Screening for tuberculosis and testing for human immunodeficiency virus in Zambian prisons

Objective: To improve the Zambia Prisons Service's implementation of tuberculosis screening and human immunodeficiency virus (HIV) testing. Methods: For both tuberculosis and HIV, we implemented mass screening of inmates and community-based screening of those residing in encampments adjacent to prisons. We also established routine systems – with inmates as peer educators – for the screening of newly entered or symptomatic inmates. We improved infection control measures, increased diagnostic capacity and promoted awareness of tuberculosis in Zambia's prisons. Findings: In a period of 9 months, we screened 7638 individuals and diagnosed 409 new patients with tuberculosis. We tested 4879 individuals for HIV and diagnosed 564 cases of infection. An additional 625 individuals had previously been found to be HIV-positive. Including those already on tuberculosis treatment at the time of screening, the prevalence of tuberculosis recorded in the prisons and adjacent encampments – 6.4% (6428/100 000) – is 18 times the national prevalence estimate of 0.35%. Overall, 22.9% of the inmates and 13.8% of the encampment residents were HIV-positive. Conclusion: Both tuberculosis and HIV infection are common within Zambian prisons. We enhanced tuberculosis screening and improved the detection of tuberculosis and HIV in this setting. Our observations should be useful in the development of prison-based programmes for tuberculosis and HIV elsewhere

Co-infection with Pansensitive and Multidrug-Resistant Strains of Mycobacterium tuberculosis

We report a case of a 23-year-old HIV-negative man with multidrug-resistant Mycobacterium tuberculosis that became evident while he was being treated for M. tuberculosis that was sensitive to all first-line drugs. This case should alert clinicians to consider co-infection as a possible cause of recrudescent disease

Buruli Ulcer Recurrence, Benin

Access to high-quality treatment prevents Buruli ulcer recurrence

Clusters of Multidrug-Resistant Mycobacterium tuberculosis Cases, Europe

These case investigations may help identify routes of transmission

Worldwide Emergence of Extensively Drug-resistant Tuberculosis

Mycobacterium tuberculosis strains are becoming resistant to not only the most powerful first-line drugs but also many second-line drugs

Drug-resistant Mycobacterium tuberculosis in Estonia

Tuberculosis (TB) infection and disease patterns among different populations are extremely heterogeneous. This thesis explores mainly by microbiological methods the epidemiology of TB in Estonia. Through the work high rates of drug resistance were found. The first countrywide study carried out in 1994 ascertained that drug resistant TB, and particularly multidrugresistant TB (MDR-TB) is a serious problem for Estonia. Initial resistance to one or more of the drugs tested was 28%, with 10% being initially multidrug-resistant. Molecular typing with IS6110 RFLP has revealed that 29% of Estonian M. tuberculosis isolates belonged to the genetically closely related group of strains with a predominant IS6110 banding pattern. This isolates were classified by spoligotyping as Beijing genotype strains, widely found in Asia. The majority (87.5%) of all multidrug-resistant isolates and two thirds (67.2%) of all isolates with any drug resistance belonged to Beijing genotype family. The incidence of TB among health care workers (HCW) in Estonia was 1.5 to 3 times higher (mean 91/100 000/year) than in the general population. In a chest hospital the incidence was 30 to 90 times higher. The highest rate was observed among physicians. In addition, this work shows that nosocomial isolates of M. tuberculosis can often be MDR after MDR-TB becomes more common in the general population. More than one third (38%) of all M. tuberculosis isolates obtained from HCW were multidrug-resistant. The investigation of means by which drug resistance evolves among drugsusceptible M. tuberculosis strains during antiT13 treatment revealed that initially drugsusceptible M. tuberculosis does not always evolve drug resistance despite highly irregular and prolonged therapy. Yet, the remained susceptibility of M. tuberculosis does not grant treatment success. When advanced method of molecular typing is not employed, exogenous re-infection with drug resistant M. tuberculosis may be misinterpreted as creation of drug resistance. This work also encompass of our experience and knowledge on testing drug susceptibility of MDR M. tuberculosis isolates to second-line and alternative drugs. In Estonia, a standardized treatment regimen with up to 6 second-line drugs can be suggested for 2/3 of MDR-TB patients; for the remaining cases additional testing of an extended panel of drugs is required. The MDR M. tuberculosis clinical isolates with unusual kanamycin-resistant but arnikacin- susceptible phenotype were characterized by identification of mutations with-in the rrs gene. Mutation possible related to intermediate level of resistance to kanamycin, showing a thymine for cytosine substitution at the 16S rRNA position 516, has not previously been associated with kanamycin resistance in M. tuberculosis. To date, genetic methods fail to detect all clinically relevant levels of drug resistance to aminoglycosides. Consequently it is important to test antimicrobial susceptibility of resistant clinical isolates of M. tuberculosis by culture

Creating Streetscapes as a Component of Tartu Green Network

Bachelor’s thesis Curriculum of Environmental Planning and Landscape DesignThe aim is to create a sustainable, holistic solution for two sites on the banks of the river “Emajõgi” in Tartu. To harness the potential of urban space and contribute to the creation of a better green corridor. The work is based on interviews and analyses that provide the basis for the design proposal concept and the final solution. The result of the work will be a design proposal for two complex streetscapes in the city of Tartu. The resulting solution can be the basis for a real design project.Eesmärk on luua jätkusuutlik, terviklik lahendus kahele alale Tartu Emajõe kaldal. Kasutada linnaruumis olevat potentsiaali ja aidata kaasa sidusamate rohekoridoride tekkimisele. Töö aluseks on intervjuud ja analüüsid, mis annavad aluse disainiettepaneku kontseptsioonile ja lõplikule lahendusele. Töö tulemuseks on disainiettepanek kahe taskupargi rajamiseks Tartu kesklinna. Leitud lahendused on linnal edasise idee-arenduse käigus võimalik tänavate ümberehituse aluseks võtta

Tartu Ülikooli-Jaani kogudus aastatel 1995–2016: ajalugu ja inimesed

Töö eesmärgiks oli uurida Tartu Ülikooli-Jaani koguduse ajalugu ja koguduses valitsevat vaimsust aastatel 1995–2016. Uurimistöös kasutati mitmesuguseid allikaid, sealhulgas arhiivimaterjale, erialakirjandust, perioodikat ja empiiriliselt kogutud materjali. Uurimistöös käsitles autor järgmisi aspekte: koguduste taasavamine ja ülesehitamine; koguduste jumalateenistused, ühinemisprotsess, õhustik ja usuline elu, kirikuruumi tajumine; kirikuhoone restaureerimine; tegevused, millesse koguduse liikmed olid kaasatud; põhjused, miks on inimesed kogudusega liitunud ja kogudusse jäänud; vaimuliku roll koguduse elus; koguduse juhtorganite roll koguduse elus; kultuurielu Tartu Jaani kirikus