Examining the cost of community-based tuberculosis treatment in South Africa.

SETTING: While South Africa has improved access to tuberculosis (TB) treatment and care, the 2015 treatment success rate for multidrug-resistant TB (MDR-TB) remains low, at 55%. Community-based TB treatment and care improves patient retention compared to the standard of care alone.OBJECTIVE: To assess the cost of a USAID-funded community-based TB model in Nelson Mandela Bay Health District (NMBHD), Eastern Cape Province, South Africa compared to the national standard of care alone.DESIGN: We estimated the cost of community-based DR-TB treatment and adherence support compared to the standard of care alone.RESULTS: Average overall costs were US$2827 lower per patient on the community-based model than the standard of care alone.CONCLUSION: The per-patient cost of the community-based model is lower than the standard of care alone. Assuming the costs and effects of a community-based model implemented in NMBHD were observed at a larger scale, implementing the model could reduce overall health system costs.

Salmonella enterica serotypes and antibiotic susceptibility in New Zealand, 2002-2007.

We analysed the serotypes and antibiotic susceptibility of 1560 human and 1505 non-human Salmonella isolated in New Zealand (NZ) between 2002 and 2007. The most common serotypes in humans were Salmonella enterica serovar Typhimurium, S. Enteritidis, S. Brandenburg and S. Infantis. Over the 6-year period human cases due to S. Agona and S. Enteritidis increased and cases due to S. Typhimurium decreased. The most common serotypes from non-human sources were S. Typhimurium, S. Brandenberg, S. Hindmarsh and S. Infantis, and there were no significant changes over time. More isolates were non-susceptible to streptomycin than to any other antibiotic. Almost all isolates were susceptible to ciprofloxacin and gentamicin. There were significant trends of increasing non-susceptibility to streptomycin and sulfonamides in isolates from human and non-human sources, while ampicillin, tetracycline and multidrug non-susceptibility also increased in human isolates. Despite these increases, rates of antibiotic non-susceptibility in Salmonella in NZ are still lower than in many international settings.

The uninsured and Medicaid Oregon tobacco user experience in a real world, phone based cessation programme.

OBJECTIVE: To describe the experience of uninsured and Medicaid Oregon tobacco users who registered in Free & Clear (F&C), a telephone based cessation programme including five scheduled outbound calls. DESIGN AND SETTING: Using a retrospective cohort design, 1334 (423 uninsured, 806 Medicaid, and 105 commercially insured) Oregon tobacco users who registered in F&C between 18 November 1998 and 28 February 2000 were identified and followed for 12 months post-registration; 648 (48.6%) were successfully contacted at 12 months. Information was collected from the F&C database. Unconditional logistic regression, adjusted for race and education, was used. RESULTS: The seven day quit rate at 12 months, assuming non-respondents were smokers, was 14.8% (95% confidence interval (CI) 13.0 to 16.9). This rate was significantly higher among commercially insured participants (v Medicaid but not uninsured) and among participants who completed > or = 5 calls (v < 5 calls). The quit rate for those contacted at 12 months was 30.6% (95% CI 27.0% to 34.3%) and varied, however not significantly, by insurance and number of calls. After adjustment, respondents who completed > or = 5 calls were 60% more likely to quit tobacco (odds ratio (OR) 1.6, 95% CI 0.9 to 3.1), and uninsured respondents who completed > or = 5 calls were 70% more likely to quit tobacco (OR 1.7, 95% CI 0.9 to 3.5), relative to those who completed < 5 calls, but the difference was not significant. CONCLUSIONS: The quit rates are similar to those reported in efficacy trials. The observed variation in quitting tobacco for respondents by number of calls completed and by insurance merits further investigation concentrating on increasing compliance with the call schedule, particularly for the uninsured.

The differentiation of Brucella species by substrate specific tetrazolium reduction.

In the development of a tetrazolium reduction assay to replace substrate stimulated oxygen uptake for the identification of Brucella species, nine tetrazolium salts were evaluated. Only the more readily reduced compounds (MTT and INT) detected increased metabolic activity with the more fastidious, slow growing strains and with B. suis strains on L-arginine and DL-ornithine. The assay was optimised with MTT. MTT reduction profiles offered with the medium on which the cells were grown. Cells grown on TSA gave profiles more similar to the published respirometric results than those grown on SDA. The optimal substrate concentration was 0.84 g l-1 and prolonged (> 3 h) exposure to substrate was necessary before adding MTT. MTT concentration was not critical and the OD was proportional to the MTT concentration between 0.03 and > 0.5 g l-1. MTT reduction was linear for 60 min after its addition. The reaction was, therefore, stopped after 60 min by adding formaldehyde solution. The optimised assay was evaluated with 71 strains of Brucella, representing all the species and biovars of the genus. Each strain was assigned to its previously identified species and sub-groups were defined.

Transoral resection of spinal cord tumors and posterior cervical spine stabilization.

Transoral resection of an anterior spinal cord tumor consists of three major phases: corpectomy (i.e., removal of vertebral bodies), tumor resection, and duraplasty (i.e., repair of the dura mater). A second surgical procedure, posterior stabilization of the occiput to the C3 vertebra, consists of an iliac crest bone graft for cervical spine fusion and the application of a rigid fixation device. This article describes a patient who underwent a transoral resection of an extramedullary intradural tumor at the C2-C3 level of the spinal cord and a posterior cervical spine stabilization procedure. Perioperative nursing concerns and interventions are discussed from the standpoint of the patient's physical and mental postoperative recovery.

The characterisation of Brucella strains isolated from marine mammals.

Small Gram negative coccobacilli isolated from seals, porpoises, dolphins and from an otter road casualty were identified as Brucellae by their colonial and cell morphology, staining characteristics, biochemical activity, agglutination by monospecific antisera and susceptibility to lysis by Brucella specific bacteriophage. Their characterisation, including metabolic profiles, is described. These strains could not be assigned to recognised nomen species of the genus Brucella and it is suggested that they comprise a new nomen species to be called B. maris (sp. nov., type strain 2/94). It is further suggested the nomen species be subdivided into three biovars corresponding to their CO2 requirement, metabolic activity on galactose, dominant antigen and animal host.

Immunoblot studies in the differential diagnosis of porcine brucellosis: an immunodominant 62 kDa protein is related to the mycobacterial 65 kDa heat shock protein (HSP-65).

Smooth Brucella spp. share certain lipopolysaccharide antigens with other bacteria, resulting in serological cross-reactions which can prevent the definitive diagnosis of brucellosis. To identify other antigens with serodiagnostic potential, immunoblot studies following sodium dodecyl sulphate-polyacrylamide gel electrophoresis were carried out. Sera from pigs experimentally infected with Brucella suis and naturally infected feral pigs, sera from pigs from a farm with a known history of Yersinia enterocolitica 0:9 infection, Brucella Complement Fixation Test (CFT) reactor pigs (aetiology unknown) and pigs from consistently Brucella CFT negative farms were examined. Although B. suis infected pigs recognized a total of nine B. melitensis antigens, individual pigs rarely recognized more than three antigens in the range. A 62 kDa antigen was recognized by the majority (73%) of the Brucella infected pigs, but only by 10 to 23% of pigs from the other groups. This antigen was shown to be the Brucella homologue of the ubiquitous 65 kDa heat shock protein (HSP-65) family by immunoblot studies with 14 monoclonal antibodies to the Mycobacterium leprae HSP-65. Only four of these monoclones (Y1.2, ML-30, D7C and IIIC8) identified the B. melitensis 62 kDa protein suggesting that unshared, potentially Brucella specific, regions exist. Sera from Y. enterocolitica 0:9 infected pigs, CFT reactor pigs (aetiology unknown), CFT negative pigs and hyperimmune pig serum raised to Y. enterocolitica 0:9 also recognized B. melitensis antigens, most notably a 17 kDa protein. This antigen appears to be a common cross-reactive protein.

Serological reactions to Brucella species in British pigs.

Until and including 1987 diagnostically significant serological titres to swine brucellosis had occurred in the serum agglutination test (SAT) or the complement fixation test (CFT), ie, > or = 100 iu or > or = 20 icftu, respectively, almost every year since reliable records began, but usually only about 0.05 per cent in the SAT and 0.005 per cent in the CFT. Brucella suis was never isolated by cultural examination. In 1988 the level of CFT reactions > or = 20 icftu rose to 0.42 per cent (1.04 per cent in the last quarter of the year) but the SAT reactions remained relatively unchanged. In 1989 the levels of both CFT and SAT reactions increased further with CFT reactions again predominating. Analyses of the serological reaction patterns in individual herds suggested that infection with brucella or some other organism capable of causing serological cross-reactions had become widespread in Great Britain, although signs of disease typical of swine brucellosis had not been observed. Some herds had reactions which persisted for many months whereas others showed them for only a short time. In early 1990 Yersinia enterocolitica serogroup O:9 was isolated from some pigs purchased from one of the reactor herds and this organism is probably responsible for the increased numbers of seroreactions. It had not previously been found in pigs in Great Britain.

Control of Leptospira hardjo infection in beef cattle by whole-herd vaccination.

A whole-herd vaccination programme to control Leptospira hardjo infection was applied to a closed herd of approximately 800 beef cattle on the island of Luing in Scotland. An experimental vaccine was produced and the herd was vaccinated annually for five years. Progress was monitored by means of a catalytic model using data for age-specific serological prevalences and geometric mean titres. Any cattle introduced to the herd were subject to antibiotic treatment and quarantine, and at the end of the trial the whole herd was treated prophylactically with antibiotics to minimise the risk of residual infection. There was a progressive right shift in age-specific serological prevalences, and by the end of the trial all young stock entering the breeding herd were seronegative. The age-specific geometric mean titres demonstrated the cessation of an endemic cycle of hardjo infection in the herd. Birth cohort analysis supported the serological evidence of a high level of control, and bacteriological monitoring at the end of the trial indicated that hardjo had been eliminated from the herd.

Failure of penicillin prophylaxis in laboratory acquired leptospirosis.

A laboratory technician developed leptospirosis following accidental inoculation, despite prompt administration of parenteral penicillin by an accepted regimen of post-exposure prophylaxis. Another technician was similarly exposed and was given doxycycline; no illness or serological conversion followed. The implications of these cases are discussed and recommendations made for post-exposure chemoprophylaxis with doxycycline.

The susceptibility of a strain of Leptospira interrogans serogroup icterohaemorrhagiae to amoxycillin, erythromycin, lincomycin, tetracycline, oxytetracycline and minocycline.

The failure of prophylactic penicillin to prevent a laboratory acquired case of Icterohaemorrhagiae leptospirosis prompted determination of the MIC and MBC of amoxycillin, erythromycin, lincomycin, tetracycline, oxytetracycline and minocycline for the infecting strain. Amoxycillin followed by erythromycin were the most effective, with MBCs of 0.5 mg/l after 7 days exposure and 0.1 mg/l after 21 days exposure respectively. Leptospires grew in the presence of high concentrations of tetracycline hydrochloride and oxytetracycline after prolonged incubation. This effect was less pronounced with minocycline, with MIC's of 0.025, 0.05 and 0.1 mg/l after 7, 14 and 21 days exposure respectively. The MIC of lincomycin was 0.25 mg/l at each time interval. These results support the high dose, long duration antibiotic regimens recommended in the literature.

Use of yohimbine hydrochloride to reverse immobilization of polar bears by ketamine hydrochloride and xylazine hydrochloride.

Yohimbine hydrochloride (YH) effectively reversed the immobilizing effects of ketamine hydrochloride (KH) combined with xylazine hydrochloride (XH) in 48 wild polar bears (Ursus maritimus) handled in the summer. Single intravenous doses of YH ranging between 0.029 and 0.198 mg/kg resulted in a median time of 10 min (range: 1-123 min) to post-injection recovery from KH-XH immobilization. Convulsions and muscle twitching were observed in some bears after YH was administered and one death occurred. Median respiratory rate and heartbeat rate increased from 5 br/min to 12 br/min and 51 BPM to 79 BPM, respectively, soon after yohimbine was administered. The median time to recovery after KH-XH administration, including processing and handling time, was 113 min for bears administered yohimbine and 202 min for bears not administered YH. After YH-induced recovery, polar bears showed signs of reduced awareness and many remained recumbent for undetermined periods although they could coordinate movements, stand, and walk or run if disturbed. YH proved to be a useful antagonist to immobilization induced by KH-XH in a field situation.

Prevention of renal carriage of leptospirosis in dogs by vaccination.

Dogs vaccinated with a Leptospira interrogans vaccine containing serogroups Canicola and Icterohaemorrhagiae and prepared from cultures grown in a protein-free medium resisted challenge with heterologous representatives of these serogroups. In contrast, control dogs were pyrexic and leptospires were isolated from the blood for nine days following Canicola challenge and six days after Icterohaemorrhagiae challenge. Leptospires were isolated from the urine of controls throughout the post challenge period and from kidneys at post mortem examination of six out of six and four out of six Canicola and Icterohaemorrhagiae challenged controls, respectively. There have been no reports of hypersensitivity reactions to this vaccine since its introduction in 1980.

Immobilization of polar bears (Ursus maritimus Phipps) with a mixture of tiletamine hydrochloride and zolazepam hydrochloride.

A 1:1 mixture of tiletamine hydrochloride and zolazepam hydrochloride was tested on 39 polar bears in and near Churchill, Manitoba, Canada during October 1983. The mean dose for satisfactory immobilization with a single injection was 5.1 mg/kg. Bears showed signs of ataxia from 1-3 min following injection and were usually sitting within 4 min. The mean induction time, taken as the adoption of sternal recumbency, was 5.1 min. Maximum relaxation was usually seen by about 20 min post-injection. The duration of immobilization appeared to be related to the dose of drug received. In bears that received a dose near the mean, recumbency lasted about 2 hr. Cubs of the year recovered more quickly than adults. Preliminary results indicated that the bears did not suffer respiratory depression and were able to thermoregulate while immobilized. Bears could be handled safely while under the effects of the drug and workers could readily evaluate the state of their sedation by their reactions. The drug did not appear to provide good analgesia at the doses tested.