A Mexican Perspective on NAFTA and the Regulation of Unfair Trade Practices

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Treatment outcome of extra-pulmonary tuberculosis in Finland: a cohort study

<p>Abstract</p> <p>Background</p> <p>We investigated the treatments given, the outcome and the patient- and treatment-system dependent factors affecting treatment outcome in a national two-year cohort of culture-verified extra-pulmonary tuberculosis cases in Finland.</p> <p>Methods</p> <p>Medical records of all cases in 1995 - 1996 were abstracted to assess treatment and outcome, using the European recommendations for outcome monitoring. For risk factor analysis, outcome was divided into three groups: favourable, death and other unfavourable. Predictors of unfavourable outcome were assessed in univariate and multivariate analysis.</p> <p>Results</p> <p>In the study cohort of 276 cases, 116 (42.0%) were men and 160 (58.0%) women. The mean age was 65.7 years. A favourable outcome was achieved in 157/276 (56.9%) cases, consisting of those cured (8.0%) and treatment completed (48.9%). Death was the outcome in 17.4% (48/276) cases, including cases not treated. Other unfavourable outcomes took place in 45 (16.3%) cases. Significant independent risk factors for death in multinomial logistic regression model were male sex, high age, immunosuppression, any other than a pulmonary specialty being responsible at the end of the treatment and other than standard combination of treatment. For other unfavourable treatment outcomes, significant risk factor was treatment with INH + RIF + EMB/SM. Deep site of TB was inversely associated with the risk of other unfavourable outcome.</p> <p>Conclusions</p> <p>The proportion of favourable outcome was far below the goal set by the WHO. Age and comorbidities, playing an important role in treatment success, are not available in routine outcome data. Therefore, comparisons between countries should be made in cohort analyses incorporating data on comorbidities.</p

The role of entry screening in case finding of tuberculosis among asylum seekers in Norway

<p>Abstract</p> <p>Background</p> <p>Most new cases of active tuberculosis in Norway are presently caused by imported strains and not transmission within the country. Screening for tuberculosis with a Mantoux test of everybody and a chest X-ray of those above 15 years of age is compulsory on arrival for asylum seekers.</p> <p>We aimed to assess the effectiveness of entry screening of a cohort of asylum seekers. Cases detected by screening were compared with cases detected later. Further we have characterized cases with active tuberculosis.</p> <p>Methods</p> <p>All asylum seekers who arrived at the National Reception Centre between January 2005 - June 2006 with an abnormal chest X-ray or a Mantoux test ≥ 6 mm were included in the study and followed through the health care system. They were matched with the National Tuberculosis Register by the end of May 2008.</p> <p>Cases reported within two months after arrival were defined as being detected by screening.</p> <p>Results</p> <p>Of 4643 eligible asylum seekers, 2237 were included in the study. Altogether 2077 persons had a Mantoux ≥ 6 mm and 314 had an abnormal chest X-ray. Of 28 cases with tuberculosis, 15 were detected by screening, and 13 at 4-27 months after arrival. Abnormal X-rays on arrival were more prevalent among those detected by screening. Female gender and Somalian origin increased the risk for active TB.</p> <p>Conclusion</p> <p>In spite of an imperfect follow-up of screening results, a reasonable number of TB cases was identified by the programme, with a predominance of pulmonary TB.</p

Risk factors for poor tuberculosis treatment outcome in Finland: a cohort study

<p>Abstract</p> <p>Background</p> <p>We investigated the patient- and treatment-system dependent factors affecting treatment outcome in a two-year cohort of all treated culture-verified pulmonary tuberculosis (TB) cases to establish a basis for improving outcomes.</p> <p>Methods</p> <p>Medical records of all cases in 1995 – 1996 were abstracted to assess outcome of treatment. Outcome was divided into three groups: favourable, death and other unfavourable. Predictors of unfavourable outcome were assessed in univariate and multivariate analysis.</p> <p>Results</p> <p>Among 629 cases a favourable outcome was achieved in 441 (70.1%), 17.2% (108) died and other unfavourable outcome took place in 12.7% (80). Significant independent risk factors for death were male sex, high age, non-HIV -related immunosuppression and any other than a pulmonary specialty being responsible for stopping treatment. History of previous tuberculosis was inversely associated with the risk of death. For other unfavourable treatment outcomes, significant risk factors were pause(s) in treatment, treatment with INH+RIF+EMB/SM, and internal medicine specialty being responsible at the end of the treatment.</p> <p>Conclusion</p> <p>We observed a significant association with unfavourable outcome for the specialty responsible for treatment being other than pulmonary, but not for the volume of cases, which has implications for system arrangements. Poor outcomes associated with immunosuppression and advanced age, with frequent comorbidity, stress a low threshold of suspicion, availability of rapid diagnostics, and early empiric treatment as probable approaches in attempting to improve treatment outcomes in countries with very low incidence of TB.</p

Three-Dimensional Geometric Analysis of Felid Limb Bone Allometry

Studies of bone allometry typically use simple measurements taken in a small number of locations per bone; often the midshaft diameter or joint surface area is compared to body mass or bone length. However, bones must fulfil multiple roles simultaneously with minimum cost to the animal while meeting the structural requirements imposed by behaviour and locomotion, and not exceeding its capacity for adaptation and repair. We use entire bone volumes from the forelimbs and hindlimbs of Felidae (cats) to investigate regional complexities in bone allometry.Computed tomographic (CT) images (16435 slices in 116 stacks) were made of 9 limb bones from each of 13 individuals of 9 feline species ranging in size from domestic cat (Felis catus) to tiger (Panthera tigris). Eleven geometric parameters were calculated for every CT slice and scaling exponents calculated at 5% increments along the entire length of each bone. Three-dimensional moments of inertia were calculated for each bone volume, and spherical radii were measured in the glenoid cavity, humeral head and femoral head. Allometry of the midshaft, moments of inertia and joint radii were determined. Allometry was highly variable and related to local bone function, with joint surfaces and muscle attachment sites generally showing stronger positive allometry than the midshaft.Examining whole bones revealed that bone allometry is strongly affected by regional variations in bone function, presumably through mechanical effects on bone modelling. Bone's phenotypic plasticity may be an advantage during rapid evolutionary divergence by allowing exploitation of the full size range that a morphotype can occupy. Felids show bone allometry rather than postural change across their size range, unlike similar-sized animals

Red Fox Vulpes vulpes (L., 1758) as a Bioindicator of Mercury Contamination in Terrestrial Ecosystems of North-Western Poland

In this study, we determined the concentrations of total mercury (Hg) in samples of liver, kidney and skeletal muscle of 27 red foxes Vulpes vulpes (L., 1758) from north-western Poland, and examined the morphometric characteristics of the collected specimens. The analysis also included the relationship between Hg concentration and the fox size, and the suitability of individual organs as bioindicators in indirect evaluation of environmental mercury contamination. Determination of Hg concentration was performed by atomic absorption spectroscopy. In the analysed samples, the Hg concentration was low and the maximum value did not exceed 0.85 mgHg/kg dry weight (dw). There were no significant differences in Hg concentrations in the analysed material between males and females or between immature and adult groups. The median concentrations of Hg in the liver, kidney and skeletal muscle were 0.22, 0.11 and 0.05 mgHg/kg dw, respectively. The correlation coefficients were significant between the concentrations of mercury in the liver, kidney and skeletal muscle (positive) and between the kidney Hg concentration and kidney mass (negative). Taking into account our results and findings of other authors, it may be argued that the red fox exhibits a measurable response to mercury environmental pollution and meets the requirements of a bioindicator

The benefits and risks of bacille Calmette-Guérin vaccination among infants at high risk for both tuberculosis and severe combined immunodeficiency: assessment by Markov model

BACKGROUND: Bacille Calmette-Guérin (BCG) vaccine is given to Canadian Aboriginal neonates in selected communities. Severe reactions and deaths associated with BCG have been reported among infants born with immunodeficiency syndromes. The main objective of this study was to estimate threshold values for severe combined immunodeficiency (SCID) incidence, above which BCG is associated with greater risk than benefit. METHODS: A Markov model was developed to simulate the natural histories of tuberculosis (TB) and SCID in children from birth to 14 years. The annual risk of tuberculous infection (ARI) and SCID incidence were varied in analyses. The model compared a scenario of no vaccination to intervention with BCG. Appropriate variability and uncertainty analyses were conducted. Outcomes included TB incidence and quality-adjusted life years (QALYs). RESULTS: In sensitivity analyses, QALYs were lower among vaccinated infants if the ARI was 0.1% and the rate of SCID was higher than 4.2 per 100,000. Assuming an ARI of 1%, this threshold increased to 41 per 100,000. In uncertainty analyses (Monte Carlo simulations) which assumed an ARI of 0.1%, QALYs were not significantly increased by BCG unless SCID incidence is 0. With this ARI, QALYs were significantly decreased among vaccinated children if SCID incidence exceeds 23 per 100,000. BCG is associated with a significant increase in QALYs if the ARI is 1%, and SCID incidence is below 5 per 100,000. CONCLUSION: The possibility that Canadian Aboriginal children are at increased risk for SCID has serious implications for continued BCG use in this population. In this context, enhanced TB Control – including early detection and treatment of infection – may be a safer, more effective alternative

Genome-Wide Polymorphism and Comparative Analyses in the White-Tailed Deer (Odocoileus virginianus): A Model for Conservation Genomics

The white-tailed deer (Odocoileus virginianus) represents one of the most successful and widely distributed large mammal species within North America, yet very little nucleotide sequence information is available. We utilized massively parallel pyrosequencing of a reduced representation library (RRL) and a random shotgun library (RSL) to generate a complete mitochondrial genome sequence and identify a large number of putative single nucleotide polymorphisms (SNPs) distributed throughout the white-tailed deer nuclear and mitochondrial genomes. A SNP validation study designed to test specific classes of putative SNPs provides evidence for as many as 10,476 genome-wide SNPs in the current dataset. Based on cytogenetic evidence for homology between cow (Bos taurus) and white-tailed deer chromosomes, we demonstrate that a divergent genome may be used for estimating the relative distribution and density of de novo sequence contigs as well as putative SNPs for species without draft genome assemblies. Our approach demonstrates that bioinformatic tools developed for model or agriculturally important species may be leveraged to support next-generation research programs for species of biological, ecological and evolutionary importance. We also provide a functional annotation analysis for the de novo sequence contigs assembled from white-tailed deer pyrosequencing reads, a mitochondrial phylogeny involving 13,722 nucleotide positions for 10 unique species of Cervidae, and a median joining haplotype network as a putative representation of mitochondrial evolution in O. virginianus. The results of this study are expected to provide a detailed template enabling genome-wide sequence-based studies of threatened, endangered or conservationally important non-model organisms

Bovine Tuberculosis in Doñana Biosphere Reserve: The Role of Wild Ungulates as Disease Reservoirs in the Last Iberian Lynx Strongholds

Doñana National Park (DNP) in southern Spain is a UNESCO Biosphere Reserve where commercial hunting and wildlife artificial feeding do not take place and traditional cattle husbandry still exists. Herein, we hypothesized that Mycobacterium bovis infection prevalence in wild ungulates will depend on host ecology and that variation in prevalence will reflect variation in the interaction between hosts and environmental risk factors. Cattle bTB reactor rates increased in DNP despite compulsory testing and culling of infected animals. In this study, 124 European wild boar, 95 red deer, and 97 fallow deer were sampled from April 2006 to April 2007 and analyzed for M. bovis infection. Modelling and GIS were used to identify risk factors and intra and inter-species relationships. Infection with M. bovis was confirmed in 65 (52.4%) wild boar, 26 (27.4%) red deer and 18 (18.5%) fallow deer. In the absence of cattle, wild boar M. bovis prevalence reached 92.3% in the northern third of DNP. Wild boar showed more than twice prevalence than that in deer (p<0.001). Modelling revealed that M. bovis prevalence decreased from North to South in wild boar (p<0.001) and red deer (p<0.01), whereas no spatial pattern was evidenced for fallow deer. Infection risk in wild boar was dependent on wild boar M. bovis prevalence in the buffer area containing interacting individuals (p<0.01). The prevalence recorded in this study is among the highest reported in wildlife. Remarkably, this high prevalence occurs in the absence of wildlife artificial feeding, suggesting that a feeding ban alone would have a limited effect on wildlife M. bovis prevalence. In DNP, M. bovis transmission may occur predominantly at the intra-species level due to ecological, behavioural and epidemiological factors. The results of this study allow inferring conclusions on epidemiological bTB risk factors in Mediterranean habitats that are not managed for hunting purposes. Our results support the need to consider wildlife species for the control of bTB in cattle and strongly suggest that bTB may affect animal welfare and conservation

СКРИНИНГ НА ТУБЕРКУЛЕЗ ВИЧ-ПОЗИТИВНЫХ БЫВШИХ И ОТБЫВАЮЩИХ НАКАЗАНИЕ ЗАКЛЮЧЕННЫХ И ЛИЦ БЕЗ ОПРЕДЕЛЕННОГО МЕСТА ЖИТЕЛЬСТВА В МНОГОЦЕНТРОВОМ КОГОРТНОМ ИССЛЕДОВАНИИ В РЕГИОНАХ СЕВЕРО-ЗАПАДА РОССИИ

The aim: of the prospective cohort study was a TB screening evaluation in HIV-infected current and released prisoners and homeless people in comparison to the local HIV-infected residents in the pilot territories. Methods: Prospective data collection of newly registered HIV and TB co-infected cases was provided inSt. Petersburg,VologdaandLeningradregions between 2008 and 2011. The patients’ social and demographic, clinical and epidemiological characteristics were analyzed and predictors of TB-attributable mortality were evaluated. Results: A total of 2888 patients were included in the analysis: 1570 local residents, 777 released prisoners, 404 prisoners and 137 homeless persons. There was no significant difference in age, but prisoners, released prisoners and homeless persons were more likely to be male, urban resident, unemployed and injection drug user, less likely to have microbiological confirmation, presented with a greater incidence of disseminated lung TB, lower CD4 cell count. Significant predictors of TB-attributable morality were current or prior incarceration, urban residence, unemployment, symptoms lasting over 1 year, extra-pulmonary TB at presentation and CD4 cell count less than 200 cell/mkl. Conclusions: Found TB cases in HIV-infected prisoners, released prisoners and homeless persons were at a significantly more advanced disease stage and presented with greater morbidity and mortality to compare to the local residents. Targeted early screening and on time started treatment interventions could improve TB outcomes in these highly vulnerable social groups.Цель: оценка выявления туберкулеза (ТБ) среди ВИЧпозитивных бывших и отбывающих наказание заключенных и бездомных лиц в сравнении с ВИЧ-позитивными постоянными жителями изучаемых территорий. Методы: исследование проводилось проспективно с 2008 по 2011 г. по данным персонифицированного учета впервые зарегистрированных случаев сочетанной инфекции ВИЧ/ТБ в Санкт-Петербурге, Ленинградской и Вологодской областях. Проведен анализ социально-демографических, клинических и эпидемиологических характеристик пациентов и оценены факторы риска летальных исходов от туберкулеза. Результаты: в исследование были включены 2888 больных: 1570 местных жителей, 777 бывших заключенных, 404 отбывающих наказание, 137 лиц без определенного места жительства (БОМЖ). Значимых возрастных различий в группах не установлено, однако заключенные и лица БОМЖ преимущественно были представлены мужчинами, чаще являлись жителями города, безработными и потребителями инъекционных наркотиков (ПИН), реже имели бактериологическое подтверждение диагноза ТБ, чаще имели диссеминированные процессы в легких и низкое число CD4 клеток. Значительными факторами риска летальных исходов от ТБ были: бывшее или настоящее заключение, проживание в городе, безработица, симптомы с длительностью более 1 года, внелегочный туберкулез при выявлении и CD4 менее 200 кл/мкл. Заключение: у ВИЧ-позитивных бывших и отбывающих наказание заключенных и лиц БОМЖ туберкулез выявлялся в более запущенных формах, заболеваемость и смертность от туберкулеза среди них были также более высокими в сравнении с постоянными жителями. Целенаправленное проведение раннего скрининга и своевременное начало лечебных мер могут улучшить исход туберкулеза среди указанной сверхуязвимой социальной группы