Tuberculosis among community-based health care researchers.

BACKGROUND: Occupational tuberculosis (TB) in hospital-based health care workers is reported regularly, but TB in community-based health care researchers has not often been addressed. OBJECTIVE: To investigate TB incidence in health care researchers in a high TB and human immunodeficiency virus prevalent setting in the Western Cape, South Africa. The health care researchers were employed at the Desmond Tutu TB Centre, Stellenbosch University. METHODS: A retrospective analysis was performed of routine information concerning employees at the Desmond Tutu TB Centre. The Centre has office-based and community-based employees. RESULTS: Of 180 researchers included in the analysis, 11 TB cases were identified over 250.4 person-years (py) of follow-up. All cases were identified among community-based researchers. TB incidence was 4.39 per 100 py (95%CI 2.45-7.93). The standardised TB morbidity ratio was 2.47 (95%CI 1.25-4.32), which exceeded the standard population rate by 147%. CONCLUSIONS: TB incidence in South Africa was 948 per 100,000 population per year in 2007; in the communities where the researchers worked, it was 1875/100,000. Community-based researchers in the study population have a 2.34 times higher TB incidence than the community. It is the responsibility of principal investigators to implement occupational health and infection control guidelines to protect researchers.

Baseline sputum time to detection predicts month two culture conversion and relapse in non-HIV-infected patients.

BACKGROUND: Few biomarkers are available to identify tuberculosis (TB) patients at risk of delayed sputum conversion and relapse. OBJECTIVES: To investigate whether baseline pre-treatment time to detection (TTD) of culture predicted 2-month bacteriological conversion and TB relapse. METHODS: A total of 263 non-HIV-infected smear-positive previously untreated pulmonary TB patients were prospectively followed from diagnosis until treatment outcome after 6 months' treatment and TB recurrence within 24 months. RESULTS: The median TTD was 3 days (range 1-17). Of 211 (80.2%) patients with favourable treatment outcome, 22 (10.4%) had recurrence, while 12 (5.7%) had confirmed relapse. Culture conversion at 2 months was associated in univariate analysis with the presence and number of cavities, extensive parenchymal involvement, male sex, sputum smear grading and TTD. In multiple logistic regression, TTD or smear grading and extensive parenchymal involvement both predicted month 2 conversion. Relapse was predicted by TTD, sex, body mass index, smear grading and number of cavities in univariate analysis, and in multivariate regression by TTD and sputum smear grading. CONCLUSIONS: Baseline TTD and smear grading predicted month 2 culture conversion, relapse and also recurrence. These markers may be useful to identify non-HIV-infected patients at risk of recurrence, and may be relevant in clinical trials.

From suspect to patient: tuberculosis diagnosis and treatment initiation in health facilities in South Africa.

SETTING: Thirteen primary health care (PHC) facilities in the Stellenbosch District, South Africa. OBJECTIVE: To assess the use of a sputum register to evaluate the tuberculosis (TB) diagnostic process and the initiation of TB treatment in selected PHC facilities in a country with a centralised laboratory system. DESIGN: This prospective study was conducted between April 2004 and March 2005. The names of all individuals submitting sputum samples for TB testing were noted in a newly introduced sputum register. We classified all TB suspects with two positive smears as TB cases and consulted TB treatment registers until 3 months after sputum submission to determine how many had started treatment. RESULTS: A total of 4062 persons aged > or =15 years submitted sputum samples, of whom 2484 were TB suspects. There were 2037 suspects with at least two results, 367 (18%) had at least two positive smears and 64 (17%) of these did not start treatment (initial defaulters). Over the entire diagnostic process, up to 5% of TB cases were missed, and up to 26% did not start treatment and were not reported. CONCLUSION: By correcting diagnostic weaknesses identified in the sputum register, PHC facilities will be able to detect, treat and cure a higher percentage of TB patients.

Initial default from tuberculosis treatment: how often does it happen and what are the reasons?

A study in 11 primary health care facilities in and around Cape Town determined the proportion of bacteriologically confirmed tuberculosis (TB) cases who did not start treatment (initial default) and identified reasons for it. Databases from centralised laboratories were compared with electronic TB treatment registers. Fourteen per cent (373/2758) of TB suspects were TB cases. Of the 58 (16%) initial defaulters, 14 (24%) died, while 26 (45%) could not be interviewed for address-related reasons. The 18 subjects who were interviewed indicated reasons for initial default that were (56%) or were not (44%) directly linked to services. High initial default rates require improvement in the quality of health services.

Decision support systems for monitoring and maintaining health in food animal populations.

To mitigate the effects of risks to food safety and infectious disease outbreaks in farmed animals, animal health authorities need to have systems in place to identify and trace the source of identified problems in a timely manner. In the event of emergencies, these systems will allow infected or contaminated premises (and/or animals) to be identified and contained, and will allow the extent of problems to be communicated to consumers and trading partners in a clear and unambiguous manner. The key to achieving these goals is the presence of an effective animal health decision support system that will provide the facilities to record and store detailed information about cases and the population at risk, allowing information to be reported back to decision makers when it is required. Described here are the components of an animal health decision support system, and the ways these components can be used to enhance food safety, responses to infectious disease incursions, and animal health and productivity. Examples are provided to illustrate the benefit these systems can return, using data derived from countries that have such systems (or parts of systems) in place. Emphasis is placed on the features that make particular system components effective, and strategies to ensure that these are kept up to date.

Swimming behavior of the nudibranch Melibe leonina.

Swimming in the nudibranch Melibe leonina consists of five types of movements that occur in the following sequence: (1) withdrawal, (2) lateral flattening, (3) a series of lateral flexions, (4) unrolling and swinging, and (5) termination. Melibe swims spontaneously, as well as in response to different types of aversive stimuli. In this study, swimming was elicited by contact with the tube feet of the predatory sea star Pycnopodia helianthoides, pinching with forceps, or application of a 1 M KCl solution. During an episode of swimming, the duration of swim cycles (2.7 +/- 0.2 s [mean +/- SEM], n = 29) and the amplitude of lateral flexions remained relatively constant. However, the latency between the application of a stimulus and initiation of swimming was more variable, as was the duration of an episode of swimming. For example, when touched with a single tube foot from a sea star (n = 32), the latency to swim was 7.0 +/- 2.4 s, and swimming continued for 53.7 +/- 9.4 s, whereas application of KCl resulted in a longer latency to swim (22.3 +/- 4.5 s) and more prolonged swimming episodes (174.9 +/- 32.1 s). Swimming individuals tended to move in a direction perpendicular to the long axis of the foot, which propelled them laterally when they were oriented with the oral hood toward the surface of the water. The results of this study indicate that swimming in Melibe, like that in several other molluscs, is a stereotyped fixed action pattern that can be reliably elicited in the laboratory. These characteristics, along with the large identifiable neurons typical of many molluscs, make swimming in this nudibranch amenable to neuroethological analyses.

Autoradiographic identification of kidney angiotensin IV binding sites and angiotensin IV-induced renal cortical blood flow changes in rats.

The present investigation initially determined that specific binding sites for the hexapeptide angiotensin IV (AngIV) are present in the rat kidney cortex and outer medulla but not in the inner medulla, using in vitro autoradiographic techniques. This binding site has been termed AT4, is distinct from the previously characterized AT1 and AT2 sites, and does not bind the specific AT1 receptor antagonist DuP753 or the AT2 receptor antagonist PD123177. Renal artery infusions of AngIV produced a dose-dependent increase in cortical blood flow without altering systemic blood pressure. In contrast, the infusion of angiotensin II (AngII) induced a dramatic decrease in cortical blood flow, accompanied by a significant elevation in systemic blood pressure. The infusion of [D-Val(1)]AngIV, an analog that does not bind at the AT4 receptor site, and the C-terminal truncated analogs AngIV (1-4) and AngIV (1-5) that possess lower affinity for this site, produced no change in cortical blood flow. The infusion of [Nle1]AngIV and [Lys1]AngIV, analogs that bind with high affinity at the AT4 receptor site, produced increases in cortical blood flow with no influence on blood pressure. Pretreatment with a specific AT4 receptor antagonist, Divalinal-AngIV, completely blocked AngIV-induced elevations in blood flow, but failed to influence AngII-induced decreases in blood flow, suggesting that these ligands are acting at different receptor sites. Pretreatment with the nitric oxide synthase inhibitor, NG-Monomethyl-L-Arginine, also blocked subsequent AngIV-induced increases in cortical blood flow. These data support the notion that AngIV exerts a unique influence upon renal hemodynamics via the AT4 receptor subtype, and suggest that AngIV-induced elevations in blood flow may be mediated by nitric oxide.