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Plum, C., M. Stolbrink, L. Zurba, K. Bissell, B. O. Ozoh, and K. Mortimer. "Availability of diagnostic services and essential medicines for non‐communicable respiratory diseases in African countries." International Journal of Tuberculosis and Lung Disease 25, no. 2 (February 1, 2021): 120–25. http://dx.doi.org/10.5588/ijtld.20.0762.
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BACKGROUND: The global burden of disease due to asthma and chronic obstructive pulmonary disease (COPD) is substantial and particularly great in low‐ and middle‐income countries, including many African countries. Management is affected by availability of diagnostic tests and essential medicines. The study aimed to explore the availability of spirometry services and essential medicines for asthma and COPD in African countries.METHOD: Questionnaires were delivered to healthcare workers at the annual meeting of the Pan African Thoracic Society Methods in Epidemiology and Clinical Research (PATS MECOR) and International Multidisciplinary Programme to Address Lung Health and TB in Africa (IMPALA). Data were analysed using simple descriptive statistics.RESULTS: A total of 37 questionnaires representing 13 African countries were returned. Spirometry availability was 73.0%. The most common reasons for non‐availability were lack of knowledge of the utility of the test. Within the study sample, 33.3% faced sporadic availability due to maintenance issues. Essential medicines availability ranged from 37.8% for inhaled corticosteroid‐long‐acting beta‐agonist inhalers to 100% for prednisolone 5 mg tablets, mainly due to supply chain problems.CONCLUSION: There is varied availability of spirometry and WHO essential medicines for COPD and asthma in African countries. Strategies are needed to improve access to basic effective care for people with non‐communicable lung disease in Africa.
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Nlandu, Yannick M., Jean-Robert R. Makulo, Nestor M. Pakasa, Ernest K. Sumaili, Clarisse N. Nkondi, Justine B. Bukabau, François K. Beya, Nazaire M. Nseka, François B. Lepira, and Raoul Bergner. "First Case of COVID-19-Associated Collapsing Glomerulopathy in Sub-Saharan Africa." Case Reports in Nephrology 2020 (September 28, 2020): 1–5. http://dx.doi.org/10.1155/2020/8820713.
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Although the lungs remain the main target of SARS-CoV-2, other organs, such as kidneys, can be affected, which has a negative impact on the outcomes of COVID-19 patients. Although previous studies of kidney disease in COVID-19 reported mainly SARS-CoV-2-induced tubular and interstitial injury, there is growing evidence coming out of Africa of glomerular involvement, especially collapsing glomerulopathy seen particularly in people of African descent. We report a case of collapsing glomerulopathy revealed by acute kidney injury and a new onset of full blown nephrotic syndrome in a black Congolese patient coinfected with COVID-19 and malaria.
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Chidumwa, Glory, Innocent Maposa, Barbara Corso, Nadia Minicuci, Paul Kowal, Lisa K. Micklesfield, and Lisa Jayne Ware. "Identifying co-occurrence and clustering of chronic diseases using latent class analysis: cross-sectional findings from SAGE South Africa Wave 2." BMJ Open 11, no. 1 (January 2021): e041604. http://dx.doi.org/10.1136/bmjopen-2020-041604.
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ObjectivesTo classify South African adults with chronic health conditions for multimorbidity (MM) risk, and to determine sociodemographic, anthropometric and behavioural factors associated with identified patterns of MM, using data from the WHO’s Study on global AGEing and adult health South Africa Wave 2.DesignNationally representative (for ≥50-year-old adults) cross-sectional study.SettingAdults in South Africa between 2014 and 2015.Participants1967 individuals (men: 623 and women: 1344) aged ≥45 years for whom data on all seven health conditions and socioeconomic, demographic, behavioural, and anthropological information were available.MeasuresMM latent classes.ResultsThe prevalence of MM (coexistence of two or more non-communicable diseases (NCDs)) was 21%. The latent class analysis identified three groups namely: minimal MM risk (83%), concordant (hypertension and diabetes) MM (11%) and discordant (angina, asthma, chronic lung disease, arthritis and depression) MM (6%). Using the minimal MM risk group as the reference, female (relative risk ratio (RRR)=4.57; 95% CI (1.64 to 12.75); p =0.004) and older (RRR=1.08; 95% CI (1.04 to 1.12); p<0.001) participants were more likely to belong to the concordant MM group, while tobacco users (RRR=8.41; 95% CI (1.93 to 36.69); p=0.005) and older (RRR=1.09; 95% CI (1.03 to 1.15); p=0.002) participants had a high likelihood of belonging to the discordant MM group.ConclusionNCDs with similar pathophysiological risk profiles tend to cluster together in older people. Risk factors for MM in South African adults include sex, age and tobacco use.
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Ruffieux, Yann, Mazvita Muchengeti, Matthias Egger, Orestis Efthimiou, Lina Bartels, Victor Olago, Maša Davidović, et al. "Immunodeficiency and Cancer in 3.5 Million People Living With Human Immunodeficiency Virus (HIV): The South African HIV Cancer Match Study." Clinical Infectious Diseases 73, no. 3 (February 2, 2021): e735-e744. http://dx.doi.org/10.1093/cid/ciab087.
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Abstract Background We analyzed associations between immunodeficiency and cancer incidence in a nationwide cohort of people living with human immunodeficiency virus (HIV; PLWH) in South Africa. Methods We used data from the South African HIV Cancer Match Study built on HIV-related laboratory measurements from the National Health Laboratory Services and cancer records from the National Cancer Registry. We evaluated associations between time-updated CD4 cell count and cancer incidence rates using Cox proportional hazards models. We reported adjusted hazard ratios (aHRs) over a grid of CD4 values and estimated the aHR per 100 CD4 cells/µL decrease. Results Of 3 532 266 PLWH, 15 078 developed cancer. The most common cancers were cervical cancer (4150 cases), Kaposi sarcoma (2262 cases), and non-Hodgkin lymphoma (1060 cases). The association between lower CD4 cell count and higher cancer incidence rates was strongest for conjunctival cancer (aHR per 100 CD4 cells/µL decrease: 1.46; 95% confidence interval [CI], 1.38–1.54), Kaposi sarcoma (aHR, 1.23; 95% CI, 1.20–1.26), and non-Hodgkin lymphoma (aHR, 1.18; 95% CI, 1.14–1.22). Among infection-unrelated cancers, lower CD4 cell counts were associated with higher incidence rates of esophageal cancer (aHR, 1.06; 95% CI, 1.00–1.11) but not breast, lung, or prostate cancer. Conclusions Lower CD4 cell counts were associated with an increased risk of developing various infection-related cancers among PLWH. Reducing HIV-induced immunodeficiency may be a potent cancer-prevention strategy among PLWH in sub-Saharan Africa, a region heavily burdened by cancers attributable to infections.
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Mandadi, Mounika, and Goetz H. Kloecker. "Representation of minorities in randomized lung cancer trials in the United States." Journal of Clinical Oncology 30, no. 15_suppl (May 20, 2012): e16517-e16517. http://dx.doi.org/10.1200/jco.2012.30.15_suppl.e16517.
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e16517 Background: The SEER data base shows a higher rate of lung cancer mortality for African Americans and a lower lung cancer mortality rate of Hispanics compared to Caucasians in the US. It is not clear if this is due to socioeconomic or biological factors. This study reviews the representation of Caucasians, African Americans (AA), Hispanics, and Asians in recent randomized trials published in the US. Methods: A systematic review was done of randomized trials in lung cancer published in the NEJM, JAMA, JCO. The percentage of patients of each race in the individual trials was listed. An average percentage with mean standard error for Caucasian, African-American, Hispanic and Asian race was obtained. The percentage for each group is compared to the racial distribution in the US Census data. Results: 30 randomized clinical trials were analyzed for racial distribution. A total of 227,411 patients were enrolled in the trials. Conclusions: African Americans and Hispanics have been significantly underrepresented in randomized trials published in the US. This affects the external validity of the trial results when generalizing the results to these minorities. Strategies to ensure accrual of people of all races are required to ameliorate the disparities clinical trial enrollment. [Table: see text]
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Reinersman, M., G. J. Riely, A. Nicastri, G. A. Soff, A. Getinet, A. G. Schwartz, M. F. Zakowski, V. W. Rusch, M. G. Kris, and M. Ladanyi. "EGFR and KRAS mutation status of lung adenocarcinomas in African Americans." Journal of Clinical Oncology 27, no. 15_suppl (May 20, 2009): 11065. http://dx.doi.org/10.1200/jco.2009.27.15_suppl.11065.
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11065 Background: The 2004 discovery of the tyrosine kinase inhibitor-sensitizing mutations in the epidermal growth factor receptor (EGFR) represents a major advance in the study and management of non-small cell lung cancer. Conversely, KRAS mutations in these cancers confer resistance to the EGFR tyrosine kinase inhibitors gefitinib and erlotinib. EGFR mutations occur almost exclusively in adenocarcinoma, and are more common in never smokers, women, and people born in East Asian (compared to Whites). No comprehensive studies exist of EGFR and KRAS mutations in lung cancers from African-American patients. Methods: We collected formalin-fixed paraffin-embedded material from 121 resected lung adenocarcinomas from African-American patients for DNA extraction. EGFR exon 19 deletions and exon 21 L858R point mutations were detected by sensitive mutation-specific PCR-based methods. KRAS codon 12 and 13 mutation testing was performed by mass-spectrometry (Sequenom)-based genotyping and direct sequencing. These data were compared to Memorial Sloan-Kettering data for EGFR and KRAS mutations in all resected adenocarcinomas in white patients. Results: EGFR mutations were detected in 23 of 121 cases (19%), while KRAS mutations were found in 21 (17%). Exon 19 deletions accounted for 18 of 23 of the EGFR mutations compared to 5 EGFR L858R mutations. KRAS mutations were primarily the transversion type mutations (17 of 21). When compared to data from Memorial Sloan-Kettering for White patients (81/273, 30%), the 17% rate of KRAS mutations in lung adenocarcinomas from African-Americans was significantly lower (p=0.01). EGFR mutation status was similar between African-Americans and Whites (19% vs 18%, p=0.9) and the proportion of exon 19 deletions and L858R mutations was comparable as well. Conclusions: This is the first large series reporting results of mutation testing in lung adenocarcinoma specimens from African-Americans. African-American patients are less likely than Whites to harbor KRAS mutations in their lung adenocarcinomas. There was no significant difference in the prevalence of EGFR mutations. Since biological characteristics underlie clinical factors, these differences may help explain differences in outcomes comparing African-Americans to other groups. No significant financial relationships to disclose.
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McGlashan, N. D., and J. S. Harington. "Lung cancer 1978-1981 in the black peoples of South Africa." British Journal of Cancer 52, no. 3 (September 1985): 339–46. http://dx.doi.org/10.1038/bjc.1985.199.
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Ravimohan, Shruthi, Sara C. Auld, Pholo Maenetje, Nelly Ratsela, Mandla Mlotshwa, Itai Ncube, Jonathan P. Smith, et al. "Lung Injury on Antiretroviral Therapy in Adults With Human Immunodeficiency Virus/Tuberculosis." Clinical Infectious Diseases 70, no. 9 (June 26, 2019): 1845–54. http://dx.doi.org/10.1093/cid/ciz560.
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Abstract Background Immune restoration on antiretroviral therapy (ART) can drive inflammation in people living with human immunodeficiency virus (HIV) who have pulmonary tuberculosis (TB), but its effects on the lungs have not been assessed. We evaluated associations between pulmonary inflammation, recovery of pathogen-specific CD4 T-cell function, and lung injury prior to and after ART initiation in adults with HIV and pulmonary TB. Methods This was a prospective cohort study in South Africa, following adults with HIV and pulmonary TB prior to and up to 48 weeks after ART initiation. Pulmonary-specific inflammation was defined as total glycolytic activity (TGA) on [18]F-fluorodeoxyglucose (FDG) positron emission tomography–computed tomography (PET-CT) at baseline and 4 weeks after ART initiation. Spirometry, respiratory symptom tests, and flow cytometry were performed at the same times to assess lung involvement and the frequency of mycobacteria-specific CD4 T-cells. In addition, we evaluated lung function longitudinally up to 48 weeks after ART initiation. Results Greater lung TGA on FDG PET-CT was associated with worse lung function and respiratory symptoms prior to ART initiation, and nearly half of subjects experienced worsening lung inflammation and lung function at Week 4 of ART. Worsening Week 4 lung inflammation and pulmonary function were both associated with greater increases in pathogen-specific functional CD4 T-cell responses on ART, and early decreases in lung function were independently associated with persistently lower lung function months after TB treatment completion. Conclusions Increases in pulmonary inflammation and decreases in lung function are common on ART, relate to greater ART-mediated CD4 T-cell restoration, and are associated with the persistent impairment of lung function in individuals with HIV/TB.
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Darmon, Nicole, and Myriam Khlat. "An overview of the health status of migrants in France, in relation to their dietary practices." Public Health Nutrition 4, no. 2 (April 2001): 163–72. http://dx.doi.org/10.1079/phn200064.
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AbstractObjectiveTo review studies on the morbidity, mortality and nutrition of migrant populations in France.DesignA systematic search of the bibliographic database Medline, and direct contact with associations and institutions concerned with migrants' health.ResultsIn France, as in other host countries, migrants belong to the lowest socio-economic strata. They have on average better health and lower mortality than the local-born population. Health benefits are particularly noticeable in Mediterranean men, especially for affluence-related diseases such as cancer and cardiovascular diseases. North African men smoke as heavily as the local-born of the same occupational categories, and yet their mortality rates from lung cancer are notably lower. Such a paradox may be the result of a synergy between different phenomena such as the selection of the fittest applicants for immigration and the maintenance of healthy lifestyles from the countries of origin. In contrast, migrant women do not enjoy the same health advantages, possibly because they are less likely to be selected on the basis of their health and because they are often non-working. Adult migrants from southern Europe and North Africa report dietary practices consistent with the typical Mediterranean diet, which is renowned for its positive effects on health.ConclusionsThe diet of Mediterranean adults living in France may partly explain the low rates of chronic diseases and high adult life expectancy observed in migrant men from northern Africa. Information about their diets might provide clues for the design of nutritional education campaigns aimed at low-income people.
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Fleishman, Aaron Julian, Julia Wittig, Jason Milnes, Andrew Baxter, Jennifer Moreau, and Khanjan Mehta. "Validation Process for a Social Entrepreneurial Telemedicine Venture in East Africa." International Journal for Service Learning in Engineering, Humanitarian Engineering and Social Entrepreneurship 5, no. 1 (May 10, 2010): 1–24. http://dx.doi.org/10.24908/ijsle.v5i1.2344.
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Mashavu (“chubby-cheeked” in Swahili) is a telemedicine system that connects medical professionals around the world with people in developing communities in East Africa. Mashavu kiosks are computer-based systems that collect medical information including weight, body temperature, lung capacity, pulse rate, blood pressure, stethoscope rhythms, photographs and basic hygiene and nutrition information. Mashavu kiosks transmit this information over a cell-phone link to a secure Internet website. Medical professionals and public health officials can view the patient’s information and respond to the person/operator and the nearest doctor(s) with recommendations. An imperative part of complex product design, especially when working in international contexts, is to gain validation. Validation ensures that the product being designed accurately fits the needs of the population for which it is being designed. The Mashavu team used methodologies from the world of engineering, business, and the social sciences to validate the concept, business plan, technology and usability of the system. This paper discusses the Mashavu venture and the methodologies employed for getting validation and uncovering the "sticky" information related to the East African context that is critical to the design and commercialization of the Mashavu telemedicine system.
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Watson, Karriem S., Leilah D. Siegel, Vida A. Henderson, Marcus Murray, I. Beverly Chukwudozie, David Odell, James Stinson, et al. "The SHARED Project: A Novel Approach to Engaging African American Men to Address Lung Cancer Disparities." American Journal of Men's Health 14, no. 5 (September 2020): 155798832095893. http://dx.doi.org/10.1177/1557988320958934.
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Black men are disproportionately impacted by lung cancer morbidity and mortality. Low-dose helical computed tomography (LDCT) lung cancer screening has demonstrated benefits for reducing lung cancer deaths by identifying cancers at earlier, more treatable stages. Despite the known benefits, LDCT screening is underutilized in black men. Studies in racially heterogeneous populations have found correlations between screening behaviors and factors such as physician trust, physician referral, and a desire to reduce the uncertainty of not knowing if they had lung cancer; yet little is known about the factors that specifically contribute to screening behaviors in black men. Community engagement strategies are beneficial for understanding barriers to health-care engagement. One community engagement approach is the citizen scientist model. Citizen scientists are lay people who are trained in research methods; they have proven valuable in increasing communities’ knowledge of the importance of healthy behaviors such as screening, awareness of research, building trust in research, and improving study design and ethics. This paper proposes an intervention, grounded in community-based participatory research approaches and social network theory, to engage black men as citizen scientists in an effort to increase lung cancer screening in black men. This mixed-methods intervention will examine the attitudes, behaviors, and beliefs of black men related to uptake of evidence-based lung cancer screening.
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Arigliani, Michele, and Atul Gupta. "Management of chronic respiratory complications in children and adolescents with sickle cell disease." European Respiratory Review 29, no. 157 (August 18, 2020): 200054. http://dx.doi.org/10.1183/16000617.0054-2020.
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Sickle cell disease (SCD) is a life-threatening hereditary blood disorder that affects millions of people worldwide, especially in sub-Saharan Africa. This condition has a multi-organ involvement and highly vascularised organs, such as the lungs, are particularly affected. Chronic respiratory complications of SCD involve pulmonary vascular, parenchymal and airways alterations. A progressive decline of lung function often begins in childhood. Asthma, sleep-disordered breathing and chronic hypoxaemia are common and associated with increased morbidity. Pulmonary hypertension is a serious complication, more common in adults than in children. Although there is a growing attention towards respiratory care of patients with SCD, evidence regarding the prognostic meaning and optimal management of pulmonary issues in children with this condition is limited.This narrative review presents state-of-the-art evidence regarding the epidemiology, pathophysiology and therapeutic options for chronic respiratory complications commonly seen in paediatric patients with SCD. Furthermore, it highlights the gaps in the current knowledge and indicates future directions for studies that aim to improve our understanding of chronic respiratory complications in children with SCD.
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Pruitt, Margaret, Rajesh Naidu Janapala, and Faysal Haroun. "Patterns of lung cancer in people living with human immunodeficiency virus (HIV): A retrospective, single-center study in Washington, D.C." Journal of Clinical Oncology 39, no. 15_suppl (May 20, 2021): e21154-e21154. http://dx.doi.org/10.1200/jco.2021.39.15_suppl.e21154.
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e21154 Background: Lung cancer is the leading cause of cancer death and the most common non-acquired immune deficiency syndrome defining malignancy in people living with HIV (PLWH). Disparities in outcomes have been observed despite lung cancer mortality reportedly decreasing in the general population over the last decade due to lower rates of smoking and the advent of novel therapies. To better understand the current trend in lung cancer in PLWH, we explored demographic characteristics, comorbidities, and lung cancer pathology and molecular data in this population. Methods: A retrospective search of patient charts was conducted from 2004 to January 2021 using billing codes for HIV and primary lung cancer. Patients who had incorrect HIV or primary lung cancer diagnoses were excluded. Results: The search yielded 45 patients, of which 11 were excluded as described above: 66% were males, 82% African American, and 18% Caucasian. About two-thirds of patients were living in zip codes with predominantly low to medium household incomes. The median pack years of patients diagnosed with Stage I or II non-small cell lung cancer (NSCLC) was 40, Stage III or IV NSCLC was 20, early stage small cell lung cancer (SCLC) was 30, and late stage SCLC was 60. The median time between HIV and lung cancer diagnoses was 21.7 years for Stage I or II NSCLC, 17.1 years for Stage III or IV NSCLC, 15.2 for early stage SCLC, and 13.3 for late stage SCLC. Of 26 patients with viral load (VL) data, 21 (80.7%) had VL less than 500 when lung cancer was diagnosed. Of the 33 charts with available pathology data, there were 16 adenocarcinomas, 6 squamous carcinomas, 3 adenosquamous carcinomas, 1 large cell neuroendocrine cancer, 4 SCLCs, 1 mesothelioma, and 2 unspecified NSCLCs. Of 19 patients with a histologic grade, 11 had a high-grade tumor (57.9%). For the NSCLCs, 8 were Stage I (28.5%), 2 Stage II (7.1%), 8 Stage III (28.5%), 9 Stage IV (32.1%), and 1 with an unspecified stage. One SCLC was early stage and the remaining 3 were late stage. Five patients had brain metastasis. Molecular data or PDL-1 expression was available for 10 adenocarcinomas (62.5%), 1 adenosquamous (33%), 3 squamous carcinomas (50%), and the large cell neuroendocrine cancer. An EGFR mutation was detected in 2 cancers. ALK rearrangement was found in 1. Other mutations were detected. Two cancers were in each PDL1 expression category: < 1%, 1-50%, and > 50%. Conclusions: Our study suggests that PLWH with lung cancer continue to have high rates of smoking. Viral load was well controlled. A range in stages of lung cancer was observed including earlier stages. Although molecular data was limited, available EGFR and ALK gene alterations, and PD-L1 expression prevalence were on par with that of the general population. With advancements in lung cancer treatment, additional research is needed in the PLWH population to better understand and mitigate disparities.
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Suryapalam, Manish, Mohammed Kashem, Huaqing Zhao, Norihisa Shigemura, Yoshiya Toyoda, and Suresh Keshavamurthy. "An Anthropometric Study of Lung Donors." Progress in Transplantation 31, no. 3 (July 22, 2021): 211–18. http://dx.doi.org/10.1177/15269248211024611.
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Purpose: A difference in the lower body to upper body ratio between similarly heighted individuals could lead to inadequately matched transplants. There has been a perception in clinical circles that body ratio varies between people of different races, and investigating this supposition would prove useful in increasing transplant match accuracy. The investigation’s purpose was to derive an equation with a greater correlation to lung length than height alone. Methods: Lung transplantation donor data for 480 adult patients was obtained and divided by ethnicity—Caucasian, African American, and Hispanic. Height, weight, age, sex, right and left lung length were evaluated for significance. The R2 value of the multiple linear regression with these variables vs. lung length was determined and tested in a separate dataset of 100 patients. Results: Only the distribution of height was significant between the 3 ethnicities ( P = 0.041). None of the ANCOVAs were significant ( P < 0.05) or near significant ( P < 0.10). For the strongest correlation model with lung length, height had a linear fit, weight had a cubic fit, and age had a logistic fit. Multiple regression models were successfully created for right lung (R2 = 0.202) and left lung (R2 = 0.213). Independent testing showed a correlation of 0.131 and 0.136, respectively. Conclusion: Using demographic information from the donor and recipient as proxies for estimating lung size should only serve as a rough guide due to their weak correlation with lung length. As a result, for greater accuracy, donor-recipient matching should be individualized by taking donor and recipient chest X-Rays and/or TLC into consideration.
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Wainwright, Megan. "Exploring ambivalent oxygen machine–people–world relations through the lens of postphenomenology." Journal of Material Culture 23, no. 4 (September 20, 2018): 426–47. http://dx.doi.org/10.1177/1359183518799521.
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Technologies for medicinal oxygen delivery at home are increasingly part of the global health technology landscape in the face of rising rates of chronic lung and heart diseases. From the mere notion of harvesting and privatizing oxygen from the atmosphere to its status as both dangerous and therapeutic, and finally to its capacity to both extend and limit life, oxygen as therapy materializes its status as an ambivalent object in global health. This analysis of ethnographic material from Uruguay and South Africa on the experience of home oxygen therapy is guided by philosopher Don Ihde’s postphenomenology – a pragmatic philosophical approach for analysing the relationships between humans and technologies. Participants related to their oxygen devices as limiting-enablers, as markers of illness and measures of recovery, and as precious and limited resources. Oxygen was materialized in many forms, each with their own characteristics shaping the ‘amplification/reduction’ character of the relationship as well as the degree to which the devices became ‘transparent’ to their users. Ihde’s four types of human–technology relations – embodiment, hermeneutic, alterity and background relations – are at play in the multistability of oxygen. Importantly, the lack of technological ‘transparency’, in Ihde’s sense of the term, reflects not only the materiality of oxygen but inequality too. While postphenomenology adds a productive material and technological flavour to phenomenology, the author argues that a critical postphenomenology is needed to engage with the political-economy of human–oxygen technology relations.
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Stokes, Alicia, Kimberly Bell, and Thomas Mellman. "375 Thought Control Strategies and Insomnia Severity in young-adult urban residing African Americans." Sleep 44, Supplement_2 (May 1, 2021): A149. http://dx.doi.org/10.1093/sleep/zsab072.374.
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Abstract Introduction Poor sleep is common in our society, particularly for African Americans. Unwanted, intrusive thoughts at bedtime contribute to sleep disturbances, and the nature of intrusive thoughts may be influenced by perception of threat among people living in stressful urban environments. Research has suggested that strategies to control intrusive thoughts vary in their adaptiveness and may be modifiable. These findings need to be confirmed in populations residing in stressful urban environments where perceived threats contribute to intrusive thoughts.The present study attempts to replicate prior research examining the relationship between thought control strategies and insomnia in urban residing young-adult African Americans. Methods Sixty-three young-adult African Americans completed the Thought Control Questionnaire for Insomnia-Revised and the Insomnia Severity Index (ISI). Results Thought control strategies previously associated with insomnia were significantly correlated with the ISI (aggressive suppression r=0.51, p<0.01 social avoidance r=0.32, p<.01, behavioral distraction r=0.386, p<0.01 and worry r=0.51, p<0.01). We did not find significant associations between the thought control strategy previously associated with healthy sleep and the ISI (cognitive distraction r= 0.20, p>0.05). In a grouped comparison between good sleepers and those with insomnia worry was the only subscale that was endorsed significantly greater among those with insomnia (t(61)=-2.91, p<.05) Conclusion These preliminary data replicate prior findings that suggest that aggressive suppression and worry are maladaptive thought control strategies. in a young-adult African American sample. Future research with a larger sample is needed to identify strategies that can improve sleep in this population. Support (if any) 5R01HL136626 from the National Heart Lung and Blood Institute
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Martín Giménez, Virna Margarita, León Ferder, Felipe Inserra, Joxel García, and Walter Manucha. "Differences in RAAS/vitamin D linked to genetics and socioeconomic factors could explain the higher mortality rate in African Americans with COVID-19." Therapeutic Advances in Cardiovascular Disease 14 (January 2020): 175394472097771. http://dx.doi.org/10.1177/1753944720977715.
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COVID-19 is said to be a pandemic that does not distinguish between skin color or ethnic origin. However, data in many parts of the world, especially in the United States, begin to show that there is a sector of society suffering a more significant impact from this pandemic. The Black population is more vulnerable than the White population to infection and death by COVID-19, with hypertension and diabetes mellitus as probable predisposing factors. Over time, multiple disparities have been observed between the health of Black and White populations, associated mainly with socioeconomic inequalities. However, some mechanisms and pathophysiological susceptibilities begin to be elucidated that are related directly to the higher prevalence of multiple diseases in the Black population, including infection and death by COVID-19. Plasma vitamin D levels and evolutionary adaptations of the renin-angiotensin-aldosterone system (RAAS) in Black people differ considerably from those of other races. The role of these factors in the development and progression of hypertension and multiple lung diseases, among them SARS-CoV-2 infection, is well established. In this sense, the present review attempts to elucidate the link between vitamin D and RAAS ethnic disparities and susceptibility to infection and death by COVID-19 in Black people, and suggests possible mechanisms for this susceptibility.
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Goldblatt, Beth, and Shirin M. Rai. "Recognizing the Full Costs of Care? Compensation for Families in South Africa’s Silicosis Class Action." Social & Legal Studies 27, no. 6 (November 15, 2017): 671–94. http://dx.doi.org/10.1177/0964663917739455.
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This article concerns recognition and compensation of the intimate, gendered work of caring by family members for workers who became ill with lung diseases as a result of poor labour conditions in the mines in South Africa. It focuses on a recent decision by a court in South Africa ( Nkala and Others v. Harmony Gold Mining Company Limited and Others, 2016) that took the unusual step of acknowledging this care work and attempting to compensate it indirectly. The article combines insights from political economy and law within a feminist frame to develop an argument about compensation for social reproductive work to address the harm experienced by the carers of mineworkers. Using the theory of depletion through social reproduction, it suggests ways of understanding the costs of care in order to fully compensate the harms suffered by the carers. This is done with reference to a photographic essay by Thom Pierce called ‘The Price of Gold’ taken in the mineworkers’ homes after their discharge from work due to illness. The article argues that ideas of depletion should inform any consideration of compensation of people engaged in caring in a range of reparatory contexts.
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Wenar, Leif. "The Basic Structure as Object: Institutions and Humanitarian Concern." Canadian Journal of Philosophy Supplementary Volume 31 (2005): 253–78. http://dx.doi.org/10.1080/00455091.2005.10716856.
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One third of the human species is infested with worms. The World Health Organization estimates that worms account for 40 per cent of the global disease burden from tropical diseases excluding malaria. Worms cause a lot of misery.In this article I will focus on one particular type of infestation, which is hookworm. Approximately 740 million people suffer from hookworm infection in areas of rural poverty: more than one human in ten, a total greater than twenty-three times the population of Canada or twice the population of the United States. The greatest numbers of cases occur in China, Southeast Asia, and Sub-Saharan Africa- that is, mostly in the places in the world where poverty is most severe.Hookworm larvae pierce the skin, enter the bloodstream, work their way into the heart and then into the lungs, where they climb the bronchial tree into the throat and are swallowed.
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McLouth, Laurie, Jennifer Gabbard, Beverly J. Levine, Chandylen L. Nightingale, Kate Furgurson, Thomas Lycan, William J. Petty, and Kathryn E. Weaver. "Who is at risk for palliative care misconceptions and how do we address them? A mixed-methods study of metastatic lung cancer patients." Journal of Clinical Oncology 37, no. 31_suppl (November 1, 2019): 67. http://dx.doi.org/10.1200/jco.2019.37.31_suppl.67.
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67 Background: A major misperception of palliative care (PC) is that it is only for people who are about to die. We recently identified this misperception as a barrier to PC in metastatic non-small cell lung cancer (mNSCLC) patients, patients who should all receive early PC per guidelines. The goal of this study was to assess patient characteristics associated with misperceptions about PC and to elicit patient perspectives on how to address them. Methods: We conducted a mixed-methods study of mNSCLC patients on immunotherapy or chemo-immunotherapy. A survey assessed sociodemographics, health literacy, and PC misperceptions. Semi-structured interviews queried perceptions of PC, experiences discussing PC with providers, and reactions to our institutional definition of PC. Qualitative data from interviews were analyzed using directed content analysis approach. Results: Sixty patients (Mean age = 63, 40% male; 18% African American, 45% inadequate health literacy) completed the survey. Twelve of the survey participants (Mean age = 65, 50% male, 25% African American, 67% inadequate health literacy; 50% with caregivers participating) also completed a semi-structured interview. Quantitative survey results showed equating PC with death and/or hospice did not differ based on gender, health literacy, rural vs. urban residence, or time since diagnosis (p’s > .05). Qualitative results showed patients and caregivers consistently associated PC with death (e.g., “the next step to the graveyard”) and hospice. Though some patients noted differences between our institution’s definition of PC and their perceptions (e.g., “delivered at any stage”), the definition did not increase interest and sometimes reinforced misperceptions (e.g., “See, that's a death spiral”). To address misconceptions, patients and caregivers suggested distinguishing PC from end of life and hospice, presenting it positively, and discussing it early into treatment. Conclusions: Lung cancer patients may associate PC with death even if they have adequate health literacy. Commonly used definitions of PC may not quell patient fears. PC needs to be presented as a positive service to patients early into treatment.
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Mejia- Mertel, Juliana, and Juan P. Rojas -Hernandez. "1707. Clinical Profile of Human T-Lymphotropic Virus Type I Infection in Pediatric Population in a Referral Hospital in Colombia." Open Forum Infectious Diseases 7, Supplement_1 (October 1, 2020): S836—S837. http://dx.doi.org/10.1093/ofid/ofaa439.1885.
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Abstract Background The Human T-lymphotropic virus type 1 (HTLV-1), affects around ten to twenty million people worldwide, predominantly in intertropical regions (Africa, Japan, Melanesia, Australia, and South America Pacific Coast). The most common disorders associated are T-cell leukemia/lymphoma (ALT) and HTLV-1-associated myelopathy (HAM). Studies have reported other clinical manifestations in HTLV-1, still studies are needed in pediatric population to improve diagnosis and treatment of infected patients. Methods Descriptive, retrospective cohort study, conducted in our referral pediatric hospital in Cali, Colombia. Included pediatric patients (1 to 18 years of age) diagnosed with HTLV-1 infection, between January 2017 to March 2020. Results Twelve patients were included, seven males and five females. Eleven patients were from and resided in the Colombian Pacific coast. Ten patients showed nutritional deficiencies. None showed clinical or laboratory signs of ALT, neither neurological symptoms or physical exam suggesting HAM. In terms of associated diseases and opportunistic infections, none had a positive HIV ELISA test, and stool tests were all negative for Strongiloydes. Four presented infective dermatitis, and two showed lesions suggesting scabies. Eight patients presented respiratory symptoms with chest CT scans showing signs of chronic inflammation, bronchiectasis, and subpleural bullae as the major findings. Additional tests were carried out in bronchoalveolar fluid, four had positive galactomannan test,suggesting pulmonary aspergillosis, two exhibited positive gene PCR testing for Mycobacterium tuberculosis. Regarding inflammatory diseases, one patient presented with symptoms of Inflammatory Bowl Disease, with biopsy confirming Crohn’s disease. Another patient presente abrupt vision loss, diagnosed with Vogt Koyanagi Hadara Syndrome after ophthalmological evaluation. Summary features HTLV-1 patients Ground-glass opacity diffusely distributed in both lungs with multiple bronchiectasis involving predominantly lung bases. Cystic images diffusely distributed in both lungs, some subpleural and other centrilobular. Conclusion It is important to consider alternative manifestations of HTLV-1 infection in the pediatric population, including pulmonary disease, opportunistic co-infections, and inflammatory disorders. It is crucial to diagnose this disease in childhood to reach a better control of this neglected infection that affects predominantly vulnerable population in low-income countries. Disclosures All Authors: No reported disclosures
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Ekeng, Bassey E., Kevin Edem, Ikechukwu Amamilo, Zachary Panos, David W. Denning, and Rita O. Oladele. "Histoplasmosis in Children; HIV/AIDS Not a Major Driver." Journal of Fungi 7, no. 7 (June 30, 2021): 530. http://dx.doi.org/10.3390/jof7070530.
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The classification of histoplasmosis as an AIDS-defining illness has largely attributed its occurrence in people to the presence of HIV/AIDS especially in Africa. Prior to the advent of the HIV/AIDS epidemic, many cases of histoplasmosis were documented both in the pediatric and adult population. Our review revealed 1461 reported cases of pediatric histoplasmosis globally in the last eight decades (1939–2021). North America (n = 1231) had the highest number of cases, followed by South America (n = 135), Africa (n = 65), Asia (n = 26) and Europe (n = 4). Histoplasmosis was much more common in the non-HIV pediatric population (n = 1418, 97.1%) compared to the HIV population. The non-HIV factors implicated were, childhood malignancies (n = 207), such as leukemias and lymphomas as well as their treatment, lung diseases (n = 7), environmental exposures and toxins (n = 224), autoimmune diseases (n = 12), organ transplants (n = 12), long-term steroid therapy (n = 3), the use of immunosuppressive drugs such as TNF-alpha inhibitors (n = 7) malnutrition (n = 12), histiocytosis (n = 3), hyperimmunoglobulin M and E syndromes (n = 15, 1.2%), pancytopaenias (n = 26), diabetes mellitus (n = 1) and T-cell deficiency (n = 21). Paediatricians should always consider or rule out a diagnosis of histoplasmosis in children presenting with symptoms suggestive of the above clinical conditions.
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Lokuruka, Michael. "COVID-19: A Review of What You Should Know and Do to Keep Safe." African Journal of Food, Agriculture, Nutrition and Development 21, no. 06 (August 7, 2021): 18170–91. http://dx.doi.org/10.18697/ajfand.101.20975.
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SARS-CoV-2, the cause of COVID-19, has resulted in high mortalities and global socio-economic disruptions. As knowledge of SARS-CoV-2 and COVID-19 evolves, the public requires up to date and appropriate information in order to keep safe in the absence of a proven vaccine. This review of the literature was written to provide the latest information on the virus and the disease. SARS-CoV-2 bears a higher genomic homology to SARS-CoV-1 than MERS-CoV-1. Globally, COVID-19 has caused more than 4.07 million deaths and infected over 188 million people by 16th July, 2021. In Africa, more than 4.5 million and over 106,000 people have been infected and died, respectively. In Kenya, over 191,000 have been infected and 3,746 people have died from COVID-19 by the date. The figure for Kenya is much lower than the over 150,000 deaths from the Spanish flu of 1918-20. SARS-CoV-2 is transmitted through expiratory droplets and direct contact, while faecal and airborne transmission have been documented, but not confirmed. It enters the body through nasal passages, conjunctiva , or mouth. It can survive on bank notes, vinyl plastic, mobile phone, glass, cardboard, cloth fabric and stainless steel for varying periods. At 50% Rh, it can survive on stainless steel, vinyl plastic and glass at 20, 30 and 40oC for 28, 7 days and less than a day, respectively. On cotton fabrics, it can survive for 7, 3 days and less than 24 hr at 20, 30 and 40oC, respectively. Age, late hospitalization, diabetes co-morbidity, obesity, chronic lung disease and hypertension are the major risk factors for COVID-19 mortality. Age and laboratory indicators are predictors of mortality. Vaccines allowed for emergency use include the Oxford/AstraZeneca, Pfizer/Biontech, Moderna, Sinopharm, SINOVAC, Sputnik V and Johnson and Johnson. Although they all have shown high efficacy against the original COVID-19 strains globally, they have lower efficacy against the Brazilian P.1, the UK B.1.1.7, Finnish FIN-796H, the New Jersey/New York B.1.526, the South African B.1.351 and the Indian Delta mutant. Regular hand washing, face masking, avoiding overcrowding, physical distancing, outdoor communing, seeking immediate medical attention and isolating when infected, all can minimize SARS-CoV-2 transmission. Potential infection from frozen foods packaging, frozen foods and food preparation surfaces has been demonstrated. However, good hygiene practices can minimize infection from foods, shopping bags, take-out containers and groceries. Animal foods should not be consumed raw, while groceries require thorough washing with potable water during preparation. Despite concerns posed by the continuing evolution of virulent mutants of SARS-CoV-2, researchers are working to develop effective vaccines in order to eliminate the threat of the virus.
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Loui, William S., Bonnie Auerbach, Jeanette Bince, Sandra Brazzel, and William Thomas. "Assessing quality in a rural oncology program using the Quality Oncology Practice Initiative (QOPI)." Journal of Clinical Oncology 30, no. 34_suppl (December 1, 2012): 275. http://dx.doi.org/10.1200/jco.2012.30.34_suppl.275.
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275 Background: Molokai General Hospital (MGH) is a critical access hospital for 7,400 people on the isolated island of Molokai. It is a small 14 bed medical center that started an outpatient oncology program six years ago. Over this period, 213 patients received care through an innovative telemedicine program partnership with the Queens Medical Center in Honolulu, Hawaii. Methods: Study design was a retrospective chart review. Results: The most common types of cancers seen were breast cancer 57 (26.7%), lung cancer 29 (13.6%), colon cancer 26 (12.2%), prostate cancer 29 (13.6%), lymphoma 8 (3.7%), and liver cancer 3 (1.4%). Cancer patients were almost 80 % minorities; over 55% were native Hawaiians or part Hawaiian. The percentage of Caucasians, Hispanic, and African American were lower than the national averages. Hawaiian 118 (55.3%), Caucasian 43 (20.8%), Filipino 30 (14%), Japanese 17 (7.9%), African American 2 (0.9%), Other Pacific Islanders 2 (0.9%), Hispanic 1 (0.4%) Using national and local benchmarks from QOPI, areas of excellence and deficiency were identified. In 29% of the core measures, MGH did a better job than the urban comparison in Honolulu, Hawaii. For breast and colon cancer, the quality was better than the national QOPI aggregate. Similarly, the symptom care was better than national average. A survivorship program was initiated 2 years ago and treatment summaries were beginning to be sent. Since its start, 45 of the total 213 (21.1%) patients have been enrolled in the Survivorship program. Conclusions: The QOPI program helped review a small rural program which lacks staff and resources for a full time Quality Improvement program. This may be a model for other small programs to check for quality of care.
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Huluka, Dawit Kebede, Desalew Mekonnen, Sintayehu Abebe, Amha Meshesha, Dufera Mekonnen, Negussie Deyessa, James R. Klinger, et al. "Prevalence and risk factors of pulmonary hypertension among adult patients with HIV infection in Ethiopia." Pulmonary Circulation 10, no. 4 (October 2020): 204589402097151. http://dx.doi.org/10.1177/2045894020971518.
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Globally, non-communicable diseases are increasing in people living with HIV. Pulmonary hypertension is a rare non-communicable disease in people living with HIV with a reported prevalence of <1%. However, data on pulmonary hypertension in people living with HIV from Africa are scarce and are non-existent from Ethiopia. This study aimed to examine the prevalence and severity of echocardiographic pulmonary hypertension and risk factors associated with pulmonary hypertension in people living with HIV in Ethiopia. A total of 315 consecutive adult people living with HIV followed at the Tikur Anbessa Specialized Hospital HIV Referral Clinic were enrolled from June 2018 to February 2019. Those with established pulmonary hypertension of known causes were excluded. A structured questionnaire was used to collect data on demographics, respiratory symptoms, physical findings, physician-diagnosed lung disease, and possible risk factors. Pulmonary hypertension was defined by a tricuspid regurgitant velocity of ≥2.9 m/sec on transthoracic echocardiography. A tricuspid regurgitant velocity ≥3.5, which translates into a pulmonary arterial pressure/right ventricular systolic pressure of ≥50 mmHg, was considered moderate-to-severe pulmonary hypertension. The mean age of the participants was 44.5 ± 9.8 years and 229 (72.7%) were females. Pulmonary hypertension was diagnosed in 44 (14.0%) of participants, of whom 9 (20.5%) had moderate-to-severe disease. In those with pulmonary hypertension, 17 (38.6%) were symptomatic: exertional dyspnea, cough, and leg swelling were seen in 12 (27.3%), 9 (20.5%), and 4 (9.1%), respectively. There was no significant difference in those with pulmonary hypertension compared to those without the disease by gender, cigarette smoking, previous history of pulmonary tuberculosis treatment, physician-diagnosed chronic obstructive pulmonary disease or bronchial asthma, duration of anti-retroviral therapy therapy or anti-retroviral regimen type. Pulmonary hypertension looks to be a frequent complication in people living with HIV in Ethiopia and is often associated with significant cardiopulmonary symptoms. Further studies using right heart catheterization are needed to better determine the etiology and prevalence of pulmonary hypertension in people living with HIV in Ethiopia compared to other countries.
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Koyuncu, Deniz, Muhammad Khalid Khan Niazi, Thomas Tavolara, Claudia Abeijon, Melanie L. Ginese, Yanghui Liao, Carolyn Mark, et al. "CXCL1: A new diagnostic biomarker for human tuberculosis discovered using Diversity Outbred mice." PLOS Pathogens 17, no. 8 (August 17, 2021): e1009773. http://dx.doi.org/10.1371/journal.ppat.1009773.
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More humans have died of tuberculosis (TB) than any other infectious disease and millions still die each year. Experts advocate for blood-based, serum protein biomarkers to help diagnose TB, which afflicts millions of people in high-burden countries. However, the protein biomarker pipeline is small. Here, we used the Diversity Outbred (DO) mouse population to address this gap, identifying five protein biomarker candidates. One protein biomarker, serum CXCL1, met the World Health Organization’s Targeted Product Profile for a triage test to diagnose active TB from latent M.tb infection (LTBI), non-TB lung disease, and normal sera in HIV-negative, adults from South Africa and Vietnam. To find the biomarker candidates, we quantified seven immune cytokines and four inflammatory proteins corresponding to highly expressed genes unique to progressor DO mice. Next, we applied statistical and machine learning methods to the data, i.e., 11 proteins in lungs from 453 infected and 29 non-infected mice. After searching all combinations of five algorithms and 239 protein subsets, validating, and testing the findings on independent data, two combinations accurately diagnosed progressor DO mice: Logistic Regression using MMP8; and Gradient Tree Boosting using a panel of 4: CXCL1, CXCL2, TNF, IL-10. Of those five protein biomarker candidates, two (MMP8 and CXCL1) were crucial for classifying DO mice; were above the limit of detection in most human serum samples; and had not been widely assessed for diagnostic performance in humans before. In patient sera, CXCL1 exceeded the triage diagnostic test criteria (>90% sensitivity; >70% specificity), while MMP8 did not. Using Area Under the Curve analyses, CXCL1 averaged 94.5% sensitivity and 88.8% specificity for active pulmonary TB (ATB) vs LTBI; 90.9% sensitivity and 71.4% specificity for ATB vs non-TB; and 100.0% sensitivity and 98.4% specificity for ATB vs normal sera. Our findings overall show that the DO mouse population can discover diagnostic-quality, serum protein biomarkers of human TB.
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Onesmo, Brigitha M., and Larama MB Rongo. "ASSESSMENT OF RESPIRATORY SYMPTOMS AND ASSOCIATED FACTORS AMONG HOUSE PAINTERS IN KINONDONI MUNICIPALITY TANZANIA." International Journal of Research -GRANTHAALAYAH 6, no. 1 (January 31, 2018): 156–71. http://dx.doi.org/10.29121/granthaalayah.v6.i1.2018.1605.
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Background: House painters are increased as people prefer to live in good and decorated houses. Mishandling of paints and inhalation of paint materials become a problem as this paints contain chemicals which are poisonous upon inhalation. However, few studies have assessed respiratory symptoms among house painters in the Africa. The main objective of this study was to assess respiratory symptoms and associated factors among house painters.
Methods: We used a questionnaire to interview 172 house painters and 148 non exposed group in different construction sites. A sub sample of 25 house painters was evaluated for lung function using EasyOne spirometer
Results: The study revealed significant results when respiratory symptoms were compared among painters and non-exposed group (p<0.05). Low level of knowledge among workers and poor use of PPE were the main factors associated with exposed to paints. Protection of those workers would be only successfully if enforcement policy is enacted about every site to provide personal protective equipment (PPE) to workers.
Conclusion: House painters are exposed to different painting materials and therefore appropriate measures are recommended.
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Khapung, Robin, and N. Mahaset. "Anaphylactic Shock in Patient with Hepatic Hydatic Cyst: An Experience at a Rural Hospital." Journal of Karnali Academy of Health Sciences 1, no. 2 (October 6, 2018): 59–61. http://dx.doi.org/10.3126/jkahs.v1i2.24142.
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Hydatid disease is mainly caused by infection with the larval stage of the dog tapeworm Echinococcus granulosus. Infestation by hydatid disease in humans most commonly occurs in the liver (55- 70%) followed by the lung (18- 35%); the two organs can be affected simultaneously in about 5-13% of cases. Hydatid disease is endemic in many parts of the world, including India, Africa, South America, New Zealand, Australia, Turkey and Southern Europe. Hydatid disease is more prevalent in rural areas where there is a closer contact between people and dogs and various domestic animals which act as intermediate vectors. Hydatid disease remains frequent in JUMLA. In Karnali Academy of Health sciences 26 surgeries for hydatid cyst was done between 2016-2018.
Hydatid cyst of liver in a child is a challenge to anesthesiologist in a remote city such as Jumla. Anaphylactic and anaphylactoid reactions during anesthesia are a major cause of concern for anesthesiologists. During the perioperative period, any symptomatology relating to sudden onset hemodynamic collapse or increased airway pressures during certain surgical procedures should raise suspicion of anaphylaxis. We report a case of intraoperative sudden anaphylaxis and its management.
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Xue, Jianmin, Xia Chen, Dale Selby, Chiung-Yu Hung, Jieh-Juen Yu, and Garry T. Cole. "A Genetically Engineered Live Attenuated Vaccine of Coccidioides posadasii Protects BALB/c Mice against Coccidioidomycosis." Infection and Immunity 77, no. 8 (June 1, 2009): 3196–208. http://dx.doi.org/10.1128/iai.00459-09.
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ABSTRACT Coccidioidomycosis (also known as San Joaquin Valley fever) is an occupational disease. Workers exposed to outdoor dust which contains spores of the soil-inhabiting fungus have a significantly increased risk of respiratory infection. In addition, people with compromised T-cell immunity, the elderly, and certain racial groups, particularly African-Americans and Filipinos, who live in regions of endemicity in the southwestern United States have an elevated incidence of symptomatic infection caused by inhalation of spores of Coccidioides posadasii or Coccidioides immitis. Recurring epidemics and escalation of medical costs have helped to motivate production of a vaccine against valley fever. The major focus has been the development of a defined, T-cell-reactive, recombinant protein vaccine. However, none of the products described to date have provided full protection to coccidioidal disease-susceptible BALB/c mice. Here we describe the first genetically engineered, live, attenuated vaccine that protects both BALB/c and C57BL/6 mice against coccidioidomycosis. Two chitinase genes (CTS2 and CTS3) were disrupted to yield the attenuated strain, which was unable to endosporulate and was no longer infectious. Vaccinated survivors mounted an immune response characterized by production of both T-helper-1- and T-helper-2-type cytokines. Histology revealed well-formed granulomas and markedly diminished inflammation. Significantly fewer organisms were observed in the lungs of survivors than in those of nonvaccinated mice. Additional investigations are required to further define the nature of the live, attenuated vaccine-induced immunity against Coccidioides infection.
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Mohammadian, Mahdi, Hamid Salehiniya, Azam Safari, Khadijah Allah Bakeshei, Fatemeh Allah Bakeshei, and Abdollah Mohammadian-Hafshejani. "Disparity and trends in the incidence and mortality of lung cancer in the world." Biomedical Research and Therapy 5, no. 6 (June 23, 2018): 2348–64. http://dx.doi.org/10.15419/bmrat.v5i6.447.
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Background: Lung Cancer (LC) is one of the most common cancers in the international arena. The aim of this study was to investigate the geographical distribution of LC incidence and mortality in the world in 2012, as well as the trend of incidence and mortality of LC during 1975 to 2010 based on the gender.
Methods: In the present study, we extracted the information on the incidence and mortality of LC in 184 countries from the International Agency for Research on Cancer (IARC) (Project GLOBOCAN, 2012). The present study categorized and presented the information on the Age-Standardized Incidence Rate (ASIR) and Age Standardized Mortality Rate (ASMR) of LC based on the continents, world regions based on the development level and Human Development Index (HDI). ASIR and ASMR of LC expressed per 100,000 people.
Results: The highest ASIR and ASMR of LC occurred in North America (ASIR=38.3 and ASMR=28.6), more developed regions (ASIR=30.8 and ASMR=24.2), and the WPRO region of the WHO (ASIR=32.8 and ASMR=28.5), and those regions with very high HDI (ASIR=31 and ASMR=23.9). Furthermore, the lowest ASIR and ASMR of LC occurred in Africa (ASIR=5 and ASMR=4.5), the less developed regions (ASIR=20 and ASMR=18), the AFRO region (ASIR=3.9 and ASMR=3.5), and regions with low HDI (ASIR=5.4 and ASMR=4.8).
Conclusion: The highest ASIR and ASMR of LC occurred in North America, more developed regions, and the WPRO region of the WHO, and those regions with very high HDI. Most regions of the world had decreasing incidence and mortality of LC in men and increasing trend in women.
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Sève, Pascal, Yves Pacheco, François Durupt, Yvan Jamilloux, Mathieu Gerfaud-Valentin, Sylvie Isaac, Loïc Boussel, et al. "Sarcoidosis: A Clinical Overview from Symptoms to Diagnosis." Cells 10, no. 4 (March 31, 2021): 766. http://dx.doi.org/10.3390/cells10040766.
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Sarcoidosis is a multi-system disease of unknown etiology characterized by the formation of granulomas in various organs. It affects people of all ethnic backgrounds and occurs at any time of life but is more frequent in African Americans and Scandinavians and in adults between 30 and 50 years of age. Sarcoidosis can affect any organ with a frequency varying according to ethnicity, sex and age. Intrathoracic involvement occurs in 90% of patients with symmetrical bilateral hilar adenopathy and/or diffuse lung micronodules, mainly along the lymphatic structures which are the most affected system. Among extrapulmonary manifestations, skin lesions, uveitis, liver or splenic involvement, peripheral and abdominal lymphadenopathy and peripheral arthritis are the most frequent with a prevalence of 25–50%. Finally, cardiac and neurological manifestations which can be the initial manifestation of sarcoidosis, as can be bilateral parotitis, nasosinusal or laryngeal signs, hypercalcemia and renal dysfunction, affect less than 10% of patients. The diagnosis is not standardized but is based on three major criteria: a compatible clinical and/or radiological presentation, the histological evidence of non-necrotizing granulomatous inflammation in one or more tissues and the exclusion of alternative causes of granulomatous disease. Certain clinical features are considered to be highly specific of the disease (e.g., Löfgren’s syndrome, lupus pernio, Heerfordt’s syndrome) and do not require histological confirmation. New diagnostic guidelines were recently published. Specific clinical criteria have been developed for the diagnosis of cardiac, neurological and ocular sarcoidosis. This article focuses on the clinical presentation and the common differentials that need to be considered when appropriate.
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Putri, Arizta Nanda, Zahtamal Zahtamal, and Zulkifli Zulkifli. "Hubungan faktor lingkungan fisik, sosial dan ekonomi dengan kejadian Tuberkulosis Paru di Kecamatan Tambang Kabupaten Kampar." SEHATI: Jurnal Kesehatan 1, no. 1 (February 28, 2021): 6–15. http://dx.doi.org/10.52364/sehati.v1i1.4.
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Pulmonary tuberculosis is an infectious disease caused by Mycobacterium tuberculosis which mostly attacks the lungs and can also attack other organs. Tuberculosis is transmitted by smear positive tuberculosis patients, Tuberculosis germs are transmitted through the air when the patient coughs and sneezes so that the germs spread in the air in the form of droplets (sputum sparks), so people can become infected if they inhale the droplet into the respiratory tract (Ministry of Health Republic of Indonesia, 2014 ). According to Achmadi (2010) risk factors for tuberculosis transmission are environmental and behavioral factors. Environmental factors include ventilation, occupancy density, temperature, lighting and humidity. Whereas behavioral factors include smoking, spitting or sputum in any place, coughing or sneezing not closing the mouth and habit of not opening the window. Based on the results of a survey in Indonesia by the Directorate General of Communicable Disease Eradication and Environmental Health (2011), the high incidence of pulmonary TB is caused by a lack of knowledge. Knowledge of tuberculosis sufferers will affect the attitude and behavior such as throwing up spit or sputum that can be carelessly a source of transmission for people around him. Prabu in Fitriani (2013) explained that family heads who have an income below the regional minimum wage (UMR) will consume foods with nutrient levels that are not in accordance with the needs of each family member so that they have an nutritional status that is lacking and will make it easier to contract infectious diseases including Lung TB. According to WHO the number of cases of tuberculosis is ranked above HIV / AIDS. In 2016 there were an estimated 10.4 million new cases of tuberculosis or 142 cases / 100,000 population, 60% of new cases occurred in 6 (six) countries namely India, Indonesia, China, Nigeria, Pakistan and South Africa, and Indonesia ranked second (WHO Global Tuberculosis Report, 2017). Based on data on Indonesia's health profile in 2018 the number of tuberculosis cases in Indonesia in 2017 was 420,994 cases and increased in 2018 to reach 511,873 cases (Ministry of Health Republic of Indonesia, 2018). The number of pulmonary tuberculosis in Riau Province in 2018 is 11,135 cases (Ministry of Health of the Republic of Indonesia, 2018). Based on data on the health profile of Kampar Regency in 2017, tuberculosis is an environmentally-based direct infectious disease that ranks second with a total of 1,071 cases after diarrheal disease with a total of 1,076 cases. The number of positive AFB cases in 2017 in Kampar District reached 1071 cases, with the highest number of sufferers found in Tambang District, 78 cases. In 2018 the number of TB cases was 1079 cases, with the highest cases also occurring at the Tambang Health Center with a total of 67 cases and 43 new cases, followed by the Siak Hulu I Health Center with a total of 57 cases (Dinkes District Health Office, 2018). Based on this, this study aims to analyze and the risk of the relationship between the physical, social and economic environment with the incidence of pulmonary tuberculosis in Tambang District, Kampar Regency.
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Mash, Robert James, Mellisa Presence-Vollenhoven, Adeloye Adeniji, Renaldo Christoffels, Karlien Doubell, Lawson Eksteen, Amee Hendrikse, et al. "Evaluation of patient characteristics, management and outcomes for COVID-19 at district hospitals in the Western Cape, South Africa: descriptive observational study." BMJ Open 11, no. 1 (January 2021): e047016. http://dx.doi.org/10.1136/bmjopen-2020-047016.
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ObjectivesTo describe the characteristics, clinical management and outcomes of patients with COVID-19 at district hospitals.DesignA descriptive observational cross-sectional study.SettingDistrict hospitals (4 in metro and 4 in rural health services) in the Western Cape, South Africa. District hospitals were small (<150 beds) and led by family physicians.ParticipantsAll patients who presented to the hospitals’ emergency centre and who tested positive for COVID-19 between March and June 2020.Primary and secondary outcome measuresSource of referral, presenting symptoms, demographics, comorbidities, clinical assessment and management, laboratory turnaround time, clinical outcomes, factors related to mortality, length of stay and location.Results1376 patients (73.9% metro, 26.1% rural). Mean age 46.3 years (SD 16.3), 58.5% females. The majority were self-referred (71%) and had comorbidities (67%): hypertension (41%), type 2 diabetes (25%), HIV (14%) and overweight/obesity (19%). Assessment of COVID-19 was mild (49%), moderate (18%) and severe (24%). Test turnaround time (median 3.0 days (IQR 2.0–5.0 days)) was longer than length of stay (median 2.0 day (IQR 2.0–3.0)). The most common treatment was oxygen (41%) and only 0.8% were intubated and ventilated. Overall mortality was 11%. Most were discharged home (60%) and only 9% transferred to higher levels of care. Increasing age (OR 1.06 (95% CI 1.04 to 1.07)), male (OR 2.02 (95% CI 1.37 to 2.98)), overweight/obesity (OR 1.58 (95% CI 1.02 to 2.46)), type 2 diabetes (OR 1.84 (95% CI 1.24 to 2.73)), HIV (OR 3.41 (95% CI 2.06 to 5.65)), chronic kidney disease (OR 5.16 (95% CI 2.82 to 9.43)) were significantly linked with mortality (p<0.05). Pulmonary diseases (tuberculosis (TB), asthma, chronic obstructive pulmonary disease, post-TB structural lung disease) were not associated with increased mortality.ConclusionDistrict hospitals supported primary care and shielded tertiary hospitals. Patients had high levels of comorbidities and similar clinical pictures to that reported elsewhere. Most patients were treated as people under investigation. Mortality was comparable to similar settings and risk factors identified.
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Cilliers, Louise, and François Retief. "Tuberculosis in ancient times." Suid-Afrikaanse Tydskrif vir Natuurwetenskap en Tegnologie 27, no. 4 (September 20, 2008): 229–39. http://dx.doi.org/10.4102/satnt.v27i4.93.
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In spite of an array of effective antibiotics, tuberculosis is still very common in developing countries where overcrowding, malnutrition and poor hygienic conditions prevail. Over the past 30 years associated HIV infection has worsened the situation by increasing the infection rate and mortality of tuberculosis. Of those diseases caused by a single organism only HIV causes more deaths internationally than tuberculosis. The tubercle bacillus probably first infected man in Neolithic times, and then via infected cattle, but the causative Mycobacteriacea have been in existence for 300 million years. Droplet infection is the most common way of acquiring tuberculosis, although ingestion (e.g. of infected cows’ milk) may occur. Tuberculosis probably originated in Africa. The earliest path gnomonic evidence of human tuberculosis in man was found in osteo-archaeological findings of bone tuberculosis (Pott’s disease of the spine) in the skeleton of anEgyptian priest from the 21st Dynasty (approximately 1 000 BC). Suggestive but not conclusiveevidence of tuberculotic lesions had been found in even earlier skeletons from Egypt and Europe. Medical hieroglyphics from ancient Egypt are silent on the disease, which could be tuberculosis,as do early Indian and Chinese writings. The Old Testament refers to the disease schachapeth, translated as phthisis in the Greek Septuagint. Although the Bible is not specific about this condition, tuberculosis is still called schachapeth in modern Hebrew. In pre-Hippocratic Greece Homer did not mention phthisis, a word meaning non-specific wasting of the body. However. Alexander of Tralles (6th century BC) seemed to narrow the concept down to a specific disease, and in the Hippocratic Corpus (5th-4th centuries BC) phthisis can be recognised as tuberculosis. It was predominantly a respiratory disease commonly seen and considered to be caused by an imbalance of bodily humours. It was commonest in autumn, winter and spring, tended to affect groups of people living close together, and young people in particular. Pregnancy exacerbated phthisis which was characterised by a chronic cough (worse at night), prominent sputum, often blood streaked and presumably arising from necrotic lung tissue. The face was typically flushed with sunken cheeks, sharp nose and very bright eyes. There was atrophy of all muscles with prominent (“winged”) shoulder blades, fever and perspiration often associated with shivering. Symptoms were described which would fit in with complicating lung abscess and empyema. Hippocrates also mentions disease entities which would fit in with extra-pulmonary tuberculosis, like Pott’s disease of the spine and cervical lymphadenopathy (scrofula), although he did not associate this with phthisis. Minimal specific therapy was prescribed. Subsequent writers in the Hellenistic and Roman eras added little to the classic Hippocratic clinical picture of phthisis, but Celsus (1st century AD) and Galen (2nd century) first suggested that it was a contagious condition. From Themison (1st century BC) onwards, therapeutic regimes became more drastic with the addition of inter alia strict dietary regimes, purges, enemas and venesection. Celsus suggested long sea voyages with ample relaxation and a change of climate. Aretaeus (1st century AD) stressed the importance of not exacerbating the suffering of people with chronic disease by imposing aggressive therapy. Except for the introduction of more drastic therapy the concept of phthisis (tuberculosis) had thus not progressed materially in the course of the millennium between Hippocrates and the end of the Roman era – and it would indeed remain virtually static for the next 1 000 years up to the Renaissance. There is, however, some evidence that the incidence of tuberculosis decreased during the major migration of nations which characterised the late Roman Empire.
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Jamalpour, Saeed, Mohamad Peirovi, and Reza Jamalpour. "Green Environment and Sustainable Development, the Result of Cement Conservation." Advanced Materials Research 935 (May 2014): 323–28. http://dx.doi.org/10.4028/www.scientific.net/amr.935.323.
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In todays world, pollution is one of the most critical and acute problems resulted by human civilization which threatens the cycle and system of life, and nowadays, pollution of the environment is not an isolated problem which a special country is concerned with. The pollutant molecule that enters the environment in Europe can reach the lungs of people living in the heart of jungles in Africa or in vast plains in Asia. One of the pollutant industries which heavily affect the environment is the industry of Portland cement production. In the process of producing cement, different kinds of pollutants including Carbon Dioxide go into the environment, and as a result, this industry stands above the majority of industries regarding the pollutant emission rate. If the number of construction projects is considered as an indicator of every countrys development, the considerable use of concrete in projects carried out in developing and developed countries, and the accelerating competition of these countries for development lead to the rapid growth in use of concrete whose main material is Portland cement, and this trend results in intensifying the effects of pollutants on the environment. As concrete should be produced to the extent needed for use, and as the concrete consumption is growing, the production of cement should be increased, and this leads to a greater cycle of pollution. Thus, as prevention is considered one of the best ways to fight pollution, with conservation of cement in concrete, not only isnt any disturbance caused in development trend, but also the cost of projects will be reduced, and due to the reduction in cement consumption, countries can benefit from sustainable development, adjust the production of cement and lower the pollution caused by cement production, and as a result, reach green environment more easily. In the present article, the effect of Portland cement production in polluting the environment as well as the conservation of cement in Iran was studied and the results were reported.
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Mariam Roy, Arya, Manojna Konda, Aravind Mohanakumar Warrier, and Issam Makhoul. "Epidemiology and factors associated with mortality among inpatients with neoplasm related pain." Journal of Clinical Oncology 37, no. 31_suppl (November 1, 2019): 72. http://dx.doi.org/10.1200/jco.2019.37.31_suppl.72.
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72 Background: Intractable pain is one of the invincible entities in cancer and about 75% of cancer patients require inpatient hospital admission at least once in their treatment course. Palliative care service has a significant role in managing cancer pain and thus reducing the recurrent hospital admissions. Methods: We analyzed the association of Mortality Rate (MR) with age, sex, race, emergency admission, hospital regions among patients admitted for Neoplasm Related Pain (NRP). Data from the National Inpatient Sample (NIS) database for the year 2016 was reviewed. Patients admitted with a principal diagnosis of NRP were identified using ICD-10 code. The prevalence of each cancer and characteristics of admissions were also studied. Statistical analysis was performed using STATA and the association was depicted with Chi-Square test. Results: A total of 28609 admissions with a primary diagnosis of NRP was identified. The mean age of admission was found to be 59.38 ± 0.08, with 53.19% patients ≥ 60 years of age. 51.39% were females, 65.58% were Caucasians,16.25% were African Americans. The overall inpatient hospital MR for NRP was 8.16%. There was a significant difference in the MR between inpatients ≥ 60 years of age and <60 years (MR=9% in age ≥ 60, P<0.001). MR was high among Caucasians (8.31%, P=0.021). There exists a small difference in the MR among hospital regions (highest in West at 8.36%, lowest in South 7.68%, p=0.001). There was no statistically significant difference in the MR among sex, emergency vs elective admissions. NRP was most commonly associated with secondary neoplasms, the prevalence in the order: secondary malignant neoplasm of bone (38%), liver and bile duct (26%), followed by lung (11%), peritoneum (10%), brain (9%). The encounter for palliative care was documented only in 8530 admissions (29%). Conclusions: MR is high on people with NRP who are ≥ 60 years, Caucasians. Regional difference also plays a role in this. Further studies are needed to address the causes of the difference. Utilization of palliative care service is found to be less in NRP admissions. Future admissions and mortality rates can be reduced by the effective utilization of palliative care, optimization of outpatient pain management.
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Simonovska, Ljiljana, Iva Paneva, and Gordana Panova. "CONTROL OF INFECTION FROM NOSOCOMIAL TRANSMISSION OF TUBERCULOSIS." Knowledge International Journal 28, no. 2 (December 10, 2018): 495–500. http://dx.doi.org/10.35120/kij2802495s.
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Tuberculosis (TB) is still a huge health problem in the world. According to the World Health Organization (WHO), in 2015, 10.4 million new tuberculosis cases were registered. Most of the newly reported cases of TB are concentrated in 6 countries in the world: India, Indonesia, China, Nigeria, Pakistan and South Africa. In 2015, 1.8 million people died of TB. Among deaths 140,000 were children (1) By implementing the WHO strategy, known as Short Term Treatment Procedures under Direct Surveillance (DOT), almost all patients with tuberculosis can be treated. At the base of the DOT, the strategy is applied to short-term regimens under the direct control of health workers .Transmission of infection in tuberculosis is usually an aerobic pathway.Recent research in developing countries has shown that health care professionals (CARs) who take care of infectious TB patients have significantly higher isk of getting infected and getting sick from TB Therefore, WHO makes recommendations and guidelines to provide effective measures to prevent TB infection between the care professionals.These recommendations are based on a three-level control of the infection, consisting of administrative control, environmental control and personal protection of the respiratory organs. According to the basic healthcare activity provided by the Institute for Lung Disease and Tuberculosis (TB) in terms of diagnosing, treating and preventing tuberculosis, the working staff and / or patients coming to the Institute for various services are at risk of infection with tuberculosis bacteria. Therefore, consistent implementation of the measures recommended by the WHO and set out in the Control Program the infection of the nosocomial transmission of tuberculosis.The program for control of nosocomial infection with tuberculosis bacteria (MT) in the Institute should be realized with activities, hierarchically divided into three, оr four levels: managerial (organizational) activities at the level of a health institution, administrative measures, which reduce the risk of exposure to infection, environmental control measures, which prevents the risk of drooping way of spreading respiratory infections with MT and measures of personal protection against infection, which reduces the risk of inhalation of infectious particles.
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Vanessa. Garcia, Cristina, Greg Matthew E. Teo, Jamie P. Morano, Beata Casanas, Sadaf Aslam, Jose Montero, Kristen Zeitler, Ripal Jariwala, and Anthony Cannella. "2124. The Epidemiology, Demographics, and Geographical Distribution of Human Non-Tuberculosis Mycobacteria (NTM) Disease in the Endemic Central Florida Region." Open Forum Infectious Diseases 6, Supplement_2 (October 2019): S718—S720. http://dx.doi.org/10.1093/ofid/ofz360.1804.
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Abstract Background Of the >100,000 people in the United States infected yearly with non-tuberculosis mycobacteria (NTM), Florida has the highest yearly incidence and prevalence of NTM disease. However, little has been documented on the epidemiology and distribution of NTM disease within Central Florida. Methods A retrospective case review study was conducted from January, 2011 to December, 2017 at a large tertiary acute care medical center in Tampa, Florida to identify all NTM infection cases. Demographics (age, sex at birth, ethnicity), comorbidities, HIV testing status, residential zip code, NTM species, and specimen sources were collected. Results Of the 507 isolates, Mycobacterium abscessus group was the most common (45.4%; n = 230), and contained M. abscessus spp. abscessus (34.5%; n = 175), M. abscessus spp. massilense (8.7%; n = 44), and M. abscessus spp. bolletii (1.18%; n = 6). Other rapid growers were M. fortuitum species (6.9%; n = 35) and M. chelonae (2.56%; n = 13). Of the slower growers, M. gordonae (19.9%; n = 101) and M. avium complex (8.28%; n = 42) were the most common. Of the M. avium complex, M. chimera was most common (4.9%; n = 25). Samples were mostly isolated from sputum (51.7%; n = 262), bronchial lavage (26%; n = 132), skin and soft tissue (11%; n = 58), and blood (7.1%; n = 36). Of the 361 unique patients, average age was 59.2 years (12 to 95 years), with 47.6% (n = 172) greater than 65 years of age, and mostly male 57.9% (n = 208). Caucasians represented 73.4% (n = 265) of our cohort, and African Americans and Hispanics represented 16.3% (n = 59) and 6.8% (n = 24), respectively. Most cases were in those residing outside the Tampa Bay metro area 81.2% (n = 293/361). Notable comorbidities included COPD (n = 83), cystic fibrosis (n = 41), lung transplant (n = 40), heart transplant (n = 12), pulmonary fibrosis (n = 12), and renal transplant (n = 7). A total of 145 individuals received HIV testing at the hospital facility, and of these 44 individuals were living with HIV. Conclusion This study identified a diversity of NTM species across a wide geographical and demographic distribution in the endemic Central Florida region. M. abscessus group had the highest prevalence. This is valuable in understanding which populations are at risk for developing NTM infection in this area of Florida. Disclosures All authors: No reported disclosures.
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Calderwood, Claire J., James P. Wilson, Katherine L. Fielding, Rebecca C. Harris, Aaron S. Karat, Raoul Mansukhani, Jane Falconer, et al. "Dynamics of sputum conversion during effective tuberculosis treatment: A systematic review and meta-analysis." PLOS Medicine 18, no. 4 (April 26, 2021): e1003566. http://dx.doi.org/10.1371/journal.pmed.1003566.
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Background Two weeks’ isolation is widely recommended for people commencing treatment for pulmonary tuberculosis (TB). The evidence that this corresponds to clearance of potentially infectious tuberculous mycobacteria in sputum is not well established. This World Health Organization–commissioned review investigated sputum sterilisation dynamics during TB treatment. Methods and findings For the main analysis, 2 systematic literature searches of OvidSP MEDLINE, Embase, and Global Health, and EBSCO CINAHL Plus were conducted to identify studies with data on TB infectiousness (all studies to search date, 1 December 2017) and all randomised controlled trials (RCTs) for drug-susceptible TB (from 1 January 1990 to search date, 20 February 2018). Included articles reported on patients receiving effective treatment for culture-confirmed drug-susceptible pulmonary TB. The outcome of interest was sputum bacteriological conversion: the proportion of patients having converted by a defined time point or a summary measure of time to conversion, assessed by smear or culture. Any study design with 10 or more particpants was considered. Record sifting and data extraction were performed in duplicate. Random effects meta-analyses were performed. A narrative summary additionally describes the results of a systematic search for data evaluating infectiousness from humans to experimental animals (PubMed, all studies to 27 March 2018). Other evidence on duration of infectiousness—including studies reporting on cough dynamics, human tuberculin skin test conversion, or early bactericidal activity of TB treatments—was outside the scope of this review. The literature search was repeated on 22 November 2020, at the request of the editors, to identify studies published after the previous censor date. Four small studies reporting 3 different outcome measures were identified, which included no data that would alter the findings of the review; they are not included in the meta-analyses. Of 5,290 identified records, 44 were included. Twenty-seven (61%) were RCTs and 17 (39%) were cohort studies. Thirteen studies (30%) reported data from Africa, 12 (27%) from Asia, 6 (14%) from South America, 5 (11%) from North America, and 4 (9%) from Europe. Four studies reported data from multiple continents. Summary estimates suggested smear conversion in 9% of patients at 2 weeks (95% CI 3%–24%, 1 single study [N = 1]), and 82% of patients at 2 months of treatment (95% CI 78%–86%, N = 10). Among baseline smear-positive patients, solid culture conversion occurred by 2 weeks in 5% (95% CI 0%–14%, N = 2), increasing to 88% at 2 months (95% CI 84%–92%, N = 20). At equivalent time points, liquid culture conversion was achieved in 3% (95% CI 1%–16%, N = 1) and 59% (95% CI 47%–70%, N = 8). Significant heterogeneity was observed. Further interrogation of the data to explain this heterogeneity was limited by the lack of disaggregation of results, including by factors such as HIV status, baseline smear status, and the presence or absence of lung cavitation. Conclusions This systematic review found that most patients remained culture positive at 2 weeks of TB treatment, challenging the view that individuals are not infectious after this interval. Culture positivity is, however, only 1 component of infectiousness, with reduced cough frequency and aerosol generation after TB treatment initiation likely to also be important. Studies that integrate our findings with data on cough dynamics could provide a more complete perspective on potential transmission of Mycobacterium tuberculosis by individuals on treatment. Trial registration Systematic review registration: PROSPERO 85226.
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Hood, Anna M., Heather Strong, Cara Nwankwo, Yolanda Johnson, Constance A. Mara, Lisa M. Shook, William Brinkman, et al. "Addressing Recruitment Challenges in the Engage-HU Trial in Young Children with Sickle Cell Disease." Blood 136, Supplement 1 (November 5, 2020): 26–27. http://dx.doi.org/10.1182/blood-2020-141471.
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Background: Sickle cell disease (SCD) is a genetic disorder that causes significant medical and neurologic morbidity in children. Hydroxyurea (HU) is the primary medication used to prevent these complications. National Heart, Lung, and Blood Institute (NHLBI) guidelines recommend offering HU to children as young as 9 months of age with SCD (HbSS or HbSB0 thalassemia) using a shared decision-making approach. Although HU has proven efficacious it remains underutilized and caregivers report that they are not always actively involved in the decision to initiate this therapy. Reasons for limited HU uptake likely include lack of clinician knowledge and training and negative caregiver perceptions. Thus, we developed the Engage-HU trial as a novel approach to address HU utilization barriers. A critical consideration for this trial was that SCD primarily affects individuals of African and Hispanic/Latino descent. In these minority populations, intervention trials are sometimes terminated early because of recruitment difficulties related to mistrust of research, caregiver burden, and transportation issues. As such, the Engage-HU trial design included best-practice strategies for recruiting people of color in research. This study describes these strategies, the initial recruitment plan, preliminary recruitment outcomes and strategies, and our procedural adaptations. Study Design and Methods: Engage-HU is a randomized control trial (NCT03442114) to assess how clinicians can engage caregivers in a shared discussion that considers their values and preferences and includes evidence that supports HU. Engage-HU compares two dissemination methods for clinicians to facilitate shared decision-making with caregivers of young children with SCD: 1) the American Society of Hematology Pocket Guide, and 2) the HU Shared-Decision Making (H-SDM) Toolkit. The study aims to recruit 174 caregivers and evaluate the effectiveness of the dissemination methods on patient-centered outcomes (caregiver confidence in decision-making and perceptions of experiencing shared decision-making) as well as HU uptake and child health outcomes. Eligible children are aged 0 to 5 years, candidates for HU, and their caregiver has not made a decision about HU in the past 3 months. The trial is being conducted at 9 sites in the United States and uses a stepped-wedge design. Data will be analyzed based on the intent-to-treat principle. All participants will remain in the arm of the study to which they were randomized, regardless of whether or not they receive the assigned dissemination method. The primary endpoints are caregiver decisional uncertainty and caregiver perception of shared decision-making measured using validated tools. Data will be analyzed using a linear mixed effects regression model with a robust variance estimator and maximum likelihood estimation with observations clustered within site. The Engage-HU trial includes adaptations to increase recruitment such as tailored messaging, a relational recruitment approach, streamlined data collection, and a Stakeholder Advisory Committee. However, even with these adaptations, the first 6-months of the trial yielded lower than anticipated recruitment. Rather than terminate the trial or accept low enrollment, the research team implemented a series of recruitment strategies to address barriers including helping to improve research coordinator knowledge of the study purpose and adjusting no-show and follow-up procedures (e.g., calls to families after missed appointments and reminder calls before appointments). Site clinicians and clinic staff were provided with additional training so they could give more context about Engage-HU to caregivers and the study principal investigator led monthly "all coordinator" calls to provide support by sharing updates and experiences about successful recruitment. Implementation of these strategies resulted in triple the number of enrollments over the next 7-months compared to the previous 6-months (Table 1). Our goal in sharing this information is to provide lessons learned that can be implemented in future trials with the systematically underserved SCD population. It is also anticipated that methods described here may also inform clinical approaches to better engage caregivers of young children around critical clinical conversations, such as initiating medications like HU. Disclosures King: Magenta Therapeutics: Membership on an entity's Board of Directors or advisory committees; Bioline: Consultancy; RiverVest: Consultancy; Novimmune: Research Funding; Celgene: Consultancy; Tioma Therapuetics: Consultancy; Amphivena Therapeutics: Research Funding; WUGEN: Current equity holder in private company; Cell Works: Consultancy; Incyte: Consultancy. Smith-Whitley:Prime: Other: Education material; Celgene: Membership on an entity's Board of Directors or advisory committees; Global Blood Therapeutics: Membership on an entity's Board of Directors or advisory committees; Novartis: Membership on an entity's Board of Directors or advisory committees. Neumayr:Emmaus: Consultancy; Bayer: Consultancy; CTD Holdings: Consultancy; Pfizer: Consultancy; ApoPharma: Consultancy, Membership on an entity's Board of Directors or advisory committees; Micelle: Other: Site principal investigator; GBT: Other: Site principal investigator; PCORI: Other: site principal investigator; Novartis: Other: co-investigator; Bluebird Bio: Other: co-investigator; Sangamo Therapeutics: Other; Silarus: Other; Celgene: Other; La Jolla Pharmaceuticals: Other; Forma: Other; Imara: Other; National Heart, Lung, and Blood Institute: Other; Health Resources and Services Administration: Other; Centers for Disease Control and Prevention: Other; Seattle Children's Research: Other. Yates:Novartis: Research Funding. Thompson:Novartis: Consultancy, Honoraria, Research Funding; CRISPR/Vertex: Research Funding; BMS: Consultancy, Research Funding; Baxalta: Research Funding; Biomarin: Research Funding; bluebird bio, Inc.: Consultancy, Research Funding.
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Khan, Hamda, Nariman Ammar, Jerlym S. Porter, Juan Ding, Jeremie H. Estepp, Jason R. Hodges, Arash Shaban-Nejad, et al. "Food Deserts Are Associated with Acute Care Utilization Among Preschool Children with Sickle Cell Disease." Blood 136, Supplement 1 (November 5, 2020): 19. http://dx.doi.org/10.1182/blood-2020-138802.
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Introduction Individuals with sickle cell disease (SCD) experience recurrent acute vaso-occlusive events (VOE) beginning in infancy, that can be prevented with hydroxyurea therapy (Wang W. Lancet 2011), while chronic organ dysfunction becomes evident in adolescence and progresses with age. Nutritional insufficiencies and deficiencies occur in SCD (e.g., zinc, vitamin D and B6), and are associated with greater frequency of VOE (McCaskill M. Nutrients 2018, Martyres D. PBC 2016, Schall J. J Pediatr 2004). While infants and young children (age <6) are particularly vulnerable to the effects of malnutrition (e.g., developmental delay and cognitive impairment), the environmental components leading to decreased food access have not been investigated relative to the impact on their healthcare outcomes. We tested the hypothesis that restricted access to healthy food sources is associated with increased SCD-related acute care utilization among children with SCD younger than age 6 years, despite treatment with hydroxyurea. Methods Participants were recruited from the IRB-approved longitudinal clinical cohort study, Sickle Cell Clinical Research and Intervention Program (Hankins J. PBC 2018). Home addresses were mapped to census-tract environmental data from the US Food Access Research Atlas (USDA ERS 2017). Food deserts were defined as "low income census tracts where at least 33% (minimum of 500 people/tract) of the population live >1.0 (urban area) or >10 (rural area) miles from a grocery store or a supermarket" (Food Access, USDA ERS 2019). Three main outcomes: emergency department (ED) visits, hospitalizations, and acute care utilization (ACU=ED + hospitalizations) from a VOE, were collected from birth to age 6 and analyzed as cross-sectional outcomes at age 6-years. Generalized linear models (GLM) were used to associate environmental factors as continuous and categorical variables with the outcomes adjusted for sickle genotype and hydroxyurea exposure. False discovery rate (FDR)-adjusted p-values (pFDR) were calculated to account for multiple comparisons. Environmental factors with pFDR<0.1 were assessed in multivariate GLM. The area under ROC curves (AUC) were generated to estimate how environmental data can improve the accuracy of predicting the acute care utilization outcomes. Results 523 children with SCD, all African American, were included. The median age at last follow-up was 5.5 years (range 1- 6), 51.7% were girls (Table 1). Differences in health care utilization and hydroxyurea use were observed according to SCD genotype. A total of 33.5 % of the studied population resided in census tracts considered food deserts. The average distance to the nearest supermarket from participants' household was 2.8 miles. Except for % of children per census tract, there were no neighborhood differences by SCD genotype (Table 1). Participant neighborhoods had on average 14.7% unemployment rate, while 30.8% of individuals were under the federal poverty threshold and received Food and Nutrition Services. 7.9% of adults had a bachelors' degree. Among the tracts where the population was considered low income, 9% did not own a car, and the proportion of those living >0.5 and >1.0 miles from a supermarket was 37% and 16%, respectively. Living in a household without a vehicle and located >0.5 miles from a supermarket was associated with increased hospitalizations and ACU (Figure 1). The odds ratio (OR) of experiencing >0 hospitalizations or ACU were 1.3 (95%CI: 1.0-1.8) or 1.5 (95%CI: 1.1-2.0), for those living in a household without a vehicle and >0.5 miles from a supermarket, respectively. Living in a household with children and >1.0 mile from a supermarket was associated with high risk of experiencing >0 hospitalizations (OR: 1.5; 95%CI: 1.2-1.8) and >0 ACU (OR: 1.3; 95%CI: 1.1-1.7) (Figure 2). The accuracy of predicting a SCD-related acute event by age 6 years significantly improved when adding markers of poor food access to the predictive model (AUC increase: ≥0.06, p=0.01) (Figure 3). Conclusion Living in food deserts limits access to affordable and nutritious foods. Food deserts are associated with poor health outcomes among pre-school children with SCD. The prediction of acute care utilization in young childhood increases when food access is considered. Treatment with hydroxyurea did not mitigate the effects of reduced food access on the frequency of acute care utilization of young children with SCD. Disclosures Estepp: ASH, NHLBI: Research Funding; Daiichi Sankyo, Esperion, Global Blood Therapeutics: Consultancy; Global Blood Therapeutics, Forma Therapeutics, Pfizer, Eli Lilly and Co: Research Funding. Hankins:LINKS Incorporate Foundation: Research Funding; National Heart, Lung, and Blood Institute: Honoraria, Research Funding; Novartis: Research Funding; UptoDate: Consultancy; MJH Life Sciences: Consultancy, Patents & Royalties; Global Blood Therapeutics: Consultancy, Research Funding; American Society of Pediatric Hematology/Oncology: Honoraria.
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Zampoli, M., J. Verstraete, M. Frauendorf, R. Kassanjee, L. Workman, B. M. Morrow, and H. J. Zar. "Cystic fibrosis in South Africa: spectrum of disease and determinants of outcome." ERJ Open Research, June 11, 2021, 00856–2020. http://dx.doi.org/10.1183/23120541.00856-2020.
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IntroductionLittle is known about cystic fibrosis (CF) in low-middle income settings. This study aimed to describe the spectrum and outcomes of CF in South Africa (SA) from the recently established SA CF registry (SACFR).MethodsDemographic, diagnosis and clinical data was extracted from the SACFR. Cross-sectional univariable and multivariable regression analysis of best forced expiratory volume in 1 s (FEV1; age≥6 years) and nutrition (all ages) in 2018 was conducted to investigate factors associated with severe lung disease (SLD; FEV1 ≤3.0 z-score) and undernutrition.ResultsBy December 2018, ancestry of 447 individuals included in the SACFR was Caucasian (315; 70%), mixed (87; 19%) and black African (41; 9%). Median diagnosis age was 7.6 months (IQR 2.7,37.1). Genotype was p.Phe508del homozygous (220; 49%); p.Phe508del heterozygous (144; 32%) and neither p.Phe508del or unknown Cystic Fibrosis Transmembrane Conductance Regulator (CFTR) variant in 83 (19%); the second most frequent CFTR variant was 3120+1G>A, common in black Africans. Median age of patients in 2018 was 14.7 years (IQR 7.4,24.4). SLD was independently associated with chronic methicillin resistant S.aureus (MRSA) (aOR 16.75; 95% CI 1.74–161.50), undernutrition (aOR 5.20; 95% CI 2.23–12.13) and age (aOR 2.23 per 10-years; 95% CI 1.50–3.31). Undernutrition was associated in univariable analysis with low weight at diagnosis, non-caucasian ancestry, chronic P.aeruginosa infection and lower socioeconomic status.ConclusionInterventions targeting MRSA infection and nutrition are needed to improve CF outcomes in SA. Most people with CF in SA are eligible for highly effective CFTR modulator therapy.
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Lawson, Agbogbenkou Tevi Déla-dem, Fulgence Abdou Faye, and Adama Berthe. "Pulmonary tuberculosis co-infection and COVID-19 in Senegal." Journal of Infectious Diseases & Case Reports, December 31, 2020, 1–4. http://dx.doi.org/10.47363/jidscr/2020(1)118.
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New Coronavirus Disease (SARS-CoV-2) is responsible for the severe acute respiratory syndrome. Appeared in Wuhan, China, in December 2019, it affects more than 188 countries around the world to date. Africa is not spared by this pandemic (COVID-19), which is on the rise. Tuberculosis (TB), a disease endemic in Africa with a fatality of 1.5 million people per year , like COVID-19, is transmitted mainly by the respiratory route and affects the lungs[1,2]. In the literature, few studies have demonstrated the association and interactions between these two pathologies. However, the fragmented data reveal that tuberculosis with pulmonary localization must be considered as a potential risk factor for aggravation or complication of the disease. COVID-19, especially since the lung damage is significant, therefore In the fight against the COVID-19 pandemic, we must not forget to suspect and appropriately manage tuberculosis [2]. We report here the case of 3 patients who presented with COVID-19-Tuberculosis co-infection, treated at the level of the Epidemic Treatment Center (CTE) of the Thiès regional hospital in Senegal and whose evolution is favorable under early and adequate treatment.
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"Lung cancer 1978–1981 in the black peoples of South Africa." Lung Cancer 2, no. 4 (December 1986): 249. http://dx.doi.org/10.1016/s0169-5002(86)80692-4.
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Auld, Sara C., Hardy Kornfeld, Pholo Maenetje, Mandla Mlotshwa, William Chase, Mboyo di-Tamba Vangu, Drew A. Torigian, Robert S. Wallis, Gavin Churchyard, and Gregory P. Bisson. "Pulmonary restriction predicts long-term pulmonary impairment in people with HIV and tuberculosis." BMC Pulmonary Medicine 21, no. 1 (January 7, 2021). http://dx.doi.org/10.1186/s12890-020-01368-4.
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Abstract Background While tuberculosis is considered a risk factor for chronic obstructive pulmonary disease, a restrictive pattern of pulmonary impairment may actually be more common among tuberculosis survivors. We aimed to determine the nature of pulmonary impairment before and after treatment among people with HIV and tuberculosis and identify risk factors for long-term impairment. Methods In this prospective cohort study conducted in South Africa, we enrolled adults newly diagnosed with HIV and tuberculosis who were initiating antiretroviral therapy and tuberculosis treatment. We measured lung function and symptoms at baseline, 6, and 12 months. We compared participants with and without pulmonary impairment and constructed logistic regression models to identify characteristics associated with pulmonary impairment. Results Among 134 participants with a median CD4 count of 110 cells/μl, 112 (83%) completed baseline spirometry at which time 32 (29%) had restriction, 13 (12%) had obstruction, and 9 (7%) had a mixed pattern. Lung function was dynamic over time and 30 (33%) participants had impaired lung function at 12 months. Baseline restriction was associated with greater symptoms and with long-term pulmonary impairment (adjusted odds ratio 5.44, 95% confidence interval 1.16–25.45), while baseline obstruction was not (adjusted odds ratio 1.95, 95% confidence interval 0.28–13.78). Conclusions In this cohort of people with HIV and tuberculosis, restriction was the most common, symptomatic, and persistent pattern of pulmonary impairment. These data can help to raise awareness among clinicians about the heterogeneity of post-tuberculosis pulmonary impairment, and highlight the need for further research into mediators of lung injury in this vulnerable population.
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Masese, Rita V., Terri DeMartino, Emily Bonnabeau, Ebony N. Burns, Liliana Preiss, Taniya Varughese, Judith M. Nocek, et al. "Effective Recruitment Strategies for a Sickle Cell Patient Registry Across Sites from the Sickle Cell Disease Implementation Consortium (SCDIC)." Journal of Immigrant and Minority Health, October 9, 2020. http://dx.doi.org/10.1007/s10903-020-01102-6.
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Abstract Sickle cell disease (SCD) is a genetic disorder predominantly affecting people of African descent and is associated with significant morbidity and mortality. To improve SCD outcomes, the National Heart Lung and Blood Institute funded eight centers to participate in the SCD Implementation Consortium. Sites were required to each recruit 300 individuals with SCD, over 20 months. We aim to describe recruitment strategies and challenges encountered. Participants aged 15–45 years with confirmed diagnosis of SCD were eligible. Descriptive statistics were used to analyze the effectiveness of each recruitment strategy. A total of 2432 participants were recruited. Majority (95.3%) were African American. Successful strategies were recruitment from clinics (68.1%) and affiliated sites (15.6%). Recruitment at community events, emergency departments and pain centers had the lowest yield. Challenges included saturation of strategies and time constraints. Effective recruitment of participants in multi-site studies requires multiple strategies to achieve adequate sample sizes.
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Landy, Rebecca, Corey D. Young, Martin Skarzynski, Li C. Cheung, Christine D. Berg, M. Patricia Rivera, Hilary A. Robbins, Anil K. Chaturvedi, and Hormuzd A. Katki. "Using Prediction-Models to Reduce Persistent Racial/Ethnic Disparities in Draft 2020 USPSTF Lung-Cancer Screening Guidelines." JNCI: Journal of the National Cancer Institute, January 5, 2021. http://dx.doi.org/10.1093/jnci/djaa211.
Full textAbstract:
Abstract We examined whether draft 2020 United States Preventive Services Task Force (USPSTF) lung-cancer screening recommendations “partially ameliorate racial disparities in screening eligibility” compared to 2013 guidelines, as claimed. Using data from the 2015 National Health Interview Survey, USPSTF-2020 increased eligibility by similar proportions for minorities (97.1%) and Whites (78.3%). Contrary to the intent of USPSTF-2020, the relative disparity (differences in percentages of model-estimated gainable life-years from National Lung Screening Trial-like screening by eligible Whites vs minorities) actually increased from USPSTF-2013 to USPSTF-2020 (African Americans: 48.3%–33.4%=15.0% to 64.5%–48.5%=16.0%; Asian Americans: 48.3%–35.6%=12.7% to 64.5%–45.2%=19.3%; Hispanic Americans: 48.3%–24.8%=23.5% to 64.5%–37.0%=27.5%). However, augmenting USPSTF-2020 with high-benefit individuals selected by the Life-Years From Screening with Computed Tomography (LYFS-CT) model nearly eliminated disparities for African Americans (76.8%–75.5%=1.2%), and improved screening efficiency for Asian/Hispanic Americans, although disparities were reduced only slightly (Hispanic Americans) or unchanged (Asian Americans). Draft USPSTF-2020 guidelines increased the number of eligible minorities versus USPSTF-2013 but may inadvertently increase racial/ethnic disparities. LYFS-CT could reduce disparities in screening eligibility by identifying ineligible people with high predicted benefit, regardless of race/ethnicity.
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Siagian, Forman Erwin. "Pulmonary Complication in Severe Malaria." International Journal of Pathogen Research, September 8, 2021, 19–27. http://dx.doi.org/10.9734/ijpr/2021/v8i130194.
Full textAbstract:
Malaria is a potentially fatal disease caused by Plasmodium spp. Transmission occurs via the bite of female mosquito, Anopheles spp. Epidemiologically, global number of malaria patient are located in Southeast Asia and Africa. Until nowadays, millions of people still living in endemic area, with children and pregnant women are among the most vulnerable group in the population. Although there have been many advances in treatment and management, but the potential for harm remains; one of the example is lung involvement in patients with severe malaria. This paper aim to discuss briefly about lung derangement in the severe malaria and the inflammatory response related to the lung dysfunction. The severity of pulmonary impairment due to complications of malaria is determined not only by the initiation of antimalarial treatment but also by the hosts associated immune response.
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Okello, Nick O., Tom W. Okello, and Mark Zunckel. "Changes in health risk associated with air pollution and policy response effectiveness, Richards Bay, South Africa." Clean Air Journal 30, no. 1 (June 22, 2020). http://dx.doi.org/10.17159/caj/2020/30/1.8012.
Full textAbstract:
Lung and bronchus cancer, asthma, acute lower respiratory infections (ALRI), ischemic heart diseases (IHD), cerebrovascular diseases (CEV) are disorders that have been widely associated with air pollution. More so, research shows that more than 5.5 million people die prematurely every year due to household and outdoor air pollution placing it as the fourth highest-ranking risk factor for death globally (Forouzanfar et al., 2015).
Setting a minimum emission standard for industrial sources is a way to control air pollution and to minimize adverse impacts on people. With an aim to ascertain pollution policy intervention effectiveness, this study uses the case of Richards Bay to determine changes in health risk associated with air quality pollution exposure and the benefits of policy intervention. The study looks at trends of mortality in the last 20 years, the change in the ranking of 6 air-related mortality causes and Year of Life Lost (YLL) as a result of pollution. Results indicate a 24% decrease in the YLL due to air quality related diseases since 2009 when minimum emission standards were promulgated. The decrease can be observed across all age groups except for the 15-24-year-old, where cases of asthma and acute lower respiratory infections (ALRI) are the major mortality drivers. The adults and the older generation are now living slightly longer, although cases of CEV in that generation as well as the younger generation is still an issue that requires continuous monitoring and intervention. The study concludes that there is an improvement that could be attributed to policy implementation. However, the increase in mortality due to certain disease cases such as cancer of the bronchus and lung whose onset could be prior to 2010 signifies that the pollution control efforts need to continue and be stepped up. The increase of ALRI, which adversely affects children, is of concern
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Amanfu, W. "Contagious bovine pleuropneumonia (lungsickness) in Africa : historical overview : Onderstepoort and veterinary research in Africa." Onderstepoort J Vet Res 76, no. 1 (September 10, 2009). http://dx.doi.org/10.4102/ojvr.v76i1.55.
Full textAbstract:
Contagious bovine pleuropneumonia (CBPP) or lung sickness, is an insidious pneumonic disease of cattle caused by Mycoplasma mycoides subspecies mycoides small colony variant (MmmSC) and it is one of the major diseases affecting cattle in Africa. With the imminent eradication of rinderpest from Africa (Somali ecosystem) CBPP has become the disease of prime concern in terms of epizootics that affect cattle on the continent. The control and/or eradication of the disease have suffered from unsustained control actions due to lack of operational funds to support such actions and deterioration in the quality of veterinary services in many countries affected by the disease. Stamping out procedures which were adopted by Botswana to control the disease (1995-1997) cannot be carried out by many countries currently affected by CBPP due to the high financial cost, the widespread nature of disease, animal welfare considerations and the potential loss of a valuable genetic resource base. The current scenario of CBPP disease epidemiology in sub-Saharan Africa requires that proactive measures are taken to safeguard countries in southern Africa which are currently free from CBPP from being contaminated by the disease thus affecting the beef industry and people's livelihoods ; and to progressively control the disease in endemic zones of Western and Central Africa.