Patterns of Orthopaedic Complications of Haemophilia at Khartoum Haemophilia Clinic

Background: Haemophilia is a common hereditary bleeding disorder caused by deficiency in clotting factor VIII (Type A) factor IX (Type B) with A:B 5:1. Severity of the disease depends on the level of the circulating factor. Bleeding tendency is the presenting feature and musculoskeletalinvolvement is a common presenting feature.Objectives: To study the demographic characteristics, clinical and radiological patterns of musculoskeletal disorders associated with haemophilia in patients presented to Khartoum Haemophilia Clinic (KHC).Patients and Methods: Demographic characteristics, patterns of clinical and radiological features of 78 patients with haemophilia A and B who presented to KHC, between March 2004 and June 2005 were analyzed.Results: There were 78 patients; all were males, their ages ranging between 1.5 and 50 years. 80% of them were either of preschool or school age groups. Haemophilia A: B was 4.5:1. Over 80% had articular involvement and the knee joint was involved in more than 50% of cases.Radiological findings were less severe in patients with haemophilia B, and were more severe in patients older than 30 years of age.Conclusion: We conclude that most of patients present with sequelae of recurrent musculoskeletal bleeds. Thus we observed that most of cases presented late with already destroyed joints. We recommend here to give treatment as prophylactic rather than on demand as it is now practiced asinevitable destruction of joints with repeated bleeds will be the presenting feature

Enhancing Dynamical Seasonal Predictions through Objective Regionalization

Improving seasonal forecasts in East Africa has great implications for food security and water resources planning in the region. Dynamically based seasonal forecast systems have much to contribute to this effort, as they have demonstrated ability to represent and, to some extent, predict large-scale atmospheric dynamics that drive interannual rainfall variability in East Africa. However, these global models often exhibit spatial biases in their placement of rainfall and rainfall anomalies within the region, which limits their direct applicability to forecast-based decision-making. This paper introduces a method that uses objective climate regionalization to improve the utility of dynamically based forecast-system predictions for East Africa. By breaking up the study area into regions that are homogenous in interannual precipitation variability, it is shown that models sometimes capture drivers of variability but misplace precipitation anomalies. These errors are evident in the pattern of homogenous regions in forecast systems relative to observation, indicating that forecasts can more meaningfully be applied at the scale of the analogous homogeneous climate region than as a direct forecast of the local grid cell. This regionalization approach was tested during the July– September (JAS) rain months, and results show an improvement in the predictions from version 4.5 of the Max Plank Institute for Meteorology’s atmosphere–ocean general circulation model (ECHAM4.5) for applicable areas of East Africa for the two test cases presented

Enhancing Dynamical Seasonal Predictions through Objective Regionalization

Improving seasonal forecasts in East Africa has great implications for food security and water resources planning in the region. Dynamically based seasonal forecast systems have much to contribute to this effort, as they have demonstrated ability to represent and, to some extent, predict large-scale atmospheric dynamics that drive interannual rainfall variability in East Africa. However, these global models often exhibit spatial biases in their placement of rainfall and rainfall anomalies within the region, which limits their direct applicability to forecast-based decision-making. This paper introduces a method that uses objective climate regionalization to improve the utility of dynamically based forecast-system predictions for East Africa. By breaking up the study area into regions that are homogenous in interannual precipitation variability, it is shown that models sometimes capture drivers of variability but misplace precipitation anomalies. These errors are evident in the pattern of homogenous regions in forecast systems relative to observation, indicating that forecasts can more meaningfully be applied at the scale of the analogous homogeneous climate region than as a direct forecast of the local grid cell. This regionalization approach was tested during the July– September (JAS) rain months, and results show an improvement in the predictions from version 4.5 of the Max Plank Institute for Meteorology’s atmosphere–ocean general circulation model (ECHAM4.5) for applicable areas of East Africa for the two test cases presented

Cyperus scariosus Chloroform Fraction Inhibits T cell Responses in Balb/C Mice

Purpose: To investigate the T cell inhibition potential of 50% ethanol extract of Cyperus scariosus (CS)and its bioactive chloroform fraction (CSC).Methods: The preliminary screening of the extract was carried out by humoral antibody response anddelayed-type hypersensitivity models employing sheep red blood cells (SRBC) as the antigen. Further,the extract was studied by skin allograft rejection test, and phagocytosis - in vitro and ex vivo - by C.albicans method and carbon clearance test, respectively. The extract was fractionated with chloroform,n-butanol and water, and then used to investigate the T-cell specific immunosuppressive potential ofthese fractions by flow cytometry.Results: On p.o. administration, CS inhibited both humoral and cell-mediated immune responsessignificantly (p < 0.01) by suppressing primary (26.8 %) and secondary (29.7 %) antibody titres, andalso inhibited cell-mediated delayed type hypersensitivity (DTH) immune response (45.9 %) at 600mg/kg dose, phagocytosis - both in vitro (37.4 %) and ex vivo (37.8 %) - and delayed the graft rejectiontime (45.8%), thus confirming marked immunosuppression. Out of the three isolated fractions, only thechloroform fraction significantly (p < 0.01) suppressed CD8+/ CD4+ T cell surface markers (14.0/25.3%) and intra-cellular Th1 cytokines, viz, IL-2 (34.4 %), and IFN-&gamma; (34.7 %), compared to cyclosporine-A(5), a standard T cell inhibitor (53.6 %) which was given to Balb/C mice at 200 mg/kg dose. CSC did notsignificantly (p < 0.01) suppress Th2 (IL-4) system.Conclusion: The findings from this investigation reveal that C. scariosus causes immunosuppressionby inhibiting Th1 cytokines

Association between psychological distress and cardiovascular health amongst cancer survivors in the United States: findings from nationally representative data

Research letter

Outcomes of Comprehensive Care for Children Empirically Treated for Multidrug-Resistant Tuberculosis in a Setting of High HIV Prevalence

Background: Few studies have examined outcomes for children treated for multidrug-resistant tuberculosis (MDR-TB), including those receiving concomitant treatment for MDR-TB and HIV co-infection. In Lesotho, where the adult HIV seroprevalence is estimated to be 24%, we sought to measure outcomes and adverse events in a cohort of children treated for MDR-TB using a community-based treatment delivery model. Methods: We reviewed retrospectively the clinical charts of children $\leq$15 years of age treated for culture-confirmed or suspected MDR-TB between July 2007 and January 2011. Results: Nineteen children, ages two to 15, received treatment. At baseline, 74% of patients were co-infected with HIV, 63% were malnourished, 84% had severe radiographic findings, and 21% had extrapulmonary disease. Five (26%) children had culture-confirmed MDR-TB, ten (53%) did not have culture results available, and four (21%) subsequently had results indicating drug-susceptible TB. All children with HIV co-infection who were not already on antiretroviral therapy (ART) were initiated on ART a median of two weeks after the start of the MDR-TB regimen. Among the 17 patients with final outcomes, 15 (88%) patients were cured or completed treatment, two (12%) patients died, and none defaulted or were lost to follow-up. The majority of patients (95%) experienced adverse events; only two required permanent discontinuation of the offending agent, and only one required suspension of MDR-TB treatment for more than one week. Conclusions: Pediatric MDR-TB and MDR-TB/HIV co-infection can be successfully treated using a combination of social support, close monitoring by community health workers and clinicians, and inpatient care when needed. In this cohort, adverse events were well tolerated and treatment outcomes were comparable to those reported in children with drug-susceptible TB and no HIV infection

Outcomes of Multidrug-Resistant Tuberculosis Treatment with Early Initiation of Antiretroviral Therapy for HIV Co-Infected Patients in Lesotho

Background: Although the importance of concurrent treatment for multidrug-resistant tuberculosis (MDR-TB) and HIV co-infection has been increasingly recognized, there have been few studies reporting outcomes of MDR-TB and HIV co-treatment. We report final outcomes of comprehensive, integrated MDR-TB and HIV treatment in Lesotho and examine factors associated with death or treatment failure. Methods: We reviewed clinical charts of all adult patients who initiated MDR-TB treatment in Lesotho between January 2008 and September 2009. We calculated hazard ratios (HR) and used multivariable Cox proportional hazards regression to identify predictors of poor outcomes. Results: Of 134 confirmed MDR-TB patients, 83 (62%) were cured or completed treatment, 46 (34%) died, 3 (2%) transferred, 1 (1%) defaulted, and 1 (1%) failed treatment. Treatment outcomes did not differ significantly by HIV status. Among the 94 (70%) patients with HIV co-infection, 53% were already on antiretroviral therapy (ART) before MDR-TB treatment initiation, and 43% started ART a median of 16 days after the start of the MDR-TB regimen. Among HIV co-infected patients who died, those who had not started ART before MDR-TB treatment had a shorter median time to death (80 days vs. 138 days, p = 0.065). In multivariable analysis, predictors of increased hazard of failure or death were low and severely low body mass index (HR 2.75, 95% confidence interval [CI] 1.27–5.93; HR 5.50, 95% CI 2.38–12.69), and a history of working in South Africa (HR 2.37, 95% CI 1.24–4.52). Conclusions: Favorable outcomes can be achieved in co-infected patients using a community-based treatment model when both MDR-TB and HIV disease are treated concurrently and treatment is initiated promptly

Intracranial Vertebrobasilar Artery Dissection Associated with Postpartum Angiopathy

Background. Cervicocephalic arterial dissection (CCAD) is rare in the postpartum period. To our knowledge this is the first reported case of postpartum angiopathy (PPA) presenting with ischemic stroke due to intracranial arterial dissection. Case. A 41-year-old woman presented with blurred vision, headache, and generalized seizures 5 days after delivering twins. She was treated with magnesium for eclampsia. MRI identified multiple posterior circulation infarcts. Angiography identified a complex dissection extending from both intradural vertebral arteries, through the basilar artery, and into both posterior cerebral arteries. Multiple segments of arterial dilatation and narrowing consistent with PPA were present. Xenon enhanced CT (Xe-CT) showed reduced regional cerebral blood flow that is improved with elevation in blood pressure. Conclusion. Intracranial vertebrobasilar dissection causing stroke is a rare complication of pregnancy. Eclampsia and PPA may play a role in its pathogenesis. Blood pressure management may be tailored using quantitative blood flow studies, such as Xe-CT

Intracellular cytokine staining and flow cytometry: Considerations for application in clinical trials of novel tuberculosis vaccines

Intracellular cytokine staining combined with flow cytometry is one of a number of assays designed to assess T-cell immune responses. It has the specific advantage of enabling the simultaneous assessment of multiple phenotypic, differentiation and functional parameters pertaining to responding T-cells, most notably, the expression of multiple effector cytokines. These attributes make the technique particularly suitable for the assessment of T-cell immune responses induced by novel tuberculosis vaccines in clinical trials. However, depending upon the particular nature of a given vaccine and trial setting, there are approaches that may be taken at different stages of the assay that are more suitable than other alternatives. In this paper, the Tuberculosis Vaccine Initiative (TBVI) TB Biomarker Working group reports on efforts to assess the conditions that will determine when particular assay approaches should be employed. We have found that choices relating to the use of fresh whole blood or peripheral blood mononuclear cells (PBMC) and frozen PBMC; use of serum-containing or serum-free medium; length of stimulation period and use of co-stimulatory antibodies can all affect the sensitivity of intracellular cytokine assays. In the case of sample material, frozen PBMC, despite some loss of sensitivity, may be more advantageous for batch analysis. We also recommend that for multi-site studies, common antibody panels, gating strategies and analysis approaches should be employed for better comparability