Mortality in patients treated for tuberculous pericarditis in sub-Saharan Africa.

Tuberculous pericarditis is one of the most severe forms of extrapulmonary tuberculosis, causing death or disability in a substantial proportion of affected people.1,2 In Africa, the incidence of tuberculous pericarditis is rising as a result of the HIV epidemic.3 The effect of HIV infection on survival in patients with tuberculous pericarditis is unknown.2,4 Whereas some investigators have suggested that HIV-infected patients with tuberculous pericarditis have a similar outcome to non-infected cases,5 others have shown that there may be an increase in mortality in HIV associated with tuberculous pericarditis.2,6,7 We established a prospective observational study, the Investigation of the Management of Pericarditis in Africa (IMPI Africa) registry, to obtain current information on the diagnosis, management and outcome of patients with presumed tuberculous pericarditis living in sub-Saharan Africa, where the burden of HIV infection is the greatest in the world.4,8-10 In this paper, we report the mortality rate and its predictors during the 6 months of antituberculosis treatment among patients enrolled in the regis

Clinical characteristics and initial management of patients with tuberculous pericarditis in the HIV era: the Investigation of the Management of Pericarditis in Africa (IMPI Africa) registry

BACKGROUND: The incidence of tuberculous pericarditis has increased in Africa as a result of the human immunodeficiency virus (HIV) epidemic. However, the effect of HIV co-infection on clinical features and prognosis in tuberculous pericarditis is not well characterised. We have used baseline data of the Investigation of the Management of Pericarditis in Africa (IMPI Africa) registry to assess the impact of HIV co-infection on clinical presentation, diagnostic evaluation, and treatment of patients with suspected tuberculous pericarditis in sub-Saharan Africa. METHODS: Consecutive adult patients in 15 hospitals in three countries in sub-Saharan Africa were recruited on commencement of treatment for tuberculous pericarditis, following informed consent. We recorded demographic, clinical, diagnostic and therapeutic information at baseline, and have used the chi-square test and analysis of variance to assess probabilities of significant differences (in these variables) between groups defined by HIV status. RESULTS: A total of 185 patients were enrolled from 01 March 2004 to 31 October 2004, 147 (79.5%) of whom had effusive, 28 (15.1%) effusive-constrictive, and 10 (5.4%) constrictive or acute dry pericarditis. Seventy-four (40%) had clinical features of HIV infection. Patients with clinical HIV disease were more likely to present with dyspnoea (odds ratio [OR] 3.2, 95% confidence interval [CI] 1.4 to 7.4, P = 0.005) and electrocardiographic features of myopericarditis (OR 2.8, 95% CI 1.1 to 6.9, P = 0.03). In addition to electrocardiographic features of myopericarditis, a positive HIV serological status was associated with greater cardiomegaly (OR 3.89, 95% CI 1.34 to 11.32, P = 0.01) and haemodynamic instability (OR 9.68, 95% CI 2.09 to 44.80, P = 0.0008). However, stage of pericardial disease at diagnosis and use of diagnostic tests were not related to clinical HIV status. Similar results were obtained for serological HIV status. Most patients were treated on clinical grounds, with microbiological evidence of tuberculosis obtained in only 13 (7.0%) patients. Adjunctive corticosteroids were used in 109 (58.9%) patients, with patients having clinical HIV disease less likely to be put on them (OR 0.37, 95% CI 0.20 to 0.68). Seven patients were on antiretroviral drugs. CONCLUSION: Patients with suspected tuberculous pericarditis and HIV infection in Africa have greater evidence of myopericarditis, dyspnoea, and haemodynamic instability. These findings, if confirmed in other studies, may suggest more intensive management of the cardiac disease is warranted in patients with HIV-associated pericardial disease

Genomic, Pathway Network, and Immunologic Features Distinguishing Squamous Carcinomas

This integrated, multiplatform PanCancer Atlas study co-mapped and identified distinguishing molecular features of squamous cell carcinomas (SCCs) from five sites associated with smokin

Nanochitosan derived from marine bacteria

Nanochitosans are polysaccharides produced by the alkalescent deacetylation of chitin and comprise a series of 2-deoxy-2 (acetylamino) glucose linked by ß-(1-4) glycosidic linkages. These are naturally formed from the deacetylation of shellfish shells and the exoskeleton of aquatic arthropods and crustaceans. Reports of chitosan production from unicellular marine bacteria inhabiting the sea, and possessing distinct animal- and plant-like characteristics abound. This capacity to synthesize chitosan from chitin arises from response to stress under extreme environmental conditions, as a means of survival. Consequently, the microencapsulation of these nanocarriers results in new and improved chitosan nanoparticles, nanochitosan. This nontoxic bioactive material which can serve as an antibacterial agent, gene delivery vector as well as carrier for protein and drug release as compared with chitosan, is limited by its nonspecific molecular weight and higher composition of deacetylated chitin. This chapter highlights the biology and diversity of nanochitosan-producing marine bacteria, including the factors influencing their activities, survival, and distribution. More so, the applications of marine bacterial nanochitosans in transfection and gene delivery; wound healing and drug delivery; feed supplement development and antimicrobial activity are discussed

Mortality in patients treated for tuberculous pericarditis in sub-Saharan Africa

Objective: To determine the mortality rate and its predictors in patients with a presumptive diagnosis of tuberculous pericarditis in sub-Saharan Africa. Design: Between 1 March 2004 and 31 October 2004, we enrolled 185 consecutive patients with presumed tuberculous pericarditis from 15 referral hospitals in Cameroon, Nigeria, and South Africa, and observed them during the 6-month course of antituberculosis treatment for the major outcome of mortality. This was an observational study, with the diagnosis and management of each patient left at the discretion of the attending physician. Using Cox regression, we have assessed the effect of clinical and therapeutic characteristics (recorded at baseline) on mortality during follow-up. Results: We obtained the vital status of 174 (94%) patients (median age 33; range 14-87 years). The overall mortality rate was 26%. Mortality was higher in patients who had clinical features of HIV infection than in those who did not (40% versus 17%, P=0.001). Independent predictors of death during follow-up were: (1) a proven non-tuberculosis final diagnosis (hazard ratio [HR] 5.35, 95% confidence interval 1.76 to 16.25), (2) the presence of clinical signs of HIV infection (HR 2.28, 1.14-4.56), (3) co-existent pulmonary tuberculosis (HR 2.33, 1.20-4.54), and (4) older age (HR 1.02, 1.01-1.05). There was also a trend towards an increase in death rate in patients with haemodynamic instability (HR 1.80, 0.90-3.58) and a decrease in those who underwent pericardiocentesis (HR 0.34, 0.10-1.19). Conclusion: A presumptive diagnosis of tuberculous pericarditis is associated with a high mortality in sub-Saharan Africans. Attention to rapid aetiological diagnosis of pericardial effusion and treatment of concomitant HIV infection may reduce the high mortality associated with the disease

Progress toward standardized diagnosis of vascular cognitive impairment: Guidelines from the Vascular Impairment of Cognition Classification Consensus Study

INTRODUCTION: Progress in understanding and management of vascular cognitive impairment (VCI) has been hampered by lack of consensus on diagnosis, reflecting the use of multiple different assessment protocols. A large multinational group of clinicians and researchers participated in a two-phase Vascular Impairment of Cognition Classification Consensus Study (VICCCS) to agree on principles (VICCCS-1) and protocols (VICCCS-2) for diagnosis of VCI. We present VICCCS-2. METHODS: We used VICCCS-1 principles and published diagnostic guidelines as points of reference for an online Delphi survey aimed at achieving consensus on clinical diagnosis of VCI. RESULTS: Six survey rounds comprising 65-79 participants agreed guidelines for diagnosis of VICCCS-revised mild and major forms of VCI and endorsed the National Institute of Neurological Disorders-Canadian Stroke Network neuropsychological assessment protocols and recommendations for imaging. DISCUSSION: The VICCCS-2 suggests standardized use of the National Institute of Neurological Disorders-Canadian Stroke Network recommendations on neuropsychological and imaging assessment for diagnosis of VCI so as to promote research collaboration

Utilization of nanochitosan in the sterilization of ponds and water treatment for aquaculture

Water pollution constitutes the leading cause of infant mortality, neonatal deformities, and shrinkage of man’s average life expectancy. Pollutants come from point and nonpoint sources; and water pollution arises from the discharge of wastewater containing undesirable impurities used for domestic, agricultural, and industrial purposes. More so, high nutrient and wastewater runoffs from fish production systems contribute to the fouling and eutrophication of recipient water bodies. Hence, aquaculture which is inextricably linked to the natural environment is challenged by the dearth of appropriate water quantity and quality, militating against fish, and fishery production. Nanochitosans as polysaccharides produced by the alkalescent deacetylation of chitin, comprise a series of 2-deoxy-2 (acetylamino) glucose linked by ß-(1-4) glycosidic linkages. They are naturally formed from the deacetylation of shellfish shells and exoskeletons of aquatic arthropods and crustaceans. The unique attributes of chitin confer a wide range of biotechnological applications on the polymer, observed in flocculation as a wastewater treatment and purification route initiated by chitosan. This chapter highlights nanochitosan properties of aquaculture relevance; and elucidates the purification potentials of nanochitosan, compared to inorganic coagulants and organic polymeric flocculants. Effects of chitosan on contaminants and microorganisms, as well as applications in fish pathogens detection, fish disease diagnosis, and control are discussed

Chapter 21 - Utilization of nanochitosan in the sterilization of ponds and water treatment for aquaculture

Water pollution constitutes the leading cause of infant mortality, neonatal deformities, and shrinkage of man’s average life expectancy. Pollutants come from point and nonpoint sources; and water pollution arises from the discharge of wastewater containing undesirable impurities used for domestic, agricultural, and industrial purposes. More so, high nutrient and wastewater runoffs from fish production systems contribute to the fouling and eutrophication of recipient water bodies. Hence, aquaculture which is inextricably linked to the natural environment is challenged by the dearth of appropriate water quantity and quality, militating against fish, and fishery production. Nanochitosans as polysaccharides produced by the alkalescent deacetylation of chitin, comprise a series of 2-deoxy-2 (acetylamino) glucose linked by ß-(1-4) glycosidic linkages. They are naturally formed from the deacetylation of shellfish shells and exoskeletons of aquatic arthropods and crustaceans. The unique attributes of chitin confer a wide range of biotechnological applications on the polymer, observed in flocculation as a wastewater treatment and purification route initiated by chitosan. This chapter highlights nanochitosan properties of aquaculture relevance; and elucidates the purification potentials of nanochitosan, compared to inorganic coagulants and organic polymeric flocculants. Effects of chitosan on contaminants and microorganisms, as well as applications in fish pathogens detection, fish disease diagnosis, and control are discussed

Nanochitosan derived from marine bacteria

Nanochitosans are polysaccharides produced by the alkalescent deacetylation of chitin and comprise a series of 2‐deoxy‐2 (acetylamino) glucose linked by ß‐(1‐4) glycosidic linkages. These are naturally formed from the deacetylation of shellfish shells and the exoskeleton of aquatic arthropods and crustaceans. Reports of chitosan production from unicellular marine bacteria inhabiting the sea, and possessing distinct animal‐ and plant‐like characteristics abound. This capacity to synthesize chitosan from chitin arises from response to stress under extreme environmental conditions, as a means of survival. Consequently, the microencapsulation of these nanocarriers results in new and improved chitosan nanoparticles, nanochitosan. This nontoxic bioactive material which can serve as an antibacterial agent, gene delivery vector as well as carrier for protein and drug release as compared with chitosan, is limited by its nonspecific molecular weight and higher composition of deacetylated chitin. This chapter highlights the biology and diversity of nanochitosan‐producing marine bacteria, including the factors influencing their activities, survival, and distribution. More so, the applications of marine bacterial nanochitosans in transfection and gene delivery; wound healing and drug delivery; feed supplement development and antimicrobial activity are discussed