Treatment outcome of tuberculosis patients at Gondar University Teaching Hospital, Northwest Ethiopia. A five - year retrospective study

Background  

In Gondar University Teaching Hospital standardized tuberculosis prevention and control programme, incorporating Directly Observed Treatment, Short Course (DOTS) started in 2000. According to the proposal of World Health Organization (WHO), treatment outcome is an important indicator of tuberculosis control programs. This study investigated the outcome of tuberculosis treatment at Gondar University Teaching Hospital in Northwest Ethiopia.     

Evaluation of the performance of CareStart™ Malaria Pf/Pv Combo and Paracheck Pf tests for the diagnosis of malaria in Wondo Genet, southern Ethiopia

Objective

To evaluate the diagnostic performance of CareStart™ Malaria Pf/Pv Combo test relative to microscopy for the diagnosis of falciparum and vivax malaria in Ethiopia.

Methods

668 febrile patients visiting two health centers in Wondo Genet, southern Ethiopia, involved in this study in 2008. Giemsa-stained thin and thick blood smears were prepared and microscopically examined under a 100× oil immersion microscope objective for Plasmodium species identification and determination of parasitaemia, respectively. CareStart™ Malaria Pf/Pv Combo test and Paracheck Pf^® test were performed as per the manufacturers’ instruction.

Findings

The diagnostic validity of CareStart™ Malaria Pf/Pv Combo test for the diagnosis of Plasmodium falciparum were very good with sensitivity of 99.4%, specificity of 98%, positive predictive value of 94.4% and negative predictive value of 99.8%. Sensitivity, specificity, positive predictive value and negative predictive value of the test for the diagnosis of P. vivax were 99.4%, 98.2%, 94.5% and 99.8%, respectively. The diagnostic performance of CareStart™ Malaria Pf/Pv Combo test is comparable to that of Paracheck Pf^® test for the diagnosis of P. falciparum (sensitivity 99.4%, specificity 98.2%).

Conclusion

Although CareStart™ Malaria Pf/Pv Combo test and Paracheck Pf^® test have comparable diagnostic performance for the diagnosis of P. falciparum, CareStart™ Malaria Pf/Pv Combo test has the added advantage of diagnosing P. vivax. Hence, it is preferable to use CareStart™ Malaria Pf/Pv Combo test for the diagnosis of malaria in areas where microscopy is not accessible and where malaria due to P. falciparum and P. vivax are co-endemic as in Ethiopia.     

IgA Response to ESAT‐6/CFP‐10 and Rv2031 Antigens Varies in Patients With Culture‐Confirmed Pulmonary Tuberculosis,Healthy Mycobacterium tuberculosis–Infected and Non‐Infected Individuals in a Tuberculosis Endemic Setting,Ethiopia

Little attention has been given to the role of antibodies against Mycobacterium tuberculosis (Mtb) infection. We have compared the levels of IgA and IgG against ESAT‐6/CFP‐10 and Rv2031c antigens in sera of patients with culture‐confirmed pulmonary tuberculosis (PTB), healthy Mtb‐infected and non‐infected individuals in endemic TB settings. Venous blood samples were collected from 166 study participants; sera were separated and assayed by an enzyme‐linked immunosorbent assay (ELISA). QuantiFERON‐TB Gold In‐Tube (QFTGIT) assay was used for the screening of latent TB infection. The mean optical density (OD) values of IgA against ESAT‐6/CFP‐10 and Rv2031 were significantly higher in sera of patients with culture‐confirmed PTB compared with healthy Mtb‐infected and non‐infected individuals (P < 0.001). The mean OD values of IgG against ESAT‐6/CFP‐10 and Rv2031 were also significantly higher in sera of patients with culture‐confirmed PTB compared with healthy Mtb‐infected and non‐infected individuals (P < 0.05). The mean OD values of IgA against both antigens were also higher in sera of healthy Mtb‐infected cases compared with non‐infected individuals. There were positive correlations (P < 0.05) between the level of IFN‐γ induced in QFTGIT assay and the OD values of serum IgA against both antigens in healthy Mtb‐infected subjects. This study shows the potential of IgA response against ESAT‐6/CFP‐10 and Rv2031 antigens in discriminating clinical TB from healthy Mtb‐infected and non‐infected cases. Nevertheless, further well‐designed cohort study is needed to fully realize the full potential of this diagnostic marker.     

Contagious caprine pleuropneumonia and Mannheimia haemolytica-associated acute respiratory disease of goats and sheep in Afar Region, Ethiopia

In April 2002, an investigation into an outbreak of acute respiratory disease in goats and sheep in Milae (Afar), Ethiopia was conducted. The investigation involved 4 flocks (722 sheep and 750 goats in total) and comprised the disease history, clinical and post-mortem examination, and microbiological analysis of nasal swabs, lung lesions, and pleural fluid samples. Clinically diseased animals exhibited severe respiratory distress, and necropsy of two of the goats demonstrated fibrinous pneumonia, lung sequestra, and excessive accumulation of straw coloured fluid in the thoracic cavity. Mannheimia haemolytica biotype T was isolated from nine (six goats and three sheep) out of 23 nasal swabs (39.1%). In the two necropsied animals Mycoplasma capricolum subsp. capripneumoniae (Mccp) was isolated from the lungs, and Mannheimia haemolytica biotype T was isolated from lung lesions and thoracic fluid. An unidentified Mycoplasma species was isolated from the thoracic fluid of one of the goats. Pseudomonas aeruginosa was isolated from a lung sequestrum of one of the necropsied goats. In vitro antimicrobial susceptibility test results indicated that two (33.3%) of the six M. haemolytica isolates that were tested were resistant to ampicillin and penicillin G, three (50%) to tetracycline, four (66.7%) to oxacillin, five (83.3%) to erythromycin, and six (100%) to clindamycin. Pseudomonas aeruginosa was resistant to all of the different classes of antimicrobials that were tested. Pleuropneumonia caused by Mccp, and secondary complications caused by M. haemolytica and the other unidentified Mycoplasma species, were confirmed as the cause of the outbreak. Morbidity was not associated with the species of animals affected (P > 0.05); however, mortality was significantly higher in goats than sheep (P < 0.05).     

The impact of water supply on trachoma prevalence

In 1998, a baseline study of the prevalence of trachoma was conducted in Dalocha District before pipe water supply was made in 1999. This cross-sectional study to determine the prevalence of active trachoma in children aged 1-10 years old was conducted in the same area in March-May, 2002 to assess the impact of water supply on trachoma prevalence. Cluster sampling method was used to identify the villages and households in the previously studied five peasant associations. All children 1-10 years of age from the selected households were examined for the presence of active trachoma (trachomatous follicles, TF, and trachomatous intense inflammation, TI). A total of 644 children, 328 (50.9%) males and 316 (49.1) females, from 329 households were examined. Of these, 358 (55.6%) had active trachoma with 235 (36.5%) having TF and 123 (19.1%) TI. This figure was comparable with the previous report from the same age group and area which was 51.1%. In conclusion, despite improvement in water supply, the difference in the overall prevalence of active trachoma was statistically not significant (p-value = 0.074) from the result of the previous study. Thus, unless it is accompanied by health education to bring about community's behavioral change regarding the importance of personal and environmental hygiene, improvement in water supply seems to have no effect on the prevalence of active trachoma.     

Challenges facing antiangiogenic therapy for cancer: impact of the tumor extracellular environment

It is well known that angiogenesis plays an important role in malignant tumor progression. Thus, a great deal of effort has been focused on the development and evaluation of novel angiogenesis inhibitors for the treatment of human malignancies. In this review, the role of angiogenesis in tumor growth will be examined, as well as efforts to develop and use antiangiogenic therapies to treat malignant tumors. In particular, focus will be on the extracellular environment and the challenges of using antiangiogenic therapy in the clinical setting, in terms of toxicities, potential mechanisms of tumor resistance and optimization of clinical trial design. Attention will be focused upon a mechanistic understanding of the variability and dynamic nature of individual tumor microenvironments, and the potential impact this has on antiangiogenic therapies.     

Screening of some medicinal plants of Ethiopia for their anti-microbial properties and chemical profiles

In the indigenous health care delivery system of Ethiopia, numerous plant species are used to treat diseases of infectious origin. Regardless of the number of species, if any of such claims could be verified scientifically, the potential significance for the improvement of the health care services would be substantial. The objective of this study was, therefore, to determine the presence of anti-microbial activity in the crude extracts of some of the commonly used medicinal plants as well as to identify the class of compounds in the plants that were subjected to such screening. Thus, the crude methanol, petroleum ether and aqueous extracts of 67 plant species were subjected to preliminary screening against 10 strains of bacterial species and 6 fungal strains using the agar dilution method. A sample concentration of 250-2000 microg/ml and 500-4000 microg/ml were used for the bacterial and fungal pathogens, respectively. The results indicated that 44 different plant species exhibited activity against one or more of the bacteria while one species, viz., Albizzia gummifera showed activity against all the 10 bacteria at different gradient of dilution. Twenty three species inhibited or retarded growth of one or more organisms at dilution as low as 250 microg/ml. Extracts of same plants species were also tested against six different fungal pathogenic agents of which eight species showed growth inhibition against one or more of the organisms. Trichila emetica and Dovyalis abyssinica, which inhibited growth of four and five fungal strains at 100 microg/ml concentration, respectively, were the most promising plants. Chemical screening conducted on the extracts of all the plants showed the presence of several secondary metabolites, mainly, polyphenols, alkaloids, tannins sterols/terpenes, saponins and glycosides. The plants containing more of these metabolites demonstrated stronger anti-microbial properties stressing the need for further investigations using fractionated extracts and purified chemical components.     

The role of activity-dependent neuroprotective protein in a mouse model of fetal alcohol syndrome

OBJECTIVE: Fetal alcohol syndrome (FAS) is the most common nongenetic cause of mental retardation. Peptides NAPVSIPQ (NAP) and SALLRSIPA (SAL), related to activity-dependent neuroprotective protein (ADNP), prevent alcohol-induced damage in a mouse model of FAS. Our objective was to characterize ADNP in this model to relate this protein to the mechanisms of damage and peptide neuroprotection. STUDY DESIGN: Timed, pregnant C57Bl6/J mice were treated on day 8. Groups were control, alcohol, peptide pretreatment, or peptide alone. Embryo and decidua were harvested at 6 and 24 hours and 10 days. To evaluate ADNP expression, real-time polymerase chain reaction was performed with results presented as the ratio of ADNP-to-glyceraldehyde-3-phosphate dehydrogenase (GAPDH) concentration. Analysis of variance was performed for overall comparisons with P<.05 considered significant. RESULTS: At 6 hours, there was no difference in ADNP between alcohol-exposed embryos compared with control embryos. At 24 hours, there was an increase in ADNP in alcohol-exposed embryos compared with controls (P<.001); these findings persisted at 10 days (P<.001). In the decidua at 6 hours, there was no difference between alcohol and control. At 24 hours, there was greater ADNP in alcohol-exposed decidua compared with controls (P<.001), which did not persist at 10 days (P=.97). Peptide pretreatment did not prevent the alcohol-induced increase in ADNP in embryo or decidua. CONCLUSION: Alcohol increased embryonic and decidual ADNP expression at 24 hours and it persisted in the embryo for 10 days. Because ADNP is a known neuroprotectant, these findings suggest that it may be released as a protective mechanism in FAS. Changes in the embryo were persistent suggesting that the embryo is more vulnerable to alcohol-induced damage than the mother.