Optimization of a rapid test for antibodies to the Chlamydia trachomatis antigen Pgp3

Serological surveillance for trachoma could allow monitoring of transmission levels in areas that have achieved elimination targets. Platforms that allow testing in basic laboratories or testing of easy-to-manage samples such as dried blood spots would contribute to the feasibility of serologic testing. Blood from 506 1–12-year-olds in 2 villages in Kongwa district, Tanzania, was tested for antibodies against the antigen Pgp3. Whole blood, plasma, and dried blood spots (DBS) were tested in lab and field settings using a cassette-enclosed Pgp3 lateral flow assay (LFA-cassette) and a pared-back “dipstick” assay (LFA-dipstick). DBS were also tested with a bead-based multiplex assay (MBA). There was no significant difference in antibody positivity between the MBA and either LFA format (ranging from 42.5% to 48.4%). Interrater agreement between an expert rater and 3 different raters in field and lab settings was uniformly good, with Cohen's kappa >0.81 in all cases.     

Bowel perforation secondary to illegally induced abortion: a tertiary hospital experience in Tanzania

ABSTRACT: BACKGROUND: Bowel perforation though rarely reported is a serious complication of induced abortion, which is often performed illegally by persons without any medical training in developing countries. A sudden increase in the number of patients in our centre in recent years prompted the authors to analyze this problem. The study was conducted to describe our own experiences in the surgical management of these patients. METHODS: This was a retrospective study involving patients who were jointly managed by the surgical and gynecological teams at Bugando Medical Centre (BMC) for bowel perforation secondary to illegally induced abortion from January 2002 to December 2011. The statistical analysis was performed using SPSS version 17.0. RESULTS: A total of 68 patients (representing 4.2% of cases) were enrolled in the study. Their ages ranged from 14 to 45 years with a median age of 21 years. Majority of patients were, secondary school students/leavers (70.6%), unmarried (88.2%), nulliparous (80.9%), unemployed (82.4%) and most of them were dependent member of the family. Previous history of contraceptive use was reported in only 14.7% of cases. The majority of patients (79.4%) had procured the abortion in the 2nd trimester. Dilatation and curettage (82.4%) was the most common reported method used in procuring abortion. The interval from termination of pregnancy to presentation in hospital ranged from 1 to 14 days (median 6 days). The ileum (51.5%) and sigmoid colon (22.1%) was the most common portions of the bowel affected. Resection and anastomosis with uterine repair was the most common (86.8%) surgical procedure performed. Complication and mortality rates were 47.1% and 10.3% respectively. According to multivariate logistic regression analysis, gestational age at termination of pregnancy, delayed presentation, delayed surgical treatment and presence of complications were significantly associated with mortality (P < 0.001). The overall median length of hospital stay (LOS) was 18 days (1 day to 128 days). Patients who developed complications stayed longer in the hospital, and this was statistically significant (P = 0.012). CONCLUSION: Bowel perforation following illegally induced abortion is still rampant in our environment and constitutes significantly to high maternal morbidity and mortality. Early recognition of the diagnosis, aggressive resuscitation and early institution of surgical management is of paramount importance if morbidity and mortality associated with bowel perforation are to be avoided.     

Effects of bone regeneration materials and tooth movement timing on canine experimental orthodontic treatment

Objectives:To evaluate the effects of bone regeneration materials and orthodontic tooth movement (OTM) timing on tooth movement through alveolar bone defects treated with guided bone regeneration (GBR) utilizing xenografts (Bio-Oss) and alloplast (β-TCP).Materials and Methods:Twenty-four standard alveolar bone defects in six male beagle dogs were treated by GBR using either Bio-Oss or β-TCP (experimental), whereas the control defects were left empty. The defects were further grouped into early or late subgroups, depending on OTM timing after GBR (ie 1 month or 2 months, respectively). Rates of OTM were measured intraorally, while computed tomography scan images were used to assess bone density, alveolar bone height, second premolar displacement, and tipping tendency.Results:Generally, the Bio-Oss early and Bio-Oss late subgroups recorded the lowest amount of tooth movement compared with other modes of GBRs assessed. Before OTM, the control group registered significantly lower bone height compared with the Bio-Oss and β-TCP groups (P < .01). The control group was inferior on bone density and bone height compared with Bio-Oss and β-TCP.Conclusions:The Bio-Oss group had favorable radiologic features (higher alveolar bone level and bone density with less premolar tipping) but showed slower OTM than the control group. The late OTM subgroup had favorable radiologic features and showed faster tooth movement than the early OTM in the β -TCP group.     

Ten-year experiences with Tetanus at a Tertiary hospital in Northwestern Tanzania: A retrospective review of 102 cases

Background

Tetanus is still a major health problem in developing countries and it is associated with a high morbidity and mortality rate. There is paucity of published data regarding the management of tetanus in Tanzania, especially the study area. This study was conducted to describe our own experiences with tetanus outlining the clinical characteristics and treatment outcome of tetanus patients in our environment and to identify predictors of outcome of these patients.

Methods

This was a ten-year period retrospective study of patients who presented with a clinical diagnosis of tetanus at Bugando Medical Centre between January 2001 and December 2010. Data was analyzed using SPSS computer software system.

Results

A total of 102 patients were studied. The male to female ratio was 11.8: 1. The majority of patients (74.5%) were aged < 40 years and 51.0% of them were farmers. Only 23.5% of patients had prior tetanus immunization. 53.5% of patients had a reasonably identifiable acute injury prior to the onset of tetanus and commonly involved the lower limbs (53.8%). The majority of patients (97.1%) had generalized tetanus. The mean incubation period and period of onset were 8.62 ± 4.34 and 3.8 ± 2.2 days respectively. Complication rate was 54.9%. The average overall duration of hospitalization was 34.12 ± 38.44 days (1-120 days). Mortality rate was 43.1%. According to multivariate logistic regression analysis, the age ≥ 40 years (P = 0.002), incubation period < 7 days (P = 0.014), tracheostomy (P = 0.004), severity of tetanus (P = 0.001) and need for ventilatory support (P = 0.013) were found to be significantly associated with higher mortality.

Conclusion

Tetanus remains a major public health problem in our centre and still carries unacceptably high morbidity and mortality despite the available advanced management facilities including ICU care. Young adult males are commonly affected. The incidence of tetanus can be reduced significantly by an effective immunization program and proper wound management of the patients. Early recognition, intense support and prompt treatment improves morbidity and mortality of patients diagnosed with tetanus.     

Virological efficacy and emergence of drug resistance in adults on antiretroviral treatment in rural Tanzania

Background  

Virological response to antiretroviral treatment (ART) in rural Africa is poorly described. We examined virological efficacy and emergence of drug resistance in adults receiving first-line ART for up to 4 years in rural Tanzania.     

Prevalence of antibodies against herpes simplex virus types 1 and 2 in children and young people in an urban region in Tanzania

Herpes simplex virus type 1 (HSV-1) is transmitted by close contact, both sexual and nonsexual, and infections are acquired during childhood and adolescence. Herpes simplex virus type 2 (HSV-2), however, is thought to be transmitted mainly by sexual contact. Most HSV-2 infections are consequently expected to occur after the onset of sexual activity. Recent reports indicate an increasing prevalence of HSV-2 on the African continent, but most studies have been performed on adult cohorts. In the present study, we collected sera from Tanzanian children and young persons from 1 to 20 years old, with at least 100 individuals in each age group. Antibodies against HSV-1 and HSV-2 were detected by an in-house Western blot method which was shown to perform well in comparison with a commercial Western blot assay. Type-specific antibodies were also analyzed by two noncommercial enzyme-linked immunosorbent assay methods based upon the antigenicities of branched synthetic oligopeptides corresponding to epitopes in glycoprotein G of HSV-1 or HSV-2. The prevalence of HSV-1 antibodies increased gradually from 73% for the age group of 1 to 4 years to 92% for the age group of 17 to 20 years. The prevalence of HSV-2 antibodies was unexpectedly high, as 15% of the children were infected by the age of 8 years, with the incidence increasing gradually to 40% in the age group of 17 to 20 years. The reason for this unexpectedly high frequency is not clear but could suggest that nonsexual transmission of HSV-2 is more common than previously thought. There was no statistically significant association between seropositivities for HSV-2 and human immunodeficiency virus.     

p24 antigen detection on dried blood spots is a feasible and reliable test for infant HIV infection in rural Tanzania

The difficulty of diagnosing HIV in infants is a major obstacle to early antiretroviral therapy (ART) in resource-limited settings. As serological tests are unreliable during the first 18 months of life, and the cost and complexity of polymerase chain reaction (PCR)-based assays limit their access in resource-limited settings, p24 antigen detection has emerged as an alternative diagnostic tool. In this study, the performance of an ultrasensitive p24 antigen assay on dried blood spots was evaluated under field conditions in rural Tanzania. Specimens were stored and shipped at tropical room temperature, and analysed within six weeks. In total, 27 consecutive children aged <18 months and exposed to vertical HIV transmission were enrolled. Overall sensitivity and specificity was 100% (95% confidence interval [CI], 47.8-100) and 95.5% (95% CI, 77.2-99.9), respectively. Our findings suggest that detection of p24 antigen on dried blood spots can be a reliable and feasible diagnostic tool for infant HIV infection in rural resource-limited settings.     

Typhoid intestinal perforations at a University teaching hospital in Northwestern Tanzania: A surgical experience of 104 cases in a resource-limited setting

Background

Typhoid intestinal perforation is still prevalent in many developing countries. Despite the advances in the management, the outcome in these patients in resource limited countries is still very poor. This study was to review our experiences on the surgical management of typhoid intestinal perforation and to determine the prognostic factors for mortality in our local setting.

Methods

This was a combined retrospective and prospective study of patients who were operated for typhoid intestinal perforation at Bugando Medical Centre between August 2006 and September 2011. Data collected were analyzed using SPSS computer software version 15.

Results

A total of 104 patients were studied representing 8.7% of typhoid fever cases. Males were affected twice more than the females (2.6:1). Their ages ranged from 8 to 76 years with a median age of 18.5 years. The peak age incidence was in the 11-20 years age group. Fever and abdominal pain were the most common presenting symptoms and majority of the patients (80.8%) perforated between within 14 days of illness. Chest and abdominal radiographs revealed pneumoperitonium in 74.7% of cases. Ultrasound showed free peritoneal collection in 85.7% of cases. Nine (10.2%) patients were HIV positive with a median CD4+ count of 261 cells/μl. The perforation-surgery interval was more than 72 hours in 90(86.5%) patients. The majority of patients (84.6%) had single perforations and ileum was the most common part of the bowel affected occurring in 86.2% of cases. Simple closure of the perforations was the most commonly performed procedure accounting for 78.8% of cases. Postoperative complication rate was 39.4% and surgical site infection was the most frequent complication in 55.5% of cases. Mortality rate was 23.1% and it was statistically significantly associated with delayed presentation, inadequate antibiotic treatment prior to admission, shock on admission, HIV positivity, low CD4 count (< 200 cells/μl), high ASA classes (III-V), delayed operation, multiple perforations, severe peritoneal contamination and presence of postoperative complications (P < 0.001). The median overall length of hospital stay was 28 days.

Conclusion

Typhoid intestinal perforation is still endemic in our setting and carries high morbidity and mortality. This study has attempted to determine the factors that statistically influence mortality in typhoid perforation in our environment. Appropriate measures focusing at these factors are vital in order to deliver optimal care for these patients in this region.     

Incidence, causes and pattern of cancellation of elective surgical operations in a university teaching hospital in the Lake Zone, Tanzania

Background

Cancellation of elective surgical operations is recognized as a major cause of emotional trauma to patients as well as their families. This study was carried out to assess the incidence, causes and pattern of cancellation of elective surgical operations in our setting and to find the appropriate solutions for better patient management.

Methods

This was a prospective hospital-based study which was conducted in a teaching hospital at Bugando medical Centre from March 2009 to February 2010.

Results

A total of 3,064 patients were scheduled for elective surgical operations. Of these, 644 (21.0%) patients'' operations were cancelled. General surgery had the highest rate of cancellations (31.5%) followed by orthopaedic surgery in 25.5%. Lack of theatre space and theatre facilities were the most common causes of cancellations in 53.0% and 28.4% of cases respectively. The majority of these cancellations were attributable to hospital administration in 82.0 % and most of them were preventable in 93.8% of cases. The mean hospital stay was 28.46 days and it was significantly related to the number of cancellations (p < 0.001).

Conclusion

Cancellation of elective surgical operations is a significant problem in our hospital. To prevent unnecessary cancellations, efforts should be made to enhance cost effectiveness through careful planning and efficient utilization of the few available hospital resources