Prevalence and Risks of Syphilis among Commercial Sex Workers in Georgetown, Guyana

ABSTRACT Objective: To determine the knowledge attitude and practice (KAP) and prevalence of syphilis and to investigate the sexual health practices and constraints among commercial sex workers (CSWs) in Guyana. Methods: The participants were randomly selected from CSWs participating in support group meetings held in Georgetown and Berbice. The survey was cross-sectional, and SPSS 20.0 was used to perform the data analysis. Results: The majority (92.9%) of CSWs tested negative for syphilis, whereas two (2.9%) of the five (7.1%) reactive Venereal Disease Research Laboratory cases indicated prior history of syphilis infection. In the study, 54.3% of participants always used condoms, whereas 74.3% did not use drugs and only 2.9% consumed alcohol every day. The participants had a fair KAP towards syphilis but few misconceptions exist. Stigma and discrimination was identified as the major constraint faced by male sex workers, and 97.1% of CSWs indicated that they preferred giving up sex work. Conclusion: Syphilis was not prevalent among the selected CSWs in Georgetown and Berbice. Prevention programmes should be continued through the support groups to maintain and increase safe sexual practices among female sex workers. Strategies should also be tailored to provide rehabilitation to the CSWs, especially for those willing to give up sex work.

A Study on Trends and Patterns of Leprosy in Guyana during a Ten year Period, 2007-2016

Leprosy is a chronic infectious disease caused by Mycobacterium leprae, an acid-fast, rod-shaped bacillus. This study reports the trends of leprosy in Guyana during the year 2007-2016. This is a retrospective study conducted by analyzing records of all cases registered with Guyana Hansen's Disease Control Programme (GHDCP) during the ten year period. A total of 265 patients data were analyzed in this study. Mean age ± standard deviation (SD) of leprosy patients was 34.5 ± 17 (95% CI 32.5-36.6). There was a noticeable overall increase in the number of leprosy cases throughout the years 2007 to 2016. The trend of PB cases on the other hand, revealed noticeable increase from 9.9% in 2007 to 12.7% in 2016 similarly percentage of multibacillary (MB) cases also showed an increase from 9.4% in 2007 to 14.1% in 2016 (p=0.61). Significantly more cases were recorded for MB (71.9%; 95% CI 66.1-77.2) (p < 0.001) than Paucibacillary (PB) (26.6%; 95% CI 21.4-32.3) (p < 0.001). Within MB, significantly more cases were with LL (28.5%; 95% CI 23.1- 34.3) followed by BL (13.9%; 95% CI 9.9-18.6) (p < 0.001). However, the highest proportion of childhood leprosy and a considerable number of new cases could witness the active transmission of the disease and the existence of new infections within the country. This study therefore provides an insight into the trends of leprosy in Guyana and the result should be considered important to create awareness and reinforcement of policies towards leprosy care.

Comparative evaluation of Ziehl Neelsen staining and knowledge, attitudes and practices of laboratory personnel in relation to Ziehl Nielsen / Evaluación comparativa de la tinción de Ziehl Neelsen y los conocimientos, actitudes y prácticas (CAP) del personal de laboratorio en relación con Ziehl Nielsen

OBJECTIVE: To describe laboratory personnel's attitude and practices toward phenol exposure during Ziehl Neelsen (ZN) acid fast staining method and to evaluate the feasibility of an alternate modified Kinyoun cold (MKC) stain. METHOD: A total of 187 sputum samples were collected from suspected tuberculosis cases and stained by the MKC method and ZN stain and were read by an experienced microscopist and a researcher. A crosssectional questionnaire survey of 35 laboratory personnel was also conducted. RESULTS: Modified Kinyoun cold stain gave sensitivity, specificity, positive and negative predictive values of 100%, 99.4%, 94.1% and 100%, respectively. Both stains corresponded with an agreement rate of 99.5%. Almost 94.7%of respondents reported that they worked in a closed area when staining and 57.1% did the staining method without ventilation. Material safety data sheet (MSDS) of phenol was not known to 77.1% of laboratory personnel. All of the participants (100%) in this study welcomed a similar, non heating method for acid-fast bacillus (AFB). There was significant association between those not comfortable with phenol exposure (77.1%) and complaints of irritation (48.6%) and headache (2.9%) [χ² = 10.98, r = 0.55, p = 0.001]. CONCLUSIONS: The MKC is suitable for use as a substitute for the ZN method for the demonstration of AFB in the primary diagnosis and treatment assessment of pulmonary tuberculosis. Focus should be given on educating laboratory staff on the hazards, risks and precautions associated with the phenol/ZN method.

OBJETIVO: Describir las actitudes y prácticas del personal del laboratorio hacia la exposición al fenol durante la aplicación del método de tinción ácido-rápida de Ziehl Neelsen (ZN), y la viabilidad de la alternativa de una tinción de Kinyoun en frío modificada (MKC). MÉTODO: Un total de 187 muestras de esputo fueron recogidas de casos con sospecha de tuberculosis, y teñidas por el método MKC y la tinción de ZN, tras lo cual fueron leídas por un microscopista y un investigador con experiencia. También se realizó una encuesta transversal a manera de cuestionario, entre las 35 personas que conformaban el personal del laboratorio. RESULTADOS: La tinción de Kinyoun en frío modificada arrojó sensibilidad, especificidad, y valores predictivos positivos y negativos de 100%, 99.4%, 94.1% y 100%, respectivamente. Ambas tinciones se correspondieron con una tasa de acuerdo de 99.5%. Casi el 94.7% de los encuestados informó que trabajaban en un área cerrada en el momento de la tinción, y 57.1% tuvo el método de la tinción sin ventilación. La ficha de datos de seguridad (FDS) de fenol era desconocida para el 77.1% del personal de laboratorio. Todos los participantes (100%) en este estudio dieron la bienvenida a un método similar, sin calentamiento, para los bacilos acidoresistentes (BAR). Hubo una asociación significativa entre aquellos para quienes la exposición al fenol les era inconfortable (77.1%) y las quejas de irritación (48.6%) y dolor de cabeza (2.9%) [χ² = 10.98, r = 0.55, p = 0.001]. CONCLUSIONES: El MKC es adecuado para uso como sustituto del método de ZN para la demostración de BAR en el diagnóstico primario y la evaluación del tratamiento de la tuberculosis pulmonar. Debe centrarse la atención en educar al personal de laboratorio en los peligros, los riesgos, y la precaución asociados con el método de fenol/ZN.

Detection of drug resistant Mycobacterium tuberculosis among patients with and without HIV infection in a rural setting / Detección de Mycobacterium tubersulosis resistente a los antibióticos entre pacientes con y sin infección por VIH en un área rural

OBJECTIVE: To analyse the sensitivity of Mycobacterium tuberculosis by nitrate reductase assay (NRA) and the Hain molecular line probe assay (LPA) in sputa of tuberculosis (TB)/HIV co-infected patients in Guyana. DESIGN: Sputum samples were collected from known TB patients at Georgetown Chest Clinic and were analysed at the Reference Laboratory, Guyana, over the period April 2010 to April 2011. RESULTS: Both methods recorded greater sensitivity for rifampin (RIF) than of isoniazid (INH). Both methods detected four RIF resistant, two INH resistant and two multi-drug resistant (MDR) strains and they had greater negative agreement indices than positive agreement indices. CONCLUSION: It was established that the sensitivity of Mycobacterium tuberculosis by the NRA and Hain LPA in TB/HIV co-infected patients has acceptable correlation and that HIV infection does not affect drug susceptibility testing.

OBJETIVO: Analizar la sensibilidad de Mycobacterium tuberculosis por medio del ensayo de nitrato reductasa (NRA) y el ensayo de sonda lineal (LPA) molecular de Hain en esputos de pacientes co-infectados TB/VIH en Guyana. DISEÑO: Muestras de esputo de pacientes de la Clínica del Tórax en Georgetown diagnosticados con tuberculosis, fueron analizadas en el Laboratorio de Referencias, en Guyana, en el período de abril de 2010 a abril de 2011. RESULTADOS: Ambos métodos registraron una mayor sensibilidad a la rifampicina (RIF) que a la isoniacida (INH). Ambos métodos detectaron cuatro cepas resistentes a RIF, dos resistentes a INH, y dos resistentes a mútiples medicamentos (RMM). Asimismo, presentaban mayores índices de concordancia negativa que de concordancia positiva. CONCLUSIÓN: Se estableció que la sensibilidad de Mycobacterium tuberculosis por medio del ensayo de NRA y el LPA de Hain en pacientes co-infectados TB/VIH, guarda una correlación aceptable, y que la infección por VIH no afecta la prueba de susceptibilidad a los medicamentos.

Comparison of urine analysis using manual and sedimentation methods / Comparación del análisis de orina usando el método manual y el método de sedimentación

OBJECTIVE: Microscopic examination of urine sediment is an essential part in the evaluation of renal and urinary tract diseases. Traditionally, urine sediments are assessed by microscopic examination of centrifuged urine. However, the current method used by the Georgetown Public Hospital Corporation Medical Laboratory involves uncentrifuged urine. To encourage high level of care, the results provided to the physician must be accurate and reliable for proper diagnosis. The aim of this study is to determine whether the centrifuge method is more clinically significant than the uncentrifuged method. METHODS: In this study, a comparison between the results obtained from centrifuged and uncentrifuged methods were performed. A total of 167 urine samples were randomly collected and analysed during the period April-May 2010 at the Medical Laboratory, Georgetown Public Hospital Corporation. The urine samples were first analysed microscopically by the uncentrifuged, and then by the centrifuged method. The results obtained from both methods were recorded in a log book. These results were then entered into a database created in Microsoft Excel, and analysed for differences and similarities using this application. Analysis was further done in SPSS software to compare the results using Pearson's correlation. RESULTS: When compared using Pearson's correlation coefficient analysis, both methods showed a good correlation between urinary sediments with the exception ofwhite bloods cells. The centrifuged method had a slightly higher identification rate for all of the parameters. CONCLUSIONS: There is substantial agreement between the centrifuged and uncentrifuged methods. However, the uncentrifuged method provides for a rapid turnaround time.

OBJETIVO: El examen microscópico del sedimento de orina es una parte esencial en la evaluación de enfermedades renales y del tracto urinario. Tradicionalmente, los sedimentos de orina son evaluados mediante examen microscópico de orina centrifugada. Sin embargo, el método actual usado por el Laboratorio Médico de la Corporación del Hospital Público de Georgetown recurre a la orina no centrifugada. Con el propósito de estimular un alto nivel de cuidado, los resultados proporcionados al médico tienen que ser exactos y fiables para un diagnóstico apropiado. El objetivo de este estudio es determinar si el método de la centrifugación es clinicamente más significativo que el método sin centrifugación. MÉTODOS: En este estudio, se hace una comparación entre los resultados obtenidos a partir del método con centrifugado y sin centrifugado. Un total de 167 muestras de orina fueron recogidas aleatoriamente y analizadas durante el periodo de abril a mayo de 2010 en el Laboratorio Médico de la Corporación del Hospital Público de Georgetown. Las muestras de orina se analizaron primero microscópicamente por el método sin centrifugado, y entonces por el método con centrifugación. Los resultados obtenidos mediante ambos métodos fueron registrados en un en un diario de documentación. Estos resultados fueron entonces introducidos en un banco de datos creado en Microsoft Excel, y analizados en cuanto a sus diferencias y similitudes usando esta aplicación. El análisis se realizó también más tarde mediante el software de SPSS para comparar los resultados usando la correlación de Pearson. RESULTADOS: Al ser comparados mediante análisis basado en el coeficiente de correlación de Pearson, ambos métodos mostraron una buena correlación de los sedimentos urinarios, con excepción de los leucocitos. El método de la centrifugación tuvo una tasa de identificación ligeramente más alta para todos los parámetros. CONCLUSIONES: Existe una correspondencia sustancial entre los métodos con centrifugado y sin centrifugado. Sin embargo, el método que no emplea la centrifugación ofrece un tiempo de respuesta más rápido.