Long Delays and Missed Opportunities in Diagnosing Smear-Positive Pulmonary Tuberculosis in Kampala, Uganda: A Cross-Sectional Study

BACKGROUND: Early detection and treatment of tuberculosis cases are the hallmark of successful tuberculosis control. We conducted a cross-sectional study at public primary health facilities in Kampala city, Uganda to quantify diagnostic delay among pulmonary tuberculosis (PTB) patients, assess associated factors, and describe trajectories of patients' health care seeking. METHODOLOGY/PRINCIPAL FINDINGS: Semi-structured interviews with new smear-positive PTB patients (≥ 15 years) registered for treatment. Between April 2007 and April 2008, 253 patients were studied. The median total delay was 8 weeks (IQR 4-12), median patient delay was 4 weeks (inter-quartile range [IQR] 1-8) and median health service delay was 4 weeks (IQR 2-8). Long total delay (>14 weeks) was observed for 61/253 (24.1%) of patients, long health service delay (>6 weeks) for 71/242 (29.3%) and long patient delay (>8 weeks) for 47/242 (19.4%). Patients who knew that TB was curable were less likely to have long total delay (adjusted Odds Ratio [aOR] 0.28; 95%CI 0.11-0.73) and long patient delay (aOR 0.36; 95%CI 0.13-0.97). Being female (aOR 1.98; 95%CI 1.06-3.71), staying for more than 5 years at current residence (aOR 2.24 95%CI 1.18-4.27) and having been tested for HIV before (aOR 3.72; 95%CI 1.42-9.75) was associated with long health service delay. Health service delay contributed 50% of the total delay. Ninety-one percent (231) of patients had visited one or more health care providers before they were diagnosed, for an average (median) of 4 visits (range 1-30). All but four patients had systemic symptoms by the time the diagnosis of TB was made. CONCLUSIONS/SIGNIFICANCE: Diagnostic delay among tuberculosis patients in Kampala is common and long. This reflects patients waiting too long before seeking care and health services waiting until systemic symptoms are present before examining sputum smears; this results in missed opportunities for diagnosis

Changes in the quality of fishburger produced from Tilapia ( Oreochromis niloticus ) during frozen storage (-18 degrees C)

In this study, the chemical and sensory qualities of fishburger produced from tilapia (Oreochromis niloticus) were investigated during frozen storage (-18 °C) over 8 months. The ratios of crude protein, lipid, moisture, crude ash, and polyunsaturated fatty acids in tilapiaburger were found to be 17.82%, 5.29%, 66.68%, 2.56% and 7.95% respectively. At the end of the study, the total volatile basic nitrogen value was found to have fluctuated throughout the storage periods. The highest thiobarbituric acid value was found at the 7th month as 0.142 mg malonaldehyde/kg. The peroxide value was 0.18 meq/kg at the beginning of the storage but increased to 5.03 meq/kg at 6th month of storage and then decreased to 0.82 meq/kg at the 8th month. The level of free fatty acids was 2.73% oleic acid at the beginning but reached 4.14% in the first month of storage and then increased to 5.92% at the end of the storage. pH values ranged between 8.01 and 7.97. At the end of the storage period, sensory quality criteria were scored as quite near those of the fresh samples. © Springer-Verlag 2004.Acknowledgements The authors are grateful to the Research Fund of ?ukurova University for financial support of this research project

Biotransformation of Seafood Processing Wastes Fermented with Natural Lactic Acid Bacteria; The Quality of Fermented Products and Their Use in Animal Feeding

WOS: 000402320900011Lactic acid bacteria species naturally present in fish (Streptococcus spp., Lactobacillus brevis, Lactobacillus plantarum, Pediococcus acidilactici and Enterococcus gallinarum) and formic acid were compared for production of fish silage, which are protein hydrolysates with immune stimulating properties. It is the first report for Enterococcus gallinarum to be used for producing fermented products. In this study, chemical and microbiological qualities of fish silage by acid or fermented methods were assessed after ripening of silages. It was observed that ripening was completed in maximum two weeks for all silage groups. Then, acid and fermented fish silage were spray dried and analysed for chemical and nutritional properties. As results of the study, these bacteria can be used as starter cultures in fermented products, especially for fish silage. In respect to essential/nonessential amino acid ratio (E/NE), the best groups among the spray-dried fish silages were prepared with formic acid, Lb. plantarum and Pd. acidilactici, respectively. Total antioxidant activity (TAO) of spray-dried fish silage was compared with ascorbic acid and TAO of spray-dried fish silages was found in range of 1.92-2.86 mg AA/g. The highest DPPH (diphenylpicrylhydrazyl) radical-scavenging ability of spray-dried fish silages was detected in AC group produced with Pediococcus acidilactici (20.26%) and GL group produced with Enterococcus gallinarum (16.95%), but there were no significant differences observed in other groups. According to the in-vitro gas production assessment, spray-dried fish silages generally had considerably high rate of digestibility. It was determined that the acid and fermented fish silage powders had high digestibility and valuable feed sources according to the results of the proximate analysis, amino acids compositions, total antioxidants, DPPH inhibition rates and in-vitro digestibility assessments.Scientific and Technological Research Council of Turkey [TUBITAK 213O166]This work was supported by The Scientific and Technological Research Council of Turkey (Project No: TUBITAK 213O166)

A comparison of the prophylactic uses of topical mupirocin and nitrofurazone in murine crush contaminated wounds

Objectives: This work was conducted to study the prophylactic efficacy of 2 topical antibiotic ointments (mupirocin and nitrofurazone) against wound infection in experimental contaminated crush wounds. Methods: Male Wistar rats underwent two 2-cm incisions at the back side and randomized into 3 groups-placebo (n = 14), mupirocin (n = 14), and nitrofurazone (n = 14)-and infected with either Staphylococcus aureus or S pyogenes. All wound edges were crushed for 5 seconds with hemostats to simulate crush injury before inoculation of the microorganisms. Half of the wounds were sutured and the other half left open. These wounds were treated 3 times daily for 6 days with topical mupirocin, nitrofurazone, or petrolatum (as placebo). At the end of 6 days, excisional biopsies were taken from wound edges and histopathologic assessments were made based on neutrophilic infiltration, edema formation, myofibroblastic proliferation, and granulation tissue formation. For the microbiologic assessments, quantitative tissue cultures were made. Results: In S aureus-inoculated wounds, mupirocin showed higher antibacterial activity against bacterial colonization and reduced infection rates compared to placebo groups. The same effect was observed for the infection rates in S pyogenes-inoculated wounds. In S pyogenes-inoculated open wounds, nitrofurazone showed higher antibacterial activity against infection, but this effect was not observed in closed wounds. In S pyogenes- and S aureus-infected wounds, mupirocin treatment significantly lowered infection rates compared to nitrofurazone treatment. Histopathologic examination showed higher myofibroblastic proliferation and higher volume of granulation tissue in the nitrofurazon groups compared to the mupirocin groups. Conclusion: Topical mupirocin application was effective against crush wound infections inoculated with S pyogenes and S aureus. Nitrofurazone provides better granulation tissue formation, but did not effectively prevent bacterial colonization and infection in crush contaminated wounds. © 2008 Elsevier Inc. All rights reserved

Comparison of disk diffusion, E-test and broth microdilution test in determination of susceptibility of Aspergillus species to amphotericin B, itraconazole and voriconazole

WOS: 000254066100013PubMed ID: 18343749In response to the recent increase in Aspergillus infections, new antifungal agents have become available accompanied by studies on antifungal susceptibility tests for epidemiological follow-up. The aim of this study was to compare the efficacy of Clinical Laboratory Standards Institute (CLSI) M 38-A broth microdilution test with the disk diffusion and E-test in determining the susceptibility of Aspergillus spp. to amphotericin B, itraconazole and voriconazole. The study was carried out on 18 A. fumigatus, 7 A. flavus, 5 A. niger and 2 A. versicolor strains isolated from clinical samples. The microdilution method was performed by following the instructions of CLSI M 38-A. The E-test and disk diffusion tests were performed according to the instructions of their manufacturers. The percent agreement between the E-test and CLSI M38-A broth microdilution test at 24 (48) h within +/- 2 dilutions was, respectively, 81% (69%) for amphotericin B, 75% (72%) for itraconazole and 85% (81%) for voriconazole. The disk diffusion test showed good correlation with the E-test but poor correlation with the broth microdilution test for the three antifungal agents we tested. In conclusion, E-test and disk diffusion test have their advantages such as ease of application and interpretation, but their correlation with the broth microdilution should be improved

Dual treatment of albendazole in hepatic hydatidosis: New therapeutic modality in 52 cases

Background: Hepatic hydatidosis still remains as a serious problem in general surgery. Recurrence and/or secondary hydatidosis rates are up to 25% in the cases treated with surgery alone. Albendazole is the most commonly used drug in the medical treatment of echinococcosis. The aim of the present study was to evaluate the effect of albendazole using the intraoperative and perioperative periods as dual therapy