50 research outputs found
Misdiagnosis and clinical significance of non-tuberculous mycobacteria in Western Kenya in the era of human immunodeficiency virus epidemic
Objectives: To determine and document the role of non-tuberculous mycobacteria (NTM) in TB-like disease morbidity and demonstrate the confusion they cause in the diagnosis of TB in western Kenya.Design: A cross-sectional study.Setting: One provincial and nine District hospitals in western Kenya.Subjects: Tuberculosis suspects.Interventions: Sputa from 872 tuberculosis suspects underwent microscopy and culture on solid and liquid media. The growth was identified using the Hain’s GenoType® Mycobacterium CM and GenoType® Mycobacterium AS kits. Consenting clients were screened for HIV infection using Trinity Biotech Uni-GoldTM test and positive cases were confirmed with the enzyme linked immunosorbent assay. A questionnaire was used to obtain demographic data.Main outcome measures: ZN smear positivity / negativity; Culture positivity or negativity; Mycobacterium species isolates (tuberculous or non-tuberculous); HIV status. Results: Sputa from 39.1% (341/872) of the participants were ZN smear positive, of these 53.1% (181/341) were culture positive. Only 3.8% (20/531) of the ZN smear negatives were culture positive. In total 41.4% (361/872) participants were infected with mycobacteria, of which 44.3% (160/361) were culture negative and 55.7% (201/361) were culture positive. The culture positives yielded 92.5% M. tuberculosis complexand 7.5% NTM. The overall prevalence of the NTM disease was 1.72% (15/872). Conclusion: A low prevalence of NT M pulmonary disease in western Kenya is reported in this study, but some the NTM disease cases could have been misdiagnosed as TB cases
A high rate of recurrent tuberculosis in western Kenya independent of human immunodeficiency virus infection
Background: Previous studies have shown that recurrent TB develops in about 2-5% of the patients after curative treatment with short-course anti-TB chemotherapy. With the advent of HIV/AIDS, the rate TB recurrence is anticipated to rise.
Objectives: To determine whether HIV infection and TB recurrence are associated with anti-TB drug resistance and the rates of ZN microscopy and culture positivity among the recurrent TB cases in western Kenya. Design and methods: A cross-sectional study was carried out between 2007 and 2009. Sputa from 872 tuberculosis suspects underwent mycobacteriologic evaluation using Ziehl Neelsen smear microscopy, LowensteinJensen and BACTEC MGIT 960 culturing, and Hain’s GenoType® Mycobacterium CM and GenoType® Mycobacterium AS molecular identification tests. Consenting participants were screened for HIV infection using Uni-Gold TM test and positives were confirmed with the enzyme linked immunosorbent assay.
Results: In total, 361/872 (41%) of the suspects mycobacterial disease (346 TB, 4.2% non-tuberculous mycobacterial disease). HIV testing was accepted by 695 (79.7%) and 39.1% of these (272/695) were found positive. Recurrence of TB constituted 44.8% (155/346) of the TB cases, with 41.9% (65/155) of them co-infected with HIV. There was nosignificant difference in TB recurrence rates with HIV status [OR = 0.57; 95% CI: 0.29-1.13; P = 0.10].
Conclusions and recommendations: This study reports a much higher (44.8%) rate of recurrent TB, compared to that of National TB control Programme of 5% in 2008 and a combined retreatment rate of 14% in 2009. The HIV co-infection and TB recurrence were not associated with anti-TB drug resistance. The majority of TB recurrent cases were ZN smear negative (67.7%) and culture negative (80%). The high TB recurrence observed in this study calls for studies to determine the proportions of the disease attributable to endogenous re-activation (relapse) and exogenous re-infection.
Keywords: Recurrent tuberculosis; HIV co-infectio
Detection and Quantification of Oestrogenic Endocrine Disruptors in Water in Mwanza Gulf in the Lake Victoria Basin, Tanzania
The aim of this study was to detect the presence and quantify the total oestrogens (estriol (E1), estradiol (E2), and estrone (E3)) in Lake Victoria water with a view of assessing their contribution to the health status of fish. A total of 27 water samples; three from each of the nine sampling sites were collected in Mwanza gulf in the city in May 2012. Solvent extraction procedures were used to obtain extracts of pollutants that were further analysed using the competitive Enzyme- Linked Immunosorbent Assay (ELISA) technique to detect and quantify the total oestrogens. Overall, the concentration of total oestrogens was low and ranged from 10 – 200 pg/L. Concentrations of these chemicals decreased along the gradient, being highest (107±81.4 pg/L) in rivers before entering into the lake and lowest (19±5.4 pg/L) in water samples collected in the lake at about 100 meters from inshore (intermediate sampling points). Levels of total oestrogens were significantly different between categories of water sources (P = 0.009). Two most polluted rivers were Butimba and Nyakurunduma with concentrations at 150 pg/L and 200 pg/L respectively. Dumping of wastes in rivers without treatment was the most likely source of the pollutants. Findings from this study have revealed the existence of oestrogens with endocrine disrupting properties at different concentrations, and that rivers are the main sources of oestrogenic endocrine disruptors in Lake Victoria water near Mwanza City.Keywords: ELISA, endocrine disruptors, oestrogens, pollutio
Professional identity transitions, violations and reconciliations among new nurses in low- and middle-income countries
We examine how new nurses construct their professional identity in Low- and Middle-Income Countries (LMICs) when they enter clinical practice and encounter practical norms violating procedural standards. We conducted interviews and focus group discussions with 47 Kenyan nurses. We describe new nurses experiencing ‘shock’ entering nursing practice (working and learning alone while responsible for many patients and doing ‘dirty work’), which contrasted with their idealized image and expectations of nursing and prior training. We explain this transition using theory about identity and identity work, which we argue elucidates nurses' experiences in LMICs. We suggest that nurses' transition into clinical practice violated pre-existing expectations for their professional identities, which then triggered identity work of ‘toughening up’, ‘maturing through experience’, and ‘learning practical norms’. Through this identity work, and finally experiencing satisfaction from caring for and nursing patients back to health, some nurses were able to restore their valued professional identity
Orbital control of Pleistocene euxinia in Lake Magadi, Kenya
Lake Magadi is an internally drained, saline and alkaline terminal sump in the southern Kenya Rift. Geochemistry of samples from an ∼200 m core representing the past ∼1 m.y. ofthe lake’s history shows some of the highest concentrations of transition metals and metalloidsever reported from lacustrine sediment, including redox-sensitive elements molybdenum,arsenic, and vanadium. Elevated concentrations of these elements represent times when thelake’s hypolimnion was euxinic—that is, anoxic, saline, and sulfide-rich. Euxinia was commonafter ca. 700 ka, and after that tended to occur during intervals of high orbital eccentricity.These were likely times when high-frequency hydrologic changes favored repeatedepisodes of euxinia and sulfide precipitation. High-amplitude environmental fluctuations atpeak eccentricity likely impacted water balance in terrestrial habitats and resource availabilityfor early hominins. These are associated with important events in human evolution,including the first appearance of Middle Stone Age technology between ca
The Hominin Sites and Paleolakes Drilling Project:Inferring the environmental context of human evolution from eastern African rift lake deposits
Funding for the HSPDP has been provided by ICDP, NSF (grants EAR-1123942, BCS-1241859, and EAR-1338553), NERC (grant NE/K014560/1), DFG priority program SPP 1006, DFG-CRC-806 “Our way to Europe”, the University of Cologne (Germany), the Hong Kong Research Grants Council (grant no. HKBU201912), the Peter Buck Fund for Human Origins Research (Smithsonian), the William H. Donner Foundation, the Ruth and Vernon Taylor Foundation, Whitney and Betty MacMillan, and the Smithsonian’s Human Origins Program.The role that climate and environmental history may have played in influencing human evolution has been the focus of considerable interest and controversy among paleoanthropologists for decades. Prior attempts to understand the environmental history side of this equation have centered around the study of outcrop sediments and fossils adjacent to where fossil hominins (ancestors or close relatives of modern humans) are found, or from the study of deep sea drill cores. However, outcrop sediments are often highly weathered and thus are unsuitable for some types of paleoclimatic records, and deep sea core records come from long distances away from the actual fossil and stone tool remains. The Hominin Sites and Paleolakes Drilling Project (HSPDP) was developed to address these issues. The project has focused its efforts on the eastern African Rift Valley, where much of the evidence for early hominins has been recovered. We have collected about 2 km of sediment drill core from six basins in Kenya and Ethiopia, in lake deposits immediately adjacent to important fossil hominin and archaeological sites. Collectively these cores cover in time many of the key transitions and critical intervals in human evolutionary history over the last 4 Ma, such as the earliest stone tools, the origin of our own genus Homo, and the earliest anatomically modern Homo sapiens. Here we document the initial field, physical property, and core description results of the 2012–2014 HSPDP coring campaign.Publisher PDFPeer reviewe
Corrigendum: What's Normal? Microbiomes in Human Milk and Infant Feces Are Related to Each Other but Vary Geographically: The INSPIRE Study
A correction has been made to the Materials and Methods section, subsection Extraction of DNA fromMilk, paragraph 2, The authors apologize for this error and state that this does not change the scientific conclusions of the article in any way. The original article has been updated
Human milk immune factors, maternal nutritional status, and infant sex: The INSPIRE study
Breastfeeding is an energetically costly and intense form of human parental investment, providing sole-source nutrition in early infancy and bioactive components, including immune factors. Given the energetic cost of lactation, milk factors may be subject to tradeoffs, and variation in concentrations have been explored utilizing the Trivers-Willard hypothesis. As human milk immune factors are critical to developing immune system and protect infants against pathogens, we tested whether concentrations of milk immune factors (IgA, IgM, IgG, EGF, TGFβ2, and IL-10) vary in response to infant sex and maternal condition (proxied by maternal diet diversity [DD] and body mass index [BMI]) as posited in the Trivers-Willard hypothesis and consider the application of the hypothesis to milk composition.This study is supported with funds from the National Science Foundation's INSPIRE Track 1 Grant: What is Normal Milk? Sociocultural, Evolutionary, Environmental, and Microbial Aspects of Human Milk Composition (Award #1344288), National Institutes of Health NICHD R01 HD092297 and the US Department of Agriculture National Institute of Food and Agriculture, Hatch project IDA01643 and in-kind donations from Medela. We sincerely thank the Washington State University Health Equity Center for their support. Additionally, we thank Andrew Doel (Medical Research Council Unit, The Gambia) for field supervision and logistics planning and Alansan Sey for questionnaire administration and taking anthropometric measurements in The Gambia; Jane Odei (University of Ghana) for supervising field data collection in Ghana; Haile Belachew (Hawassa University), and Birhanu Sintayehu for planning and logistics and the administration and staff at Adare Hospital in Hawassa for assistance with logistics in Ethiopia; Catherine O. Sarange (Egerton University) for field supervision and logistics planning and Milka W. Churuge and Minne M. Gachau for recruiting, questionnaire administration, and taking anthropometric measurements in Kenya; Gisella Barbagelatta (Instituto de Investigación Nutricional) for field supervision and logistics planning, Patricia Calderon (Instituto de Investigación Nutricional) for recruiting, questionnaire administration, and taking anthropometric measurements, and Roxana Barrutia (Instituto de Investigación Nutricional) for the management and shipping of samples in Peru; Leónides Fernández, Cristina García-Carral and Irene Espinosa (Complutense University of Madrid) for technical assistance and expertise, and M. Ángeles Checa (Zaragoza, Spain), Katalina Legarra (Guernica, Spain), and Julia Mínguez (Huesca, Spain) for participation in the collection of samples in Spain; Kirsti Kaski and Maije Sjöstrand (both Helsingborg Hospital) for participation in the collection of samples, questionnaire administration, and anthropometric measurements in Sweden; Renee Bridge and Kara Sunderland (both University of California, San Diego); Janae Carrothers and Shelby Hix (Washington State University) for logistics planning, recruiting, questionnaire administration, sample collection, and taking anthropometric measurements in California and Washington; Glenn Miller (Washington State University) for his expertise and critical logistic help that were needed for shipping samples and supplies worldwide.Peer reviewe
What's Normal? Microbiomes in Human Milk and Infant Feces Are Related to Each Other but Vary Geographically: The INSPIRE Study
Background: Microbial communities in human milk and those in feces from breastfed infants vary within and across populations. However, few researchers have conducted cross-cultural comparisons between populations, and little is known about whether certain “core” taxa occur normally within or between populations and whether variation in milk microbiome is related to variation in infant fecal microbiome. The purpose of this study was to describe microbiomes of milk produced by relatively healthy women living at diverse international sites and compare these to the fecal microbiomes of their relatively healthy infants. Methods: We analyzed milk (n = 394) and infant feces (n = 377) collected from mother/infant dyads living in 11 international sites (2 each in Ethiopia, The Gambia, and the US; 1 each in Ghana, Kenya, Peru, Spain, and Sweden). The V1-V3 region of the bacterial 16S rRNA gene was sequenced to characterize and compare microbial communities within and among cohorts. Results: Core genera in feces were Streptococcus, Escherichia/Shigella, and Veillonella, and in milk were Streptococcus and Staphylococcus, although substantial variability existed within and across cohorts. For instance, relative abundance of Lactobacillus was highest in feces from rural Ethiopia and The Gambia, and lowest in feces from Peru, Spain, Sweden, and the US; Rhizobium was relatively more abundant in milk produced by women in rural Ethiopia than all other cohorts. Bacterial diversity also varied among cohorts. For example, Shannon diversity was higher in feces from Kenya than Ghana and US-California, and higher in rural Ethiopian than Ghana, Peru, Spain, Sweden, and US-California. There were limited associations between individual genera in milk and feces, but community-level analyses suggest strong, positive associations between the complex communities in these sample types. Conclusions: Our data provide additional evidence of within- and among-population differences in milk and infant fecal bacterial community membership and diversity and support for a relationship between the bacterial communities in milk and those of the recipient infant's feces. Additional research is needed to understand environmental, behavioral, and genetic factors driving this variation and association, as well as its significance for acute and chronic maternal and infant health