Treatment outcomes among HIV-positive orphaned and non-orphaned children on antiretroviral therapy in Johannesburg, South Africa

Background. Limited research investigating treatment outcomes for HIV-positive orphans compared with non-orphans has shown mixed results, with several studies indicating that HIV-positive orphans are at greater risk of delayed access to HIV care and poor antiretroviral therapy (ART) adherence, while other data suggest that ART outcomes of orphans can be similar to those of non-orphans. Understanding the impact of orphan status on short-term ART outcomes could improve targeted intervention strategies, and subsequent long-term treatment and developmental outcomes, for HIV-positive infants, children and adolescents.Objectives. To evaluate the relationship between orphan status and ART outcomes among HIV-positive infants, children and adolescents initiating ART at two large public sector HIV clinics in Johannesburg, South Africa.Methods. This was a retrospective cohort study of HIV-positive children aged <18 years initiating standard first-line ART between June 2004 and May 2013. Using propensity scores, orphans and non-orphans were matched for age, sex, World Health Organization stage and ART regimen. The effect of orphanhood on attrition from care (all-cause mortality and loss to follow-up) was evaluated using Cox proportional hazards regression analysis, and its effect on having a detectable viral load (≥400 copies/mL) at 12 months on ART using binomial regression analysis with modified Poisson distribution.Results. A total of 251 (29.4%) orphans (maternal, paternal or both) and 603 (70.6%) non-orphans were included at ART initiation. Following multiple imputation for missing data and propensity score matching, 222 orphans and 222 non-orphans were included. Orphans had a median age of 8.0 years (interquartile range (IQR) 4.9 - 10.7) and non-orphans 7.4 years (IQR 4.2 - 10.2). A total of 12 (5.4%) orphans and 33 (14.9%) non-orphans experienced attrition from care during the first 12 months on ART (adjusted hazard ratio 0.32, 95% confidence interval (CI) 0.17 - 0.63). Among those alive and in care, with a viral load at 12 months on ART, 18.0% of orphans (33/183) and 14.8% of non-orphans (24/162) had a detectable viral load (adjusted risk ratio 1.15, 95% CI 1.04 - 1.28).Conclusions. Orphans were less likely than non-orphans to experience attrition, but among those in care at 12 months, orphans were more likely to have detectable viral loads. Lower attrition among orphans may be due to their being in institutional or foster care, ensuring that they make their visits; however, their higher rates of non-suppression may result from lack of psychosocial support or stigma resulting in struggles to adhere. Additional research investigating age-specific outcomes will be important to elucidate these effects further

Knowledge, risk perception and access to healthcare services for HIV and tuberculosis among university students in Johannesburg, South Africa

background. An increasingly diverse body of students is entering university in South Africa. HIV and tuberculosis (TB) are pressing health issues for this vulnerable population and the university campus offers an opportunity to intervene with health promotion activities. Objectives. This study describes knowledge and risk perception of TB and HIV among high school leavers entering tertiary education. Methods. A cross-sectional survey among first-year students, aged 18-25 years, registered at one of three universities chosen for the study in Johannesburg, South Africa. Informed consent was obtained prior to completing a self-administered, close-ended, structured questionnaire. Factors associated with poor knowledge or high risk perception were identified using modified Poisson regression. Results. In total, 792 students were included; 53.3% (n=438) were categorised as having poor TB knowledge and 52.1% (n=412) poor HIV knowledge, while 43.4% (n=344) were categorised as having high TB risk perception and 39.8% (n=315) high HIV risk perception. Male students were more likely to have poor knowledge of HIV and perceive themselves at risk of acquiring HIV. Low socioeconomic status was associated with a high risk perception of HIV. One in 3 participants (30.6%) stated that they had never had an HIV test. In total, 24students (9 males, 15 female) reported that they were HIV-positive, of whom 15 (62.5%) were on antiretroviral therapy. Only 14.1% had been screened for TB in the past 6 months. Conclusion. The findings indicate a need to enhance health promotion activities among university students so as to aid preventive strategies for reducing the burden of HIV and TB infection

Can routine inpatient mortality data improve HIV mortality estimates? Inpatient mortality at an urban hospital in South Africa

Background. South Africa (SA) has one of the world's largest HIV treatment programmes, to which a dramatic increase in life expectancy has been attributed. However, there continue to be concerns regarding the reporting of HIV-related mortality in SA, which varies by source. As accurate HIV mortality estimates are key to measuring the success of the national programme as well as identifying areas for improvement, we propose a complementary approach to monitoring changes in HIV-related mortality using routine inpatient records to examine trends in causes of death and HIV status over time.Objectives. To investigate the feasibility of this approach by calculating mortality due to natural causes in the medical ward of a hospital during 2010 by HIV status.Methods. We conducted a cross-sectional study of inpatient mortality at a regional hospital in Johannesburg, SA, analysing all deaths due to natural causes among adult medical ward inpatients. Cause of death was recorded from the mortuary register. HIV status was ascertained directly from the mortuary register or from laboratory tests specific for HIV diagnosis or monitoring.Results. Of 1 167 inpatients who died, the majority were HIV-positive (58%). HIV positivity among males (55%) was slightly lower than that among females (61%), and HIV-positive patients were younger (median 40 years) than those who were HIV-negative (56 years) and of unknown HIV status (68 years). 'Infections and parasites' was the most common cause of natural death (29%). On average, HIV-positive patients were admitted for slightly longer (mean 10.5 days) than HIV-negative patients (9.6 days) and those of unknown HIV status (8.9 days), yet HIV-positive inpatient deaths accounted for the majority (62%) of the total bed days.Conclusions. Even with widespread access to antiretroviral therapy, the majority of inpatient natural deaths at a large public sector hospital in 2010 were of HIV-positive patients and were probably related to HIV. In view of the importance of accurate data on causes of death, both for the HIV programme and to track other diseases, large-scale expansion of this approach over a longer period should be considered

An automatic selections method for cerebral blood flow autoregulation signals from neonates

Interpretation and quantification of cerebral blood flow autoregulation can be carreid out from step responses to arterial blood pressure changes estimated with various identification methods. However estimates usually need to be visually inspected to rejected some that are not physiologically acceptable...

A review of the ticks (Acari, Ixodida) of Brazil, their hosts and geographic distribution - 1. The State of Rio Grande do Sul, Southern Brazil

A review of the ticks (Acari, Ixodida) of the State of Rio Grande do Sul, southern Brazil, was completed as a step towards a definitive list (currently indicated as 12) of such species, their hosts and distribution. The ticks: Argas miniatus (poultry), Ixodes loricatus (opossums), Amblyomma aureolatum (dogs), A. calcaratum (anteaters), A. cooperi (capybaras), A. nodosum (anteaters), A. tigrinum (dogs) (Neotropical) and Rhipicephalus sanguineus (dogs) (introduced, cosmopolitan, Afrotropical) were confirmed as present, in addition to the predominant, Boophilus microplus (cattle) (introduced, pan-tropical, Oriental). Of the further 18 species thus far reported in the literature as present in the state, but unavailable for examination: only Ornithodoros brasiliensis (humans and their habitations) (Neotropical), Ixodes affinis (deer) (Nearctic/Neotropical) and I. auritulus (birds) (Nearctic/Neotropical/Afrotropical/ Australasian) are considered likely; 13 species would benefit from corroborative local data but the majority appear unlikely; reports of A. maculatum (Nearctic/Neotropical, but circum-Caribbean) are considered erroneous; the validity of A. fuscum is in doubt. The very recent, first known report of the tropical Anocentor nitens (horses)(Nearctic/Neotropical), but still apparent absence of the tropical A. cajennense (catholic) (Nearctic/Neotropical) and the sub-tropical/temperate Ixodes pararicinus (cattle) (Neotropical) in Rio Grande do Sul are important for considerations on their current biogeographical distribution and its dynamics in South America. The state has relatively long established, introduced ("exotic"), Old World tick species (B. microplus, R. sanguineus) that continue to represent significant pests and disease vectors to their traditional, introduced domestic animal hosts, cattle and urban dogs. There are also indigenous, New World ticks (A. miniatus, O. brasiliensis, A. aureolatum, A. nitens), as both long established and possibly newly locally introduced species in the state, that should be considered as potential and emergent pests and pathogen vectors to humans and their more recently acquired, introduced domestic animal hosts; rural poultry, dogs and horses.

Hepatoprotective activity of Trichopus zeylanicus extract against paracetamol-induced hepatic damage in rats.

Trichopus zeylanicus extract has been evaluated for its antihepatotoxic and choleretic activities in rats. The plant leaf suspension (1000 mg/kg; wet weight) as well as its methanol extract (100 mg/kg) showed a remarkable hepatoprotective activity against paracetamol-induced hepatotoxicity as judged from the serum marker enzymes, liver histology and levels of lipid peroxides in liver. The effect of the methanol extract was found to be concentration dependent. The water and hexane extracts were almost inactive. The methanol extract (100 mg/kg) also exhibited choleretic activity in anesthetized normal rats. In short, we report here for the first time the antihepatotoxic as well as choleretic properties of T. zeylanicus.

Human cutaneous leishmaniasis caused by Leishmania (Viannia) braziliensis in Santiago del Estero, Argentina: identification of parasites by monoclonal antibodies and isoenzymes

Estudos de diagnostico, caracterizacao parasitaria e identificacao foram conduzidos em pacientes humanos com lesoes cutaneas de leishmaniose na Provincia de Santiago del Estero, no norte da Argentina. Os procedimentos de diagnostico foram: biopsias de lesoes para utilizacao em esfregacos e inoculacao em hamster; aspiracao (com agulha) de ulceras, para cultura "in vitro". As tecnicas a IFAT-IgG e o teste intradermico de Montenegro. Oito cepas de parasitas foram isoladas, sendo estas obtidas de pacientes com lesoes ativas...

Costs, benefits and operational implications of using quantitative techniques to screen for schistosomiasis haematobium in Egypt.

The official strategy for schistosomiasis control in Egypt relies on individual case detection and treatment. Screening for Schistosoma haematobium has traditionally involved urine sedimentation which shows whether or not eggs are present in the urine, thereby providing only a qualitative assessment of infection status. Recently the Ministry of Health introduced the nucleopore filtration technique into a few villages to assess its applicability for broader use in areas where S. haematobium is endemic. This method gives an indirect quantitative measure of morbidity in terms of egg counts/10 ml urine. The overall purpose of this study was to provide rapid feedback to the Ministry on the likely implications of expanding the use of the filtration technique by examining the benefits, costs and operational problems that may be involved. From 2 villages in Giza Governorate, systematic random samples were taken from the general populations and from schools. Each selected person provided a urine specimen on which the two diagnostic techniques were performed. Filtration offered no additional benefits over sedimentation in terms of defining if a person was infected or not, with sensitivities ranging from 59.6%-75% for filtration and from 60%-73.1% for sedimentation. The additional non-labor costs of using the filtration technique in the two villages were calculated and showed that, if extended to all rural health units in Egypt, the Ministry would need to find an additional 31.6 million pounds (US$9.5 million) each year. A number of operational problems would also be involved in the wider application of the technique.

Economics and tropical diseases: a research agenda using schistosomiasis as an example.

There is a growing interest in health economics in developing countries. In this paper, some of the economic literature concerning schistosomiasis is reviewed and a set of economic questions is derived which could form the basis of a broad research agenda for tropical diseases. The major criterion used to identify research issues is that they should be of practical value to control programs.

Effect of quassin on the metabolism of catecholamines in different life cycle stages of Culex quinquefasciatus.

Quassin, a mosquito larvicide isolated from Quassia amara, inhibits tyrosinase activity in the larvae of Culex quinquefasciatus. Since tyrosinase is directly involved in sclerotisation of the cuticle, it is suggested that quassin, as a larvicide, inhibits development of the cuticle. In presence of quassin phenylalanine, tyrosine and L-dopa levels were increased in larvae. In the larval stages, mosquitoes have a high concentration of phenylalanine and tyrosine with the level of the latter being very high just before pupation and then declines sharply. Monoamine oxidase (MAO), an enzyme directly involved in the metabolism of catecholamines, remained unaffected by quassin, in fact the level of adrenaline also remained unchanged in larvae during quassin poisoning. MAO showed high variation in its activity between synthetic and natural substrates. Tyramine is not a substrate for MAO. Tyrosinase activity was high in developing stages and negligibly low in adults and showed specificity to L-dopa. Phenylalanine and tyramine are unaffected by tyrosinase. Blood feeding did not influence the activity of both these enzymes.

Larvicidal efficacy of Quassin against Culex quinquefasciatus.

Crushed aqueous extracts of leaf, wood, bark and flowers of Quassia amara showed antilarval activity against C quinquefasciatus. Quassin has been identified to be the antilarval principle present in this plant and was effective against mosquito larvae at a concentration of 6 ppm. Quassin was present to the extent of 0.1 to 0.14 per cent (average 0.12%) on a dry weight basis in wood of Q. amara. This compound is an unsaturated lactone and it gave a positive response to the Legal test, characteristic of unsaturated lactones. Quassin lost its antilarval activity on treatment with strong alkalies. Quassin was over five times as active as carbaryl, a synthetic antilarval agent.