15 research outputs found
Fear of the dark in children: is stationary night blindness the cause?
No abstract available
Low-cost diagnostic test for susceptible and drug-resistant tuberculosis in rural Malawi
Background: Rural settings where molecular tuberculosis diagnostics are not currently available need easy-to-use tests that do not require additional processing or equipment. While acid-fast bacilli (AFB) smear is the most common and often only tuberculosis diagnosis test performed in rural settings, it is labour intensive, has less-than-ideal sensitivity, and cannot assess tuberculosis drug susceptibility patterns. Objective: The objective of this study was to determine the feasibility of a multidrug-resistant (MDR) or extensively drug-resistant (XDR)-tuberculosis coloured agar-based culture test (tuberculosis CX-test), which can detect Mycobacterium tuberculosis growth and evaluate for drug susceptibility to isoniazid, rifampicin and a fluoroquinolone (i.e. ciprofloxacin) in approximately 14 days. Method: In this study, 101 participants were enrolled who presented to a rural health clinic in central Malawi. They were suspected of having active pulmonary tuberculosis. Participants provided demographic and clinical data and submitted sputum samples for tuberculosis testing using the AFB smear and tuberculosis CX-test. Results: The results showed a high level of concordance between the AFB smear (12 positive) and tuberculosis CX-test (13 positive); only one sample presented discordant results, with the molecular GeneXpert MTB/RIFÂź test confirming the tuberculosis CX-test results. The average time to a positive tuberculosis CX-test was 10 days. Of the positive samples, the tuberculosis CX-test detected no cases of drug resistance, which was later confirmed by the GeneXpert MTB/RIFÂź. Conclusion: These findings demonstrate that the tuberculosis CX-test could be a reliable low-cost diagnostic method for active pulmonary tuberculosis in high tuberculosis burden rural areas
Clinical Illness and Outcomes in Patients with Ebola in Sierra Leone
Background
Limited clinical and laboratory data are available on patients with Ebola virus disease (EVD). The Kenema Government Hospital in Sierra Leone, which had an existing infrastructure for research regarding viral hemorrhagic fever, has received and cared for patients with EVD since the beginning of the outbreak in Sierra Leone in May 2014.
Methods
We reviewed available epidemiologic, clinical, and laboratory records of patients in whom EVD was diagnosed between May 25 and June 18, 2014. We used quantitative reverse-transcriptaseâpolymerase-chain-reaction assays to assess the load of Ebola virus (EBOV, Zaire species) in a subgroup of patients.
Results
Of 106 patients in whom EVD was diagnosed, 87 had a known outcome, and 44 had detailed clinical information available. The incubation period was estimated to be 6 to 12 days, and the case fatality rate was 74%. Common findings at presentation included fever (in 89% of the patients), headache (in 80%), weakness (in 66%), dizziness (in 60%), diarrhea (in 51%), abdominal pain (in 40%), and vomiting (in 34%). Clinical and laboratory factors at presentation that were associated with a fatal outcome included fever, weakness, dizziness, diarrhea, and elevated levels of blood urea nitrogen, aspartate aminotransferase, and creatinine. Exploratory analyses indicated that patients under the age of 21 years had a lower case fatality rate than those over the age of 45 years (57% vs. 94%, P=0.03), and patients presenting with fewer than 100,000 EBOV copies per milliliter had a lower case fatality rate than those with 10 million EBOV copies per milliliter or more (33% vs. 94%, P=0.003). Bleeding occurred in only 1 patient.
Conclusions
The incubation period and case fatality rate among patients with EVD in Sierra Leone are similar to those observed elsewhere in the 2014 outbreak and in previous outbreaks. Although bleeding was an infrequent finding, diarrhea and other gastrointestinal manifestations were common. (Funded by the National Institutes of Health and others.
The effect of socio-economic deprivation on severity of glaucoma at presentation
OBJECTIVE: To evaluate the influence of socio-economic factors on severity of glaucoma at presentation METHODS: All newly diagnosed glaucoma patients at the University Hospitals-NHS, Aberdeen and South Glasgow University Hospitals-NHS, in 2006, were included. Glaucoma was severe at presentation if there was a repeatable visual-field loss with a mean deviation index greater than 12 dB in the Humphreys visual fields test or an absolute paracentral scotoma within the central 5 degrees of the visual fields. Home address was used to determine the Scottish Index of Multiple Deprivation (SIMD) rank. The SIMD rank, demographics and severity of glaucoma at presentation were investigated using general linear modelling. RESULTS: There were 48 patients with severe glaucoma and 74 patients with non-severe glaucoma. In four, the severity could not be determined. Severity of glaucoma at presentation was significantly associated with SIMD rank, being most severe in patients from areas with the lowest ranks (p = 0.026). Age was a significant factor (p = 0.024), with severe glaucoma being more common in elderly patients. CONCLUSIONS: Age and socio-economic deprivation were associated with severity of glaucoma at presentation, with patients from areas of higher socio-economic deprivation presenting with more advanced glaucoma
Pollutions dans un monde liquide : sources, devenirs et conséquences pour la planification spatiale marine au Sénégal
Introduction LâocĂ©an a Ă©tĂ© historiquement considĂ©rĂ© comme un endroit suffisamment vaste pour pouvoir accueillir toutes sortes de dĂ©chets produits par les sociĂ©tĂ©s humaines sans dommages (Gorman, 1993). La logique a Ă©tĂ© poussĂ©e trĂšs loin par les sociĂ©tĂ©s industrielles qui prennent tardivement conscience des limites de cette approche. Lâorigine et la nature des dĂ©chets rejetĂ©s dans le milieu marin sont particuliĂšrement variĂ©es : ceux liĂ©s Ă lâexploitation des navires, aux activitĂ©s nuclĂ©aires c..
Pollution in a liquid world : sources and impacts of pollution in Senegal and the implications for marine spatial planning
Introduction Historically, the ocean has been considered large enough to accommodate all kinds of waste produced by human societies without causing damage (Gorman, 1993). This logic has been taken to extremes by industrial societies, which are only now becoming aware of the limits of this approach. The origin and nature of the waste discharged into the marine environment vary highly: waste from the operation of ships, civil and military nuclear activities, industrial and domestic wastewater, ..
Assessing greywater characteristics in the sahel region and perception of the local population on its reuse in agriculture
Research on greywater reuse in water stressed areas is in full swing. However, the perception of greywater reuse is one of the least researched areas in West Africa, particularly in Sahelian countries. This study aimed to fills a significant gap in the existing literature, which has largely ignored the specific socio-demographic contexts of developing countries in the Sahelian regions. The study involved in-depth interviews with 240 rural households and the collection of 40 greywater samples in four locations for laboratory analysis. The survey focused on greywater management and household perceptions of greywater reuse in agriculture. The analyses focused on determining the physico-chemical and microbiological parameters of greywater collected from households. The results showed that over 80Â % of households discharged greywater into the natural environment without prior treatment. The majority of respondents were aware that poor greywater management poses a health risk. The results also showed an association between locality, gender, education level and perceptions of poor grey water management. Respondents were willing to accept the reuse of greywater in agriculture, to consume irrigated vegetables and to install a greywater treatment system. The quality analysis showed that the greywater was not in compliance with the legal discharge limits. This study highlights that in order to promote sustainable greywater management practices within households, it is important to design effective greywater treatment systems that meet the needs of the target population. Awareness campaigns, education and training programmes on wastewater management could also be established
Evaluation of the tuberculosis culture color plate test for rapid detection of drug susceptible and drug-resistant Mycobacterium tuberculosis in a resource-limited setting, Addis Ababa, Ethiopia
Timely diagnosis of tuberculosis (TB) is limited in Ethiopia. We evaluated the performance of a low technology, thin layer agar, Mycobacterium tuberculosis (M.tb) culture color plate (TB-CX) test with concurrent drug susceptibility testing (DST) to isoniazid (INH), rifampin (RIF), and pyrazinamide (PZA) directly from sputum specimens. Patients undergoing examination for TB and multidrug-resistant (MDR)-TB were enrolled in Addis Ababa, Ethiopia from March 2016 to February 2017. All subjects received a GeneXpert MTB/RIF PCR test. TB-CX test results were compared to reference Löwenstein-Jensen (LJ) culture for M.tb detection and DST for susceptibility to INH and RIF. Kappa statistic was applied to test agreement between results for TB-CX test and the reference methods, a cut-off Kappa value of 0.75 was considered as high level of agreements. A total of 137 participants were analyzed: 88 (64%) were new TB cases, 49 (36%) were re-treatment cases. The TB-CX test detected M.tb and DST in an average of 13 days compared to 50 days for the conventional DST result. The sensitivity and specificity of the TB-CX test for detecting M.tb were 94% and 98%, respectively (concordance, 96%; kappa 0.91). The sensitivity of the TB-CX test to detect drug resistance to INH, RIF, and MDR-TB was 91%, 100%, and 90% respectively. The specificity of the TB-CX test for detecting INH, RIF, and MDR-TB was 94%, 40%, and 94% respectively. Overall agreement between TB-CX test and LJ DST for detection of MDR-TB was 93%. The TB-CX test showed strong agreement with the GeneXpert test for detecting M.tb (89%, kappa 0.76) but low agreement for the detection of RIF resistance (57%, kappa 0.28). The TB-CX test was found to be a good alternative method for screening of TB and selective drug resistant-TB in a timely and cost-efficient manner