Alcohol use, drunkenness and tobacco smoking in rural western Kenya.

OBJECTIVES: To describe the prevalence of smoking and alcohol use and abuse in an impoverished rural region of western Kenya. METHODS: Picked from a population-based longitudinal database of demographic and health census data, 72 292 adults (≥18 years) were asked to self-report their recent (within the past 30 days) and lifetime use of tobacco and alcohol and frequency of recent 'drunkenness'. RESULTS: Overall prevalence of ever smoking was 11.2% (11.0-11.5) and of ever drinking, 20.7% (20.4-21.0). The prevalence of current smoking was 6.3% (6.1-6.5); 5.7% (5.5-5.9) smoked daily. 7.3% (7.1-7.5) reported drinking alcohol within the past 30 days. Of these, 60.3% (58.9-61.6) reported being drunk on half or more of all drinking occasions. The percentage of current smokers rose with the number of drinking days in a month (P < 0.0001). Tobacco and alcohol use increased with decreasing socio-economic status and amongst women in the oldest age group (P < 0.0001). CONCLUSIONS: Tobacco and alcohol use are prevalent in this rural region of Kenya. Abuse of alcohol is common and likely influenced by the availability of cheap, home-manufactured alcohol. Appropriate evidence-based policies to reduce alcohol and tobacco use should be widely implemented and complemented by public health efforts to increase awareness of their harmful effects.

Comparison of percutaneous nucleoplasty and open discectomy in patients with lumbar disc protrusions.

INTRODUCTION: Coblation nucleoplasty is a minimally invasive method, at middle way between conservative and open surgical treatment of patients with degenerative disc disease and lumbar disc protrusion. Authors compare the outcome of patients treated through the two methods. MATERIAL AND RESULTS: Two groups of 80 patients each were treated through open discectomy and nucleoplasty. Patients with radicular symptoms caused by disc protrusions, having antero-posterior diameter of herniated disc less 6 mm, resistant to conservative treatment, were operated using nucleoplasty. When antero-posterior diameter of the disc herniation was > 6 mm, classical discectomy method was applied. Classical surgeries (discectomies) were performed by the senior author (D.A.), while the nucleoplasty procedures all three authors equally participated. In the first group improvement of radicular pain was immediate. At 1 year after the procedure only one third of the patients returned to work. In the group treated through nucleoplasty improvement of pain was slow but gradual. After 1 postoperative year the VAS score of patients treated through the two methods were very close. At 3 days post nucleoplasty all patients returned to work. In this group there were not intraoperative or post-operative complications. One patient was afterwards operated through open discectomy. CONCLUSION: Coblation nucleoplasty is a safe and efficient method to treat patients with lumbar disc protrusion.

TB preventive therapy for people living with HIV: key considerations for scale-up in resource-limited settings.

Tuberculosis (TB) is the leading cause of death for persons living with the human immunodeficiency virus (PLHIV). TB preventive therapy (TPT) works synergistically with, and independently of, antiretroviral therapy to reduce TB morbidity, mortality and incidence among PLHIV. However, although TPT is a crucial and cost-effective component of HIV care for adults and children and has been recommended as an international standard of care for over a decade, it remains highly underutilized. If we are to end the global TB epidemic, we must address the significant reservoir of tuberculous infection, especially in those, such as PLHIV, who are most likely to progress to TB disease. To do so, we must confront the pervasive perception that barriers to TPT scale-up are insurmountable in resource-limited settings. Here we review available evidence to address several commonly stated obstacles to TPT scale-up, including the need for the tuberculin skin test, limited diagnostic capacity to reliably exclude TB disease, concerns about creating drug resistance, suboptimal patient adherence to therapy, inability to monitor for and prevent adverse events, a 'one size fits all' option for TPT regimen and duration, and uncertainty about TPT use in children, adolescents, and pregnant women. We also discuss TPT delivery in the era of differentiated care for PLHIV, how best to tackle advanced planning for drug procurement and supply chain management, and how to create an enabling environment for TPT scale-up success.

Detection of Apparent Cell-free M. tuberculosis DNA from Plasma.

New diagnostics are needed to improve clinicians' ability to detect tuberculosis (TB) disease in key populations such as children and persons living with HIV and to rapidly detect drug resistance. Circulating cell-free DNA (ccfDNA) in plasma is a diagnostic target in new obstetric and oncologic applications, but its utility for diagnosing TB is not known. Here we show that Mycobacterium tuberculosis complex DNA can be detected in plasma of persons with sputum smear-positive TB, even in the absence of mycobacteremia. Among 40 participants with bacteriologically-confirmed smear-positive TB disease who had plasma tested by quantitative PCR (qPCR), 18/40 (45%) had a positive result on at least one triplicate reaction. Our results suggest that plasma DNA may be a useful target for improving clinicians' ability to diagnose TB. We anticipate these findings to be the starting point for optimized methods of TB ccfDNA testing and sequence-based diagnostic applications such as molecular detection of drug resistance.

Mixed impact of Xpert(®) MTB/RIF on tuberculosis diagnosis in Cambodia.

SETTING: National Tuberculosis (TB) Program sites in northwest Cambodia. OBJECTIVE: To evaluate the impact of Xpert(®) MTB/RIF at point of care (POC) as compared to non-POC sites on the diagnostic evaluation of people living with the human immunodeficiency virus (PLHIV) with TB symptoms and patients with possible multidrug-resistant (MDR) TB. DESIGN: Observational cohort of patients undergoing routine diagnostic evaluation for TB following the rollout of Xpert. RESULTS: Between October 2011 and June 2013, 431 of 822 (52%) PLHIV with TB symptoms and 240/493 (49%) patients with possible MDR-TB underwent Xpert. Xpert was more likely to be performed when available as POC. A smaller proportion of PLHIV at POC sites were diagnosed with TB than at non-POC sites; however, at POC sites, a higher proportion of those diagnosed with TB were bacteriologically positive. There was poor agreement between Xpert and other tests such as smear microscopy and culture. Overall, the evaluation of patients with possible MDR-TB increased following Xpert rollout, yet for patients confirmed as having drug resistance on drug susceptibility testing, only 46% had rifampin resistance that would be identified with Xpert. CONCLUSION: Although utilization of Xpert was low, it may have contributed to an increase in evaluations for possible MDR-TB and a decline in empiric treatment for PLHIV when available as POC.

Contexte : Sites du Programme National contre la Tuberculose (TB) dans le nord-ouest du Cambodge.Objectif : Evaluer l'impact du Xpert® MTB/RIF dans des sites où il est réalisé sur place (POC) comparés aux autres sites sur le diagnostic des personnes vivant avec le VIH (PVVIH) et ayant des symptômes de TB ainsi que des patients présumées de TB multirésistante (MDR).Schéma : Cohorte d'observation de patients bénéficiant d'une évaluation diagnostique de routine pour la TB après le lancement de l'Xpert.Résultats : Entre octobre 2011 et juin 2013, 431/822 (52%) PVVIH ayant des symptômes de TB et 240/493 (49%) patients avec suspicion de TB-MDR ont eu un test Xpert. L'Xpert a été réalisé plus souvent lorsqu'il était disponible en POC. Une plus faible proportion de PVVIH a eu un diagnostic de TB dans les sites POC que dans les sites non-POC ; cependant, dans les sites POC, une proportion plus élevée des patients ayant eu un diagnostic de TB a eu une bactériologie positive. L'accord entre l'Xpert et les autres tests (par exemple la microscopie de frottis ou la culture) a été médiocre. Dans l'ensemble, l'évaluation des patients présumées de TB-MDR a augmenté après le lancement de l'Xpert, mais parmi les patients ayant eu une pharmacorésistance confirmée par test de pharmacosensibilité, seulement 46% ont eu une résistance à la rifampicine qui aurait été identifiée par Xpert.Conclusion : Même si l'utilisation de l'Xpert a été faible, l'Xpert pourrait avoir contribué à une augmentation de l'évaluation des suspicions de TB-MDR et à un déclin du traitement empirique des PVVIH quand il est disponible sur place.

Marco de referencia: Los centros del Programa Nacional contra la Tuberculosis en el noroeste de Camboya.Objetivo: Evaluar la repercusión de la práctica de la prueba Xpert® MTB/RIF en el lugar de la consulta, en comparación con la realización de la prueba en otro centro, sobre la evaluación diagnóstica de las personas aquejadas de infección por el virus de la inmunodeficiencia humana (PVVIH) que presentan síntomas de tuberculosis (TB) y de los pacientes con presunción de TB multidrogorresistente (TB-MDR).Método: Fue este un estudio observacional de cohortes de pacientes en curso de evaluación diagnóstica corriente de la TB, después de la introducción de la prueba Xpert.Resultados: De octubre del 2011 a junio del 2013 se practicó la prueba Xpert a 431 de los 822 PVVIH que presentaban síntomas de TB (52%) y a 240 de los 493 pacientes con presunción de TB-MDR (49%). La probabilidad de realizar la prueba Xpert fue mayor cuando esta se podía practicar en el lugar de la consulta. La proporción de PVVIH en quienes se diagnosticó TB en los centros que practicaban localmente la prueba Xpert fue menor que en los demás centros; sin embargo, en los centros que contaban con la prueba fue más alta la proporción de casos de TB confirmados bacteriológicamente. Se observó una baja concordancia entre los resultados de la prueba Xpert y las otras pruebas (la baciloscopia y el cultivo). En general, tras el despliegue de la prueba molecular se investigó un mayor número de pacientes con presunción de TB-MDR; sin embargo, de los pacientes en quienes se confirmó la farmacorresistencia mediante pruebas de sensibilidad solo un 46% presentaba resistencia a rifampicina, que podía detectar la prueba Xpert.Conclusión: Si bien la utilización de la prueba Xpert fue muy limitada, su disponibilidad contribuyó a la investigación de más casos con presunción de TB-MDR y a una disminución del tratamiento empírico de las PPVIH, cuando la prueba Xpert se practicaba en el lugar de la consulta.

Clearing the smoke around the TB-HIV syndemic: smoking as a critical issue for TB and HIV treatment and care.

The collision of the tuberculosis (TB) and human immunodeficiency virus (HIV) epidemics has been described as a 'syndemic' due to the synergistic impact on the burden of both diseases. This paper explains the urgent need for practitioners and policy makers to address a third epidemic that exacerbates TB, HIV and TB-HIV. Tobacco use is the leading cause of preventable death worldwide. Smoking is more prevalent among persons diagnosed with TB or HIV. Smoking is associated with tuberculous infection, TB disease and poorer anti-tuberculosis treatment outcomes. It is also associated with an increased risk of smoking-related diseases among people living with HIV, and smoking may also inhibit the effectiveness of life-saving ART. In this paper, we propose integrating into TB and HIV programmes evidence-based strategies from the 'MPOWER' package recommended by the World Health Organization's Framework Convention on Tobacco Control. Specific actions that can be readily incorporated into current practice are recommended to improve TB and HIV outcomes and care, and reduce the unnecessary burden of death and disease due to smoking.

Principal component analysis of the absorption and resonance Raman spectra of the metallochromic indicator antipyrylazo III.

Metallochromic indicators, whose spectral properties are changed in the presence of metal cations, are used mainly in biological studies to monitor Ca2+ and Mg2+ ions. Antipyrylazo III is such indicator, employed for mid-range Ca2+ concentrations (10-1000 microM). The stoichiometry of the interactions of antipyrylazo III with Ca2+, Mg2+, Ba2+, Sr2+ and Zn2+ ions and the relevant binding constants were studied by principal component analysis (PCA) of the absorption spectral changes. The resonance Raman spectra of the above systems were measured as well, and the resolved Raman spectra of the various species were calculated and assigned. The vibrational spectra are more featured, more characteristic of the binding ions and exhibit stronger relative spectral changes upon binding the cations. The basis sets of Raman spectra could thus be used as an analytical tool for these divalent metallic cations.

Rollout of Xpert(®) MTB/RIF in Northwest Cambodia for the diagnosis of tuberculosis among PLHA.

OBJECTIVE: To describe the implementation and utilization of the Xpert (®) MTB/RIF (Xpert) assay to diagnose tuberculosis (TB) among people living with the human immunodeficiency virus/acquired immune-deficiency syndrome (HIV/AIDS, PLHA) in Cambodia. DESIGN: Following the rollout of Xpert, an evaluation was conducted in four provinces of Cambodia from March to December 2012 to determine the utilization, performance, and turnaround time (TAT) of Xpert among PLHA. Data were collected from paper-based patient registers. RESULTS: Of 497 PLHA with a positive TB symptom screen, 357 (72%) were tested with smear microscopy, and 250 (50%) with Xpert; 25 (10%) PLHA tested with Xpert were positive for TB and none were rifampicin-resistant. The utilization of Xpert increased from 23% to 75%, with a median TAT of 1 day. Across districts, utilization ranged from zero to 85%, while the TAT ranged from zero to 22 days. CONCLUSION: While early data show increasing utilization of Xpert for PLHA with a positive symptom screen, most patients underwent smear microscopy as an initial diagnostic test. Training delays and challenges associated with specimen referral may have contributed to variability in Xpert uptake and TAT, particularly for sites without onsite Xpert testing. Enhanced programmatic support, particularly for specimen referral and results reporting, may facilitate appropriate utilization.

Objectif : Décrire la mise en œuvre et l'utilisation du test Xpert(R) MTB/RIF afin de diagnostiquer la tuberculose (TB) parmi des personnes vivant avec le VIH/SIDA (virus de l'mmunodéficience humaine/syndrome de l'immunodéficience acquise ; PLHA) au Cambodge.Schéma : Après le déploiement du test Xpert, une évaluation a été réalisée dans quatre provinces du Cambodge entre mars et décembre 2012 afin de déterminer l'utilisation, la performance et le délai d'exécution du Xpert parmi les PLHA. Des données ont été recueillies à partir des dossiers papiers des patients.Résultats : Sur 497 PLHA ayant une grille de symptômes de TB positive, 357 (72%) ont bénéficié d'une microscopie de frottis et 250 (50%) ont eu un test Xpert ; 25 (10%) PLHA testés par Xpert étaient positifs pour la TB et aucun n'était résistant à la rifampicine. L'utilisation du Xpert est passée de 23% à 75% avec un délai d'exécution médian d'un jour. Dans les districts, l'utilisation allait de zéro à 85% et le délai de mise en œuvre allait de zéro à 22 jours.Conclusion : Si les données précoces montrent une utilisation croissante du Xpert chez les PLHA avec une grille de symptômes positive, la majorité des patients bénéficiait initialement d'un diagnostic par examen microscopique de frottis. Les délais de formation et les problèmes posés par l'envoi des spécimens peuvent avoir contribué à la variabilité du recours au Xpert et au délai de sa mise en œuvre, particulièrement dans les endroits dépourvus de possibilité de test Xpert sur place. Davantage de soutien aux programmes, notamment en termes d'envoi des spécimens et de retour des résultats, pourrait faciliter son utilisation appropriée.

Objetivo: Describir la introducción y la utilización de la prueba Xpert(R) MTB/RIF en el diagnóstico de la tuberculosis (TB) de las personas aquejadas de infección por el virus de la inmunodeficiencia humana (VIH) y sida (PLHA) en Camboya.Método: Tras el despliegue de Xpert, se llevó a cabo una evaluación en cuatro provincias de Camboya de marzo a diciembre del 2012 con el fin de determinar el tipo de utilización, el rendimiento diagnóstico y el tiempo de obtención de los resultados de la prueba Xpert en las PLHA. Se recogieron los datos de los pacientes a partir de los registros en soporte de papel.Resultados: De los 497 PLHA y una detección positiva de síntomas de la TB, en 357 casos se practicó una baciloscopia (72%) y en 250 la Xpert (50%); 25 de las personas examinadas con Xpert obtuvieron un resultado positivo (10%) y en ninguna se observó resistencia a rifampicina. La utilización de la prueba aumentó de 23% a 75% y la mediana del lapso hasta obtener el resultado fue un día. En los diferentes distritos, el uso de la prueba osciló entre 0% y 85% y el lapso hasta la notificación del resultado fue de cero a 22 días.Conclusión: Los datos iniciales indicaron un aumento de la utilización de la prueba Xpert en las PLHA que presentan una detección positiva de síntomas de la TB, pero en la mayoría de los pacientes se practicó la baciloscopia del esputo como prueba diagnóstica inicial. Es posible que los retrasos en la capacitación y las dificultades relacionadas con la remisión de las muestras hayan contribuido a la variabilidad en la aceptación de la Xpert y en el tiempo de obtención de los resultados, sobre todo en los centros donde no se practica la prueba en el lugar de atención. Se podría fomentar el uso apropiado de esta prueba mediante un apoyo programático, dirigido especialmente a la remisión de las muestras y la notificación de los resultados.

Evaluation of integrated registers for tuberculosis and HIV surveillance in children, Ethiopia, 2007-2009.

In 2008, Ethiopia implemented tuberculosis (TB) treatment registers that included columns for recording human immunodeficiency virus (HIV) test results (integrated registers) to replace the previous system of separate TB and HIV registers (pre-integration registers). We compared the proportion of children with documented HIV rapid test results at eight hospitals before and after adopting the integrated registers. HIV status was more consistently documented in the integrated registers; however, HIV status for infants aged <18 months could not be assessed, as the registers did not capture results from polymerase chain reaction-based testing. Recording procedures should be revised to document age-appropriate HIV diagnostic results and ensure referral for appropriate care.

Evaluation of an international training course to build programmatic capacity for tuberculosis control.

We evaluated the international training course of the Research Institute of Tuberculosis, Kiyose, Japan, by e-mailing structured questionnaires to participants who attended the course from 2001 to 2007. Of 62 responding participants, 34 developed action plan projects (APPs) and 28 developed operations research projects (ORPs). Among respondents drafting APPs, 27 (79%) started implementing projects, and 24 (88%) completed over half of their planned activities. Among respondents drafting ORPs, 11 (39%) started projects but no scientific papers were published. The main reasons for the failure to implement ORPs were due to lack of time, funds, and disapproval by supervisors. A sequential training model may better address barriers to teaching and assisting ORPs.

Electro-oculographic measures in patients with chronic whiplash and healthy subjects: a comparative study.

BACKGROUND: Despite their high incidence, costs, and long lasting disability, whiplash associated disorders (WAD) lack an identifiable objective pathology that explains their acute or chronic symptoms. OBJECTIVE: In view of previous suggestions of a possible effect of neck torsion on several electro-oculography (EOG) parameters, the main objective of this study was to examine their applicability in differentiating patients from uninvolved subjects. METHODS: Smooth pursuit and saccadic eye movements were assessed in 26 patients with chronic WAD and 23 healthy subjects. All tests were executed in three neck positions: neutral and rotations to left and right. RESULTS: Neck torsion did not influence eye movement performance of either the WAD or healthy groups. However, compared with the healthy group, patients with WAD had significantly lower smooth pursuit velocity gain (SPVG) (p = 0.01) and prolonged saccadic latency (p = 0.001), irrespective of neck position. CONCLUSIONS: Despite scattered differences that reached significance, the electro-oculographic measures used in this study do not seem to offer a clinically relevant method for differentiating between patients with WAD and normal subjects.