Dietary intake of first- and third-year female dietetics students at a South African university

Objective: A survey was undertaken to evaluate and compare dietary intakes of first- and third-year female dietetics students. Design: This was a cross-sectional survey. Setting: The University of Pretoria (UP) was the site of the survey. Population: The study encompassed first- (2012–2015) and third- (2012–2017) year female dietetics students (N = 368). Outcome: Dietary intake data from multiple-day weighed food records were analysed on nutrient, food group and meal and snacking pattern levels. Results: Recorded energy intakes of participants (n = 105 first years, n = 166 third years; response rate: 73.6%) were below Estimated Energy Requirements. Across year groups, intakes exceeded and fell below the Acceptable Macronutrient Distribution Range for fat and carbohydrates respectively; however, third years consumed cereals, grains and starchy vegetables more often. Over 50% of first and third years exceeded Estimated Average Requirements of respectively 3 and 6 of 10 tested micronutrients. Third years recorded higher (all p < 0.001) intakes of protein, magnesium, calcium, zinc and vitamin A than first years. Similarly, their Nutrient Adequacy Ratios were higher (all p < 0.001) for magnesium, calcium and vitamins A, B6 and B12. Average Mean Adequacy Ratios were 70% (first years) and 77% (third years). The year groups differed in terms of food group intake. The number of daily eating occasions decreased over weekends for first and third year students, yet intakes of energy (p < 0.05) and fat (p < 0.001) were higher over weekends. Conclusions: Amidst likely under-recording and/or under-eating, UP female dietetics students’ intakes of some micronutrients may be low. Recorded intakes of third years exceeded those of first years. Recorded nutrient intake improved from the first to the third year of the study in dietetics students.https://www.tandfonline.com/journals/ojcn20Human NutritionStatistic

Diversity of Mycobacterium tuberculosis strains in Nairobi, Kenya

Setting: Tuberculosis (TB) patients attending 16 public health facilities in Nairobi, Kenya. Objective: To determine the Mycobacterium tuberculosis (M.tuberculosis) strain families circulating in Nairobi, Kenya. Methods: Sputum specimens from consecutive new and previously treated smear positive pulmonary TB patients were collected between February and August 2010 and cultured on Lowenstein9Jensen media. Spoligotyping was done on DNA extracted from the first isolate of each patient. The international spoligotype data base (SpolDB4) was used to group isolates into strain families. Results: Fourty seven different strain families were identified from 536 isolates. The principal groups were; CAS1_KILI 96/536 (17%), T1 69/536 (12%), Beijing 65/536 (12%), LAM9 46/536 (9% ), LAM3 &amp; S/Conversant 37/536 (7% ), LAM11_ZWE 26/536 (5%), CAS1_DELHI 24/536 (4%) and T2 24/536 (4%). Others identified and are found in the SpolDB4 were 113/536 (21%). A possible new M.tuberculosis strain family was identified with 21/536 (4%) isolates which was designated as Nairobi subtype. Others identified not previously included in the SpolDB4 accounted for 15/536 (3%). Conclusion: We found a diverse array of M.tuberculosis strain families which could be indicative of a cosmopolitant polulation with frequent migration that may suggest that the dorminant strain families may have been present in the population for an extended period of time or on going transmision of closely related strains families. The emergence of the Beijing strains poses a serious threat to TB control due to its high virulence and frequent association with multidrug resistance. We therefore call for strenghthening efforts on early case finding through enhanced public health education campains and provision of accessible diagnostic services with enhanced treatment compliance

Ethionamide cross-and co-resistance in children with isoniazid-resistant tuberculosis

BACKGROUND: Ethionamide (ETH) is a structural analogue of isoniazid (INH). Both are pro-drugs requiring activation by separate and common enzyme pathways, which could lead to co-and/or cross-resistance. OBJECTIVE: To characterise paediatric INH-resistant mycobacterial isolates to investigate the presence of ETH resistance and mutations in the katG gene and the inhA promoter region. METHODS: Forty-fi ve INH-resistant and 19 INHs usceptible Mycobacterium tuberculosis control isolates from children from the Western Cape Province, South Africa, were analysed to quantify INH minimal inhibitory concentration, test for ETH resistance and investigate mutations in the katG gene and/or inhA promoter region. RESULTS: Among 45 INH-resistant children, ETH resistance was present in 19 of 39 (49%). An inhA promoter mutation was identifi ed in 15 (33.3%); 12/14 (86%) of these isolates were also ETH-resistant. Of the 21 isolates with a katG mutation, six (29%) were ETH-resistant. No isolate had both katG and inhA promoter mutations. Nine (20%) isolates had neither inhA promoter nor katG mutations. Of 15 isolates with inhA promoter mutation, 14 (93%) displayed low-or intermediate-level INH resistance. Among the 19 INH-susceptible isolates, ETH resistance was present in 1/18 (6%) and none showed inhA or katG gene mutations. CONCLUSION: We found a high level of cross-and coresistance with ETH among INH-resistant M. tuberculosis isolates from children in this geographic area. © 2009 The Union.Articl

Drug susceptibility testing using molecular techniques can enhance tuberculosis diagnosis.

Sputum samples were collected from tuberculosis patients in a high tuberculosis incidence area in the Western Cape, South Africa. The aim of this study was to evaluate the performance and time to diagnosis of a genotypic drug susceptibility testing method. During June 2000 and November 2003, a total of 1,540 samples were sent for drug susceptibility testing (DST) to the national health laboratory services, and of those, a phenotypic DST result was obtained for 1,373 samples whereas a genotypic DST result was obtained for 1,301 of 1,540 samples. Performance-based calculations were done on 1,244 samples for which both a phenotypic and genotypic DST result was available. The reproducibility of the genotypic and phenotypic DST methods was 97% and 95%, respectively. The sensitivity and specificity of the genotypic DST method was 68% and 99% for Isoniazid and 87% and 99% for Rifampicin, respectively. Smear gradation was found to influence the performance of the genotypic DST method. The genotypic DST method gave accurate DST results for 75% of the samples within 20 days (range, 15-25), whereas the phenotypic DST results were only available for 75% of the samples after 38 days (range, 26-115) (p<0.001). Conclusion: This study showed that the genotypic DST could improve tuberculosis control by rapid diagnosis of drug resistant tuberculosis. This finding may have important implications for the control of drug resistant tuberculosis as it may reduce the chance for further transmission events.Articl

Sequence polymorphism in the rrs gene of Mycobacterium tuberculosis is deeply rooted within an evolutionary clade and is not associated with streptomycin resistance

A mutation (C-to-T transition) at position 491 of the rrs gene was identified in a Mycobacterium tuberculosis strain family (n = 208 isolates) that was predominant in a suburb of Cape Town, South Africa. This nucleotide change is not involved in streptomycin resistance, and we suggest caution in assuming that all mutations in genes targeted by antituberculosis drugs confer drug resistance.Articl

Ethambutol resistance testing by mutation detection

OBJECTIVE: To identify chromosomal mutations that confer resistance to ethambutol (EMB) in Mycobacterium tuberculosis. DESIGN: Drug-resistant (n = 235) and drug-susceptible (n = 117) M. tuberculosis isolates collected from the Western Cape in South Africa were subjected to embB gene analysis and the results were compared to phenotypic EMB testing. RESULTS: Genotypic analysis identified mutations at codon 306 of the embB gene in 20% (47/235) of the resistant isolates in comparison to only 1.7% (4/235) of those that were phenotypically resistant to EMB by the agar diffusion method. No gene mutations were detected in susceptible isolates. Phenotypic retesting in BACTEC demonstrated that the 47 genotypically resistant isolates were phenotypically resistant to EMB. This implies that 91.4% (43/47) of EMB resistance had been phenotypically missed by routine laboratory procedures. EMB resistance was closely linked to multidrug resistance (MDR); 87.2% (41/47) of the EMB-resistant isolates were resistant to both isoniazid and rifampicin. A newly developed one-step amplification refractory mutation system polymerase chain reaction (ARMS-PCR) method correctly detected the EMB-resistant genotype. CONCLUSION: Implementation of more accurate diagnosis of EMB resistance may enhance patient management in South Africa, as standardised treatment of MDR-TB with second-line drugs is currently dependent on the outcome of the EMB resistance test. © 2006 The Union.Articl