Factors associated with pastoral community knowledge and occurrence of mycobacterial infections in human-animal interface areas of Nakasongola and Mubende districts, Uganda

<p>Abstract</p> <p>Background</p> <p>Nontuberculous mycobacteria (NTM) are emerging opportunistic pathogens whose role in human and animal disease is increasingly being recognized. Major concerns are their role as opportunistic pathogens in HIV/AIDS infections. The role of open natural water sources as source and livestock/wildlife as reservoirs of infections to man are well documented. This presents a health challenge to the pastoral systems in Africa that rely mostly on open natural water sources to meet livestock and human needs. Recent study in the pastoral areas of Uganda showed infections with same genotypes of NTM in pastoralists and their livestock. The aim of this study was to determine the environmental, animal husbandry and socio-demographic factors associated with occurrence and the pastoral community knowledge of mycobacterial infections at the human-environment-livestock/wildlife interface (HELI) areas in pastoral ecosystems of Uganda.</p> <p>Methods</p> <p>Two hundred and fifty three (253) individuals were subjected to a questionnaire survey across the study districts of Nakasongola and Mubende. Data were analyzed using descriptive statistics and multivariable logistic regression analysis.</p> <p>Results</p> <p>Humans sharing of the water sources with wild animals from the forest compared to savannah ecosystem (OR = 3.3), the tribe of herding pastoral community (OR = 7.9), number of rooms present in household (3-5 vs. 1-2 rooms) (OR = 3.3) were the socio-demographic factors that influenced the level of knowledge on mycobacterial infections among the pastoral communities. Tribe (OR = 6.4), use of spring vs. stream water for domestic use (OR = 4.5), presence of sediments in household water receptacle (OR = 2.32), non separation of water containers for drinking and domestic use (OR = 2.46), sharing of drinking water sources with wild animals (OR = 2.1), duration of involvement of >5 yrs in cattle keeping (OR = 3.7) and distance of household to animal night shelters (>20 meters) (OR = 3.8) were significant socio-demographic factors associated with the risk of occurrence of mycobacterioses among the pastoral communities in Uganda.</p> <p>Conclusion</p> <p>The socio-demographic, environmental and household related factors influence the risk of occurrence as well as pastoralists' knowledge of mycobacterial infections in the pastoral households at the human-environment-livestock/wildlife pastoral interface areas of Uganda.</p

Proposed Nonparametric Tests for the Simple Tree Alternative in a Mixed Design

For the general alternative, many test statistics exist for the dependent and independent variables. However, no documented test statistics exist for simple tree alternative for the dependent variables, independent variables, and mixed designs that consider both dependent and independent variables. This research proposes six nonparametric test statistics when we have a mixed design that consists of observations from a Randomized Complete Block Design (RCBD) and a Completely Randomized Design (CRD). A simulation was conducted to compare the proposed test statistics under five conditions: changing number of treatments, varying the underlying distribution, increasing the variance between the RCBD and CRD, changing the proportions of the RCBD portion to the CRD, and changing the shifts configurations for the treatment effects. The simulation results indicate that Approach II and Approach VI had the highest powers overall. Approach II is when equal weight √ is assigned to the standardized modified Fligner-Wolfe and standardized modified Page’s test statistic. While, Approach VI is when more weight, attributed to the sample size is assigned to the standardized modified Fligner-Wolfe, the CRD portion and less weight attributed to small number of blocks is assigned to the standardized modified Page’s test statistic, which is the RCBD portion of the mixed design. It was noted that, when the sample size was greater than the number of blocks and the RCBD and CRD variances are equal, Approach VI had the highest powers. On the other hand, when the variance in the CRD was greater than the variance of RCBD, Approach II had the highest powers. Also, when the number of blocks for the RCBD portion is greater than the sample size for the CRD portion in the mixed design, Approach II had the highest powers when the variance in the CRD portion was equal to the variance in the RCBD portion. On the other hand, when the variance in the CRD portion was greater than the variance in the RCBD portion Approach VI had the highest powers

Proposed Nonparametric Tests for the Simple Tree Alternative in a Mixed Design

Video summarizing Ph.D. dissertation for a non-specialist audience

Cost effectiveness of medtronic carelink express device usage in emergency department

BACKGROUND: Patients with Medtronic devices presenting to emergency department (ED) need interrogation of the device. Manual interrogation via on-call personnel may take time, increase direct cost to the patient and increase the overflow in the ED. CareLink Express (CLE) technology allows automatic interrogation in the ED that will be interpreted instantly electronically. OBJECTIVE: Direct cost effectiveness to patients using this new technology was evaluated. METHODS: In 12 months there were 147 consecutive patients with Medtronic devices (61-84 years old, 62.3% males) who came to ED for interrogation. The first 6 months, the patients were interrogated via traditional method (60 patients). The following 6 months, CLE was used (54 patients). Demographics, comorbidities, diagnosis, device findings, admission, reprogramming, length of stay (LOS) in ED, cost and follow-ups were compared between the groups. RESULTS: Demographics were similar between groups. Comorbidities including chronic kidney disease, diabetes, hypertension, dyslipidemia, congestive heart failure, coronary artery disease and history of coronary artery bypass grafting also were similar. There was no difference in diagnosis category. Both groups had similar device interrogation findings (64.5% vs. 72.1% normal, p=0.33). The use of CLE did not affect the decision for hospital admission (45.6% vs. 53.2%, p=0.36), nor rate of reprogramming (7.4% vs. 13.9%, p=0.2). Median follow-up with out-patient cardiology clinic was the same in both groups (23 vs. 33 days, p=0.35). The use of CLE significantly shortened the LOS in ED (185.2±63.1 vs. 229.8±81.7 min, p CONCLUSIONS: CareLink Express facilitates shorter LOS in the ED for patients with Medtronic devices with significant cost effectiveness to the patient without compromising the decision for disposition or follow-up

Inappropriate usage of selected antimicrobials: Comparative residue proportions in rural and urban beef in Uganda.

IntroductionIn most developing countries like Uganda, antimicrobials including β-lactams and tetracyclines are used indiscriminately in livestock. When livestock get sick and treatment is necessary, some producers and veterinarians use these drugs with minimal controls to prevent residues from occurring in the beef sent to markets. This study was done to determine the presence of drug residues above acceptable limits of two commonly used antimicrobials in Uganda's rural and urban beef.MethodsA cross-sectional study was conducted of 134 cattle carcasses from eight different slaughter slabs over twelve weeks. This study entailed 81 samples of rural and 53 samples of urban origin. To enable detailed analysis these samples were categorized according to age (maturity), breed, and sex. For each of the 134 carcasses, three samples of liver, kidney and muscle were taken and homogeneously mixed into one sample, which was tested for β-lactam and tetracycline drug residues.ResultsThe results were statistically significant for β-lactam levels (χ2 = 22.10, df = 10, p = 0.0146) with average concentration (μg/kg) of 2.93:29.3 (rural: urban), though not for tetracycline levels (χ2 = 3.594, df = 10, P = 0.9638) with average concentration (μg/kg) of 5.028:12.83 (rural: urban). Age (maturity) had significant effect at all values of antibiotic level (F(1, 68) = 5.06, p = 0.0278). Age effect was extremely significant (F(1, 68) = 15.51, p = 0.0002).ConclusionA significant difference existed in drug residue proportions of β-lactam and tetracycline antimicrobials among Uganda's rural and urban beef. A significant difference also occured in drug residue proportions of these two commonly used antimicrobials related to age (maturity), but neither breed, nor sex, of Uganda's rural and urban beef

Myocardial Work Index: A Novel Method for Assessment of Myocardial Function in South Asian Recreational Athletes

Purpose: We used a novel noninvasive method based on speckle-tracking echocardiography to evaluate myocardial performance in South Asian recreational athletes who completed a half marathon. Methods: Transthoracic echocardiography was performed on 24 recreational athletes 48 hours before they took part in a half marathon (premarathon), within 2 hours of half marathon completion (postmarathon), and 72 hours after completion. Clinical, laboratory, and echocardiographic variables were collected. Speckle-tracking echocardiography was performed in all subjects to characterize myocardial mechanics. Results: Mean age of participants was 41.8 ± 7.4 years, and 23 (95.8%) were male. No subject had a prior history of coronary artery disease. Significant changes in pre- and postmarathon values suggested myocardial injury, including an increase in mean brain natriuretic peptide (BNP), an increase in left atrial volume, and an overall reduction in peak left ventricular global longitudinal strain. All subjects had a similar value of global work index, the average myocardial work, premarathon. Global work index did not change in 11 patients (Group 1), and global work index increased in 13 patients (Group 2) immediately postmarathon. Group 2 patients were noted to have higher heart rate, lower end-diastolic and end-systolic volumes, and higher BNP levels, suggesting myocardial stress. Conclusions: South Asian athletes completing a half marathon exhibited two different responses to the cardiac stress of the half marathon, as outlined by the use of myocardial work indices, a novel method for assessing cardiac performance

Comparative study on catheter directed thrombolysis – continuous tissue plasminogen activator vs angiojet catheter power pulse spray rheolytic thrombectomy outcome study – single-center experience

BACKGROUND: Acute arterial occlusion of native and graft vessels has a variety of treatment options, including catheter-directed thrombolysis (CDT), power pulse spray with rheolytic thrombectomy (PPSRT) and surgery. We studied acute limb ischemia (ALI) outcomes with CDT vs PPSRT with adjunctive CDT as crossover at a tertiary care center. METHODS: We undertook a comprehensive retrospective analysis of ALI (onset) patients treated with CDT (Group 1) and PPSRT with adjunctive CDT as crossover (Group 2). Data were collected from electronic medical records and billing codes. Continuous variables were expressed as mean ± standard deviation and range, and categorical variables as frequency and percentage. Differences between the groups were analyzed with t-tests or analysis of variance and chi-square or Fisher\u27s exact test. RESULTS:A total of 243 patients admitted for ALI were divided into Group 1 (n=165, 68%; mean age 67.3±13.8, females 48.5%) and Group 2 (n=78, 32%; mean age 68.5±14.4, females 53.8%). Based on propensity-matched comparison, there was less preprocedure tissue loss in Group 1 than Group 2 (5.5% vs 11%, p=0.022 [OR 0.35; 95% CI, 0.14-0.89]). Acute Rutherford IIa (26% vs 41%) and IIb (57% vs 36%) with p=0.059 were not statistically significant. Achieving complete lysis \u3e95% (72% vs 83%, p=0.134) was not statistically different between the two groups. Major bleeding (21% vs 9%, p=0.029 [OR 2.56; 95% CI, 1.08-6.07]), post-lysis 30-day embolectomy (16% vs 5%, p=0.017 [OR 3.52; 95% CI 1.19-10.45]), 30-day compartment syndrome (9% vs 1%, p=0.042 [OR 6.95; 95% CI, 0.9-53.88]), length of hospitalization (7% vs 4%, p=0.0004) and time to lysis (24 hrs vs 3 hrs, p CONCLUSIONS: Although there was no difference in achieving complete lysis in CDT or PPSRT with adjunctive CDT, there was less major bleeding, post-lysis 30-day embolectomy and 30-day compartment syndrome, as well as shorter length of hospitalization and time to lysis in Group 2. These data support the utility of PPSRT with adjunctive CDT over CDT alone