PcP) using clinical features, induced sputum for immunofluorescent staining, real-time PCR, and posttreatment follow-up. PcP incidence was highest in patients with the lowest CD4 counts but uncommon compared with incidences of pulmonary tuberculosis and bacterial pneumonia

Nash Equilibria in Discrete Routing Games with Convex Latency Functions

In a discrete routing game, each of n selfish users employs a mixed strategy to ship her (unsplittable) traffic over m parallel links. The (expected) latency on a link is determined by an arbitrary non-decreasing, non-constant and convex latency function φ. In a Nash equilibrium, each user alone is minimizing her (Expected) Individual Cost, which is the (expected) latency on the link she chooses. To evaluate Nash equilibria, we formulate Social Cost as the sum of the users ’ (Expected) Individual Costs. The Price of Anarchy is the worst-case ratio of Social Cost for a Nash equilibrium over the least possible Social Cost. A Nash equilibrium is pure if each user deterministically chooses a single link; a Nash equilibrium is fully mixed if each user chooses each link with non-zero probability. We obtain: For the case of identical users, the Social Cost of any Nash equilibrium is no more than the Social Cost of the fully mixed Nash equilibrium, which may exist only uniquely. Moreover, instances admitting a fully mixed Nash equilibrium enjoy an efficient characterization. For the case of identical users, we derive two upper bounds on the Price of Anarchy: For the case of identical links with a monomial latency function φ(x) = x d, the Price of Anarchy is the Bell number of order d + 1. For pure Nash equilibria, a generic upper bound from the Wardrop model can be transfered to discrete routing games. For polynomial latency functions with non-negative coefficients and degree d, this yields an upper bound of d + 1. For th

Primordialists and Constructionists: a typology of theories of religion

This article adopts categories from nationalism theory to classify theories of religion. Primordialist explanations are grounded in evolutionary psychology and emphasize the innate human demand for religion. Primordialists predict that religion does not decline in the modern era but will endure in perpetuity. Constructionist theories argue that religious demand is a human construct. Modernity initially energizes religion, but subsequently undermines it. Unpacking these ideal types is necessary in order to describe actual theorists of religion. Three distinctions within primordialism and constructionism are relevant. Namely those distinguishing: a) materialist from symbolist forms of constructionism; b) theories of origins from those pertaining to the reproduction of religion; and c) within reproduction, between theories of religious persistence and secularization. This typology helps to make sense of theories of religion by classifying them on the basis of their causal mechanisms, chronology and effects. In so doing, it opens up new sightlines for theory and research

Transfer Matrices and Partition-Function Zeros for Antiferromagnetic Potts Models. V. Further Results for the Square-Lattice Chromatic Polynomial

We derive some new structural results for the transfer matrix of square-lattice Potts models with free and cylindrical boundary conditions. In particular, we obtain explicit closed-form expressions for the dominant (at large |q|) diagonal entry in the transfer matrix, for arbitrary widths m, as the solution of a special one-dimensional polymer model. We also obtain the large-q expansion of the bulk and surface (resp. corner) free energies for the zero-temperature antiferromagnet (= chromatic polynomial) through order q^{-47} (resp. q^{-46}). Finally, we compute chromatic roots for strips of widths 9 <= m <= 12 with free boundary conditions and locate roughly the limiting curves.Comment: 111 pages (LaTeX2e). Includes tex file, three sty files, and 19 Postscript figures. Also included are Mathematica files data_CYL.m and data_FREE.m. Many changes from version 1: new material on series expansions and their analysis, and several proofs of previously conjectured results. Final version to be published in J. Stat. Phy

108 AUROTHIOMALATE INHIBITS COX-2 EXPRESSION AND PGE2 PRODUCTION IN CHONDROCYTES BY INCREASING MKP-1 EXPRESSION AND DECREASING p38 AND JNK PHOSPHORYLATION

The very high occurrence of cardiovascular events presents a major public health issue, because treatment remains suboptimal. Lowering LDL cholesterol (LDL-C) with statins or ezetimibe in combination with a statin reduces major adverse cardiovascular events. The cardiovascular risk reduction in relation to the absolute LDL-C reduction is linear for most interventions without evidence of attenuation or increase in risk at low LDL-C levels. Opportunities for innovation in dyslipidaemia treatment should address the substantial risk of lipid-associated cardiovascular events among patients optimally treated per guidelines but who cannot achieve LDL-C goals and who could benefit from additional LDL-C-lowering therapy or experience side effects of statins. Fresh approaches are needed to identify promising drug targets early and develop them efficiently. The Cardiovascular Round Table of the European Society of Cardiology (ESC) convened a workshop to discuss new lipid-lowering strategies for cardiovascular risk reduction. Opportunities to improve treatment approaches and the efficient study of new therapies were explored. Circulating biomarkers may not be fully reliable proxy indicators of the relationship between treatment effect and clinical outcome. Mendelian randomization studies may better inform development strategies and refine treatment targets before Phase 3. Trials should match the drug to appropriate lipid and patient profile, and guidelines may move towards a precision-based approach to individual patient management. Stakeholder collaboration is needed to ensure continued innovation and better international coordination of both regulatory aspects and guidelines. It should be noted that risk may also be addressed through increased attention to other risk factors such as smoking, hypertension, overweight, and inactivity

Formation and Evolution of Supermassive Black Holes

The correlation between the mass of supermassive black holes in galaxy nuclei and the mass of the galaxy spheroids or bulges (or more precisely their central velocity dispersion), suggests a common formation scenario for galaxies and their central black holes. The growth of bulges and black holes can commonly proceed through external gas accretion or hierarchical mergers, and are both related to starbursts. Internal dynamical processes control and regulate the rate of mass accretion. Self-regulation and feedback are the key of the correlation. It is possible that the growth of one component, either BH or bulge, takes over, breaking the correlation, as in Narrow Line Seyfert 1 objects. The formation of supermassive black holes can begin early in the universe, from the collapse of Population III, and then through gas accretion. The active black holes can then play a significant role in the re-ionization of the universe. The nuclear activity is now frequently invoked as a feedback to star formation in galaxies, and even more spectacularly in cooling flows. The growth of SMBH is certainly there self-regulated. SMBHs perturb their local environment, and the mergers of binary SMBHs help to heat and destroy central stellar cusps. The interpretation of the X-ray background yields important constraints on the history of AGN activity and obscuration, and the census of AGN at low and at high redshifts reveals the downsizing effect, already observed for star formation. History appears quite different for bright QSO and low-luminosity AGN: the first grow rapidly at high z, and their number density decreases then sharply, while the density of low-luminosity objects peaks more recently, and then decreases smoothly.Comment: 31 pages, 13 figures, review paper for Astrophysics Update

A measurement of the tau mass and the first CPT test with tau leptons

We measure the mass of the tau lepton to be 1775.1+-1.6(stat)+-1.0(syst.) MeV using tau pairs from Z0 decays. To test CPT invariance we compare the masses of the positively and negatively charged tau leptons. The relative mass difference is found to be smaller than 3.0 10^-3 at the 90% confidence level.Comment: 10 pages, 4 figures, Submitted to Phys. Letts.