Multidrug-Resistant Tuberculosis Treatment Outcomes in Karakalpakstan, Uzbekistan: Treatment Complexity and XDR-TB among Treatment Failures

BACKGROUND: A pilot programme to treat multidrug-resistant TB (MDR-TB) was implemented in Karakalpakstan, Uzbekistan in 2003. This region has particularly high levels of MDR-TB, with 13% and 40% among new and previously treated cases, respectively. METHODOLOGY: This study describes the treatment process and outcomes for the first cohort of patients enrolled in the programme, between October 2003 and January 2005. Confirmed MDR-TB cases were treated with an individualised, second-line drug regimen based on drug susceptibility test results, while suspected MDR-TB cases were treated with a standardised regimen pending susceptibility results. PRINCIPAL FINDINGS: Of 108 MDR-TB patients, 87 were started on treatment during the study period. Of these, 33 (38%) were infected with strains resistant to at least one second-line drug at baseline, but none had initial ofloxacin resistance. Treatment was successful for 54 (62%) patients, with 13 (15%) dying during treatment, 12 (14%) defaulting and 8 (8%) failing treatment. Poor clinical condition and baseline second-line resistance contributed to treatment failure or death. Treatment regimens were changed in 71 (82%) patients due to severe adverse events or drug resistance. Adverse events were most commonly attributed to cycloserine, ethionamide and p-aminosalicylic acid. Extensively drug resistant TB (XDR-TB) was found among 4 of the 6 patients who failed treatment and were still alive in November 2006. CONCLUSIONS: While acceptable treatment success was achieved, the complexity of treatment and the development of XDR-TB among treatment failures are important issues to be addressed when considering scaling up MDR-TB treatment

Prenatal exposure to organochlorine compounds and neonatal thyroid stimulating hormone levels.

It has been suggested that prenatal exposure to some organochlorine compounds (OCs) may adversely affect thyroid function and may, therefore, impair neurodevelopment. The main aim of this study was to examine the relationship of cord serum levels of 1,1,1-trichloro-2,2-bis(4-chlorophenyl)ethane (4,4'-DDT), 1,1-dichloro-2,2-bis(4-chlorophenyl)ethylene (4,4'-DDE), β-hexachlorocyclohexane (β-HCH), hexachlorobenzene (HCB), four individual polychlorobiphenyl (PCB) congeners (118, 138, 153, and 180), and their sum, with neonatal thyroid stimulating hormone (TSH) levels in blood samples in a mother-infant cohort in Valencia, Spain. This study included 453 infants born between 2004 and 2006. We measured OC concentrations in umbilical cord serum and TSH in blood of newborns shortly after birth. Associations between neonatal TSH levels and prenatal OC exposure adjusted for covariates were assessed using multivariate linear regression analyses. Neonatal TSH levels tended to be higher in newborns with β-HCH levels in umbilical cord above 90th percentile (104 ng/g lipid) than in those with levels below the median (34 ng/g lipid), with an adjusted increment in neonatal TSH levels of 21% (95% confidence interval=-3, 51; P=0.09). No statistically significant association was found between the remaining OCs and TSH at birth. Prenatal exposure to β-HCH may affect neonatal thyroid hormone status and its function in neurological development

Climate Change and the Risk of Desertification with a Focus in the United States

The rapidly intensifying climate change is an impending threat to mankind. Rising temperatures over the past century have resulted in more frequent and intense droughts and increased dust activity. North Africa is major hub of dust generation followed by central Asia and China. The source of dust is not only the local droughts, but it is also transported over long distances. Dust can significantly impact health of exposed population. While PM10 is inhalable, PM2.5 can penetrate the epithelium and sit in the tissues and PM1.0 can enter systemic circulation translocating to different organs. Dust exposure has been implicated in increased incidence and exacerbation of cardiopulmonary conditions including, pneumonia, pro-thrombotic state, and myocardial ischemia. Chronic exposure is associated with condition including silicosis, asthma, cognitive decline, Alzheimer’s disease, and arsenic toxicity. Dust exposure is also associated with spikes in endemic infections including valley fever in the United States, meningitis in North Africa, and tuberculosis in India. African dust activity has been observed to accelerate algal blooms on the southeast coast of the United States, causing harm to marine and human life. In summary, the health effects of dust are far and wide in time and distance and significantly affect the health of exposed population

Insecticide use: Contexts and ecological consequences

Constraints to the sustainability of insecticide use include effects on human health, agroecosystems (e.g., beneficial insects), the wider environment (e.g., non-target species, landscapes and communities) and the selection of insecticide-resistant traits. It is possible to find examples where insecticides have impacted disastrously on all these variables and others where the hazards posed have been (through accident or design) ameliorated. In this review, we examine what can currently be surmised about the direct and indirect long-term, field impacts of insecticides upon the environment. We detail specific examples, describe current insecticide use patterns, consider the contexts within which insecticide use occurs and discuss the role of regulation and legislation in reducing risk. We consider how insecticide use is changing in response to increasing environmental awareness and inevitably, as we discuss the main constraints to insecticide use, we suggest why they cannot easily be discarded