Use of 3-(4,5-Dimethylthiazol-2-yl)-2,5-Diphenyl Tetrazolium Bromide for Rapid Detection of Rifampin-Resistant Mycobacterium tuberculosis

We describe a test which uses the ability of viable cells to reduce 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyl tetrazolium bromide (MTT) to detect resistance to a bactericidal drug, rifampin, in in vitro-cultured Mycobacterium tuberculosis. The assay shows a linear relationship between the number of viable bacteria and the ability to reduce MTT. Dead mycobacteria were unable to reduce MTT. Rifampin-sensitive M. bovis (BCG) and M. tuberculosis exposed to rifampin showed a rifampin concentration-dependent inhibition of the ability to reduce MTT, while the resistant strains were unaffected. The inhibition of MTT reduction after treatment with rifampin paralleled the reduction in the number of CFU. By using mixing experiments in which the population percentages of rifampin-sensitive and -resistant strains were varied, the assay could detect the presence of rifampin resistance in the mixture when at least 1% of the bacterial population was composed of drug-resistant strains. The assay is cheap, can be visually read, and requires less than 3 days to obtain susceptibility results. The total time required to obtain results, from the time sputum is received in the laboratory, is, in most cases, less than 4 to 5 weeks, which is the time required for primary culture of the bacteria. The MTT assay could, in combination with a test to detect resistance to isoniazid, be a cheap and rapid screening method for multidrug-resistant M. tuberculosis that is affordable even by low-income countries where tuberculosis is a major public health problem.     

Unhealthy Diet Pattern Mediates the Disproportionate Prevalence of Obesity among Adults with Socio-Economic Disadvantage: An Australian Representative Cross-Sectional Study

The role of unhealthy dietary pattern in the association between socio-economic factors and obesity is unclear. The aim was to examine the association between socio-economic disadvantage and obesity and to assess mediation effect of unhealthy dietary pattern defined using the Mediterranean diet criteria. The data source was the Australian National Nutrition and Physical Activity Survey. The study sample included 7744 participants aged 18 years and over, 28% of whom had obesity. We used the Australian Socio-Economic Indexes for Areas (SEIFA) classification system for categorizing socio-economic disadvantage; calculated the Mediterranean Diet Score (MDS) using standard criteria; and used measured body mass index to define obesity. We conducted a mediation analysis using log–binomial models to generate the prevalence ratio for obesity and the proportion mediated by the MDS. The most disadvantaged group was associated with higher level of obesity after controlling for covariates (1.40, 95% CI 1.25, 1.56) compared to the least disadvantaged group, and in a dose–response way for each decreasing SEIFA quintile. The relationship between socio-economic disadvantage and obesity was mediated by the MDS (4.0%, 95% CI 1.9, 8.0). Public health interventions should promote healthy dietary patterns, such as the Mediterranean diet, to reduce obesity, especially in communities with high socio-economic disadvantage.     

Medical and social consequences of tuberculosis in rural Ethiopia

An institution based cross sectional study was conducted in June 1996 at a rural health centre in South Gonder Administrative Zone of Northern Ethiopia. Interview and respective review of medical records of patients were done. A total of 211 tuberculosis (TB) patients were included in the study, 133 (63%) males and 78 (37%) females. Majority (79.6%) of patients had pulmonary disease. Clinical observation based on symptoms and signs suggestive of tuberculosis was used as a sole criteria to prescribe anti-tuberculosis treatment in 54.1% (114/211) of all the patients. Acid fast staining of sputum was done for 51.2% (86/168) of the pulmonary patients out of whom only 31.4% were smear positive. Social ostracism was observed to have been affecting tuberculosis patients and their families to a great extent. Divorce rate due to tuberculosis among patients was 29.1% (37/127). Patients have reported loss or threat to lose their job. Dietary misconceptions were rampant. The TB control activities were ineffective and poorly organised. Starting anti-tuberculosis treatment without proper diagnosis was observed to have negative consequences on the patients and the control programme. Appropriate counselling service along with the medical treatment was provided to patients with eventual family reunions. Patients were also organised into local 'TB clubs' by their residential locations so as to improve treatment adherence and the level of TB awareness among the patients and the community. It is strongly recommended that the political system and health authorities of Ethiopia should have to give much more attention and commitment to the TB control activities in Ethiopia.     

Cellular,synaptic, and biochemical features of resilient cognition in Alzheimer's disease

Although neuritic plaques and neurofibrillary tangles in older adults are correlated with cognitive impairment and severity of dementia, it has long been recognized that the relationship is imperfect, as some people exhibit normal cognition despite high levels of Alzheimer's disease (AD) pathology. We compared the cellular, synaptic, and biochemical composition of midfrontal cortices in female subjects from the Religious Orders Study who were stratified into three subgroups: (1) pathological AD with normal cognition (“AD-Resilient”), (2) pathological AD with AD-typical dementia (“AD-Dementia”), and (3) pathologically normal with normal cognition (“Normal Comparison”). The AD-Resilient group exhibited preserved densities of synaptophysin-labeled presynaptic terminals and synaptopodin-labeled dendritic spines compared with the AD-Dementia group, and increased densities of glial fibrillary acidic protein astrocytes compared with both the AD-Dementia and Normal Comparison groups. Further, in a discovery-type antibody microarray protein analysis, we identified a number of candidate protein abnormalities that were associated with a particular diagnostic group. These data characterize cellular and synaptic features and identify novel biochemical targets that may be associated with resilient cognitive brain aging in the setting of pathological AD.     

An adolescent with significant emotional and medically unexplained complaints: case report and proposal of an intervention

Background

Ethiopia is a country in which child and adolescent mental health needs are often not met. In order to promote capacity building, a Collaborative International Exchange Programme has been established between Jimma University at Jimma, Ethiopia, and Ludwig-Maximilian University in Munich, Germany. The programme focuses on training non-physician health professionals in mental health speciality. One of the courses in the training programme, child psychiatry, involves a child psychiatrist and a children’s nurse supporting the management of a patient described in this case report. Its conceptual framework is based on the section “significant emotional and medically unexplained complaints” of the “WHO mental health GAP intervention guide for mental, neurological and substance use disorders in non-specialized health settings”.

Objective

The purpose of this case report is to promote confidence in mental health professionals when managing patients with similar conditions, and to stimulate further evaluation of the conceptual approach in developing countries.

Patient

The subject of this case report is a 14-year-old adolescent girl admitted to the psychiatric clinic at Jimma University Teaching Hospital. She was admitted for intractable retching, inability to eat, weight loss, and inability to walk. Challenges included the combination of medical and psychiatric symptoms, and the significant impairment of functioning in this adolescent. The first aim in the management of this patient was to guarantee vital functions. In a problem-oriented approach, different domains were addressed to restore nutritional, social, emotional, and motor functions. Treatment consisted of various elements of psychosocial interventions. The patient improved in 2 weeks and the final diagnosis was conversion disorder.

Conclusion

Psychosocial interventions can be developed in cooperation, and applied in a setting where little child mental health expertise is available. Case-based learning relying on local expertise is suitable in meeting local needs and in developing mental health services for children and adolescents.

     

Considerations in the design of clinical trials for cognitive aging

What will it take to develop interventions for the treatment of age-related cognitive decline? Session V of the Summit provided perspectives on the design of clinical trials to evaluate promising but unproven interventions, and some of the steps needed to accelerate the discovery and evaluation of promising treatments. It considered strategies to further characterize the biological and cognitive changes associated with normal aging and their translation into the development of new treatments. It provided regulatory, scientific, and clinical perspectives about neurocognitive aging treatments, their potential benefits and risks, and the strategies and endpoints needed to evaluate them in the most rapid, rigorous, and clinically meaningful way. It considered lessons learned from the study of Alzheimer's disease, the promising roles of biomarkers in neurocognitive aging research, and ways to help galvanize the scientific study and treatment of neurocognitive aging.     

High bisphenol A (BPA) concentration in the maternal,but not fetal,compartment increases the risk of spontaneous preterm delivery

Objective: The objective of this study is to determine if BPA exposure, as measured by maternal plasma (MP) and amniotic fluid (AF) BPA concentrations is associated with an increased risk of spontaneous preterm birth (PTB) and preterm premature rupture of membranes (pPROM).

Methods: In this nested case–control study, MP samples from women in term labor (n?=?30), preterm labor that ended with preterm delivery (n?=?25), or who had pPROM (n?=?30) and amniotic fluid samples from term labor (n=?45), preterm labor (n?=?60), and pPROM (n?=?35) were assayed for BPA by enzyme immunoassay.

Results: BPA was detectible in 100% of MP and AF samples. Women with MP BPA concentrations in the fourth quartile were at increased risk of PTB (cOR?=?4.12, 95% CI?=?1.32–12.87; aOR?=?4.78, 95% CI?=?1.14–20) but not pPROM. High (fourth quartile) AF BPA values also tended to increase the risk of pPROM (cOR?=?2.47, 95% CI?=?0.96–6.37) but results were not statistically significant.

Conclusions: Increased BPA concentration is associated with an increased risk for PTB or pPROM depending on the maternal–fetal compartment(s) affected. High MP plasma BPA concentrations are associated with PTB with intact membranes but high AF BPA concentrations may weakly be associated with pPROM.     

Do adult patients with diabetes mellitus living in rural part of Ethiopia and having poor social support have disproportionately poor self-care practice? A systematic review and meta-analysis

ObjectiveThis systematic review and meta-analysis is aimed at determining the pooled national percentage of diabetic self-care practice and its determinants among adult diabetic patients in Ethiopian.MethodsDifferent electronic databases including PubMed/Medline and search engines such as Google scholar were used to retrieve published studies. The Joanna Briggs Institute quality appraisal checklists were used to appraise the quality of studies. Data were extracted using excel spreadsheets and analyses were done by STATA 14. Heterogeneity among studies was diagnosed using the I² test. The DerSimonian and Laird random-effects model was employed for substantial heterogeneity (I2 > 50%). The pooled estimate of diabetic self-care and odds ratio was reported based on the 95% CI.ResultsA total of 3861 studies were identified, of which only 19 studies have reached the final qualitative synthesis and quantitative analysis. Well over half of the Ethiopian diabetic patients have good self-care 54.04% (47.07–61.01, I² = 97.3, P < 0.001). Subgroup analysis by region showed that the highest pooled estimate was observed in Southern Nations Nationalities and Peoples 81.96% (71.85–92.04), I² = 89.1, p < 0.002), whereas the lowest was from the Harari region 44.53% (32.16–56.89%) I² = 94%, p < 0.001). Being knowledgeable about diabetes Mellitus 2.69 (1.62, 4.46; I2 = 99%, p < 0.001), having good social support 2.25 (1.49–3.39; I² = 99%, p = 0.00), owning private glucometer 3.04(1.64, 5.65; I² = 97.4, P < 0.001), and being urban residents 3.26 (2.24, 4.74; I² = 96.3%, P < 0.001) promote diabetic victims to apply self-care practice.ConclusionsDespite the life-threatening complications of diabetes Mellitus, the percentage of patients applying self-care has remained low in Ethiopia, depicting the high proportion of diabetic patients are prone to develop long and short-term sequelae of diabetes Mellitus. Therefore, improving the client’s awareness about the disease and counseling clients about the significance of social support are believed to be possible strategies to improve self-care practice and policymakers are strongly recommended to combat complications to attain sustainable development goal 3.4 Aims to reduce premature death.RegistrationThe protocol has been registered under the prospective Register of Systematic Review and Meta-analysis (PROSPERO) and received a unique registration number CRD42020151014.