Digital Commons Network^™

Do User Fees Increase Tuberculosis Notifications?, Chioma Y. Chukwumah

Economics Honors Projects

Public health sectors around the world strive to provide accessible and affordable care. Tight government budgets and growing populations lead countries to consider adding or raising charges to health care consumers. These user fees may affect the quality, equity and revenue of health care. This paper investigates the impact of user fees on notifications of tuberculosis. In the panel data composed of 176 countries from 1960 to 2012, I find no evidence that suggests user fees increase tuberculosis. In contrast, I find strong and robust evidence suggesting user fees are associated with fewer new cases of tuberculosis.

Daily Contact With A Patient And Poor Housing Affordability As Determinants Of Pulmonary Tuberculosis In Urban Pakistan, Batool A. Haider, Saeed Akhtar, Juanita Hatcher

Community Health Sciences

Objective: This study aimed to evaluate the factors associated with pulmonary tuberculosis (TB) among individuals aged 15years or more in urban Karachi, Pakistan.DESIGN AND SETTING: A case-control design was implemented in three major tertiary-care hospitals to select cases (n=342) with active pulmonary TB (i.e. two sputum smears positive for Mycobacterium tuberculosis with clinical and radiographic evidence of current pulmonary TB and diagnosed between August 2002 and October 2003. Selected controls (n=342) were surgery patients from the same hospitals at time of recruitment of the cases, without clinical and radiographic evidence of pulmonary TB.Results: Multivariable logistic regression model showed that daily …

"Conspicuous Consumption:" Germs And Climate Cures In Denver, 1882-1915, Sydney Rene Gwinn

Graduate Student Theses, Dissertations, & Professional Papers

This thesis argues that the health-seeker’s quest for climatic cures persisted after the germ theory of disease began to alter medical approaches to tuberculosis after its announcement in 1882. Buoyed by anti-modern sentiments and a lack of effective medicinal interventions, physicians continued to recommend that tuberculosis patients travel to Denver to seek recovery in a healthier climate. In turn, Denver’s polity and public health approaches were shaped by the influences of the migration of tuberculosis patients to the city. After 1882, new approaches focused on sanitation and isolation began to take hold among physicians and public health reformers who worked …

Apopo Annual Report 2013, Apopo

Global CWD Repository

2013 has been a busy year once again for the APOPO mine action team. In Mozambique APOPO has been instrumental in clearing Gaza Province of landmines and Explosive Remnants of War (ERW) to the point where Gaza has been declared “Impact Free”. The teams have since been deployed to other Provinces within the country to continue their efforts with the aim of assisting Mozambique to achieve full compliance with its Anti-Personal Mine Ban Convention obligations by December 2014.

In Angola, APOPO has partnered with Norwegian People’s Aid (NPA) and is providing our unique Mine Detection Rats (MDRs) to assist with …

Is Starting Antiretroviral Therapy (Art) In Hiv Positive Adults With Cd4 Cell Count Of <300 Cells/Μl Within Four Weeks Of Initiating New Tuberculosis (Tb) Therapy More Effective In Reducing Mortality Rates Than Starting Art Four Weeks Or Later After Initiating New Tb Therapy?, Janna Erlien

PCOM Physician Assistant Studies Student Scholarship

OBJECTIVE: The objective of this selective EBM review is to determine whether or not starting antiretroviral therapy (ART) in HIV positive adults with CD4 cell count of /µl within four weeks of initiating new tuberculosis therapy more effective in reducing mortality rates than starting ART four weeks or later after initiating new tuberculosis therapy.

STUDY DESIGN: Systematic review of three English language primary studies published in the New England Journal of Medicine in 2011.

DATA SOURCES: Three open label, randomized, controlled trials published in 2011, comparing the timing of ART for HIV+ adults with confirmed or suspected new TB …

Tuberculosis Screening And Treatment Outcomes In Zambia, Jennifer Harris

All ETDs from UAB

Zambia is a country in Southern Africa with dual HIV and tuberculosis (TB) epidemics. The annual TB incidence is 444/100,000 and 64% of TB patients are co-infected with HIV. Accurate screening and diagnosis for TB is challenging since it often presents with non-specific signs and symptoms and the available diagnostics are neither sensitive nor specific. Papers one and two of this dissertation focus on the derivation of TB screening rules to more accurately identify high-risk persons in two Zambian populations: inmates and HIV clinic patients. Among inmates, being HIV positive and having a body mass index < 18.5 most strongly predicted HIV disease. Chest pain was also strongly associated, but this may have been a chance finding. For HIV clinic patients, we developed four rules with increasing complexity of clinical tools used for screening. Sensitivity was very high with all rules; the addition of vital signs and pulmonary exam findings to symptom-based screening rules greatly increased the rules' specificity. Furthermore, a rule incorporating pulmonary exam findings performed similarly to a rule with chest radiography suggesting pulmonary exam may be an inexpensive alternative to x-ray. The final paper looks at TB incidence, mortality and intermediate clinical outcomes in a cohort of HIV clinic patients with and without TB during their first 12 months of HIV care. TB incidence was very high during this time period, despite thorough screening at baseline. Mortality was elevated in both culture-confirmed and clinically-diagnosed TB patients, with much of the elevated risk concentrated in TB patients who had culture-confirmed but clinically-unapparent disease. Looking at intermediate outcomes among patients who started anti-retroviral therapy, the change in CD4 cell count was similar for patients with and without TB. TB patients started off with lower mean body weights and hemoglobin concentrations but also showed greater increases over 12 months, thus `catching up' with the TB-negative patients. If these findings are replicable in other cohorts they could have substantial impact on TB screening and diagnostic procedures in resource limited, high burden countries like Zambia.

The South Carolina Sanatorium: The Landscape Of Public Healthcare In The Segregated South, Amanda Noll

Theses and Dissertations

This site-specific study examines the development of the South Carolina Sanatorium, which operated as a state-funded tuberculosis treatment center between 1915 and 1953. Using the South Carolina Sanatorium as a case study, this thesis draws upon the history of the Progressive Era, medicine, and architecture to analyze the influence of segregation on public healthcare in the South. By looking at the development of individual buildings and the site as whole, the built environment of the South Carolina Sanatorium is used as a framework to assess the effects of segregation on tuberculosis treatment in South Carolina.

Induction Of Stronger And Long Lasting Vaccine Immunity To Tuberculosis, Pearl Bakhru

Dissertations and Theses (Open Access)

Tuberculosis is a major cause of death due to an infection in mankind. BCG vaccine protects against childhood tuberculosis although, it fails to protect against adult tuberculosis. BCG vaccine localizes to immature phagosomes of macrophages, and avoids lysosomal fusion, which decreases peptide antigen production. Peptides are essential for macrophage-mediated priming of CD4 and CD8 T cells respectively through MHC-II and MHC-I pathways. Furthermore, BCG reduces the expression of MHC-II in macrophages of mice after infection, through Toll-like receptor-1/2 (TLR-1/2) mediated signaling. In my first aim, I hypothesized that BCG-induced reduction of MHC-II levels in macrophages can decrease CD4 T cell …

Epidemiology Of Tuberculosis In Ohio, Usha Bala Vayuvegula

Master of Public Health Program Student Publications

Background: Tuberculosis (TB) is a global infectious disease often associated with HIV. Study of the distribution and epidemiologic trends may help target prevention and control measures towards high risk areas and groups.

Objective: To determine TB trends in four counties in Ohio, i.e. Franklin, Cuyahoga, Hamilton and Montgomery counties, and to explore differences in distribution of cases across gender, age groups and races.

Methods: TB surveillance data was collected from the Ohio Department of Health website for 12 years (1999-2011). Mean TB rates across gender were compared using the two sample t-test. One way ANOVA was used to compare means …

Multidrug Resistant Pulmonary Tuberculosis Treatment Regimens And Patient Outcomes: An Individual Patient Data Meta-Analysis Of 9,153 Patients, Shama D. Ahuja, David Ashkin, Monika Avendano, Rita Banerjee, Melissa Bauer, Jamie N. Bayona

Dartmouth Scholarship

Dick Menzies and colleagues report findings from a collaborative, individual patient-level meta-analysis of treatment outcomes among patients with multidrug-resistant tuberculosis.

Background: Treatment of multidrug resistant tuberculosis (MDR-TB) is lengthy, toxic, expensive, and has generally poor outcomes. We undertook an individual patient data meta-analysis to assess the impact on outcomes of the type, number, and duration of drugs used to treat MDR-TB.

Co-Infected Diseases And State Health Policy: Botswana And South Africa's Response To Hiv And Tuberculosis, Margaret H. Schmidt

Lawrence University Honors Projects

The emergence of human immunodeficiency virus (HIV) has led to the growth of co-infection with other illnesses including tuberculosis. Many states are now attempting to address the problems presented with co-infected patients from a variety pathogens. In particular sub-Saharan Africa has suffered exponentially more from HIV and TB co-infection than other parts of the world. Thus, why have Botswana and South Africa not created national health policies to treat these diseases together? The following describes the process of how World Health Organization recommendations are translated into state policy. In turn, while donorship and international policy alterations create strong punctuations, the …

Characteristics Of Extra Pulmonary Tb Cases In The Specialized Center For Chest And Respiratory Disease, Mohammad Yahya Abdulrazaq, Abdulla Janger Al-Farttoosi, Hayder H.Ali Al-Sikafi

Iraqi Postgraduate Medical Journal

ABSTRACT: BACKGROUND: Tuberculosis (TB) is a serious global problem. It remains the number one killer infectious disease in developing countries. The clinical manifestations of TB could be either Pulmonary or Extra pulmonary (EPTB). Extrapulmonary tuberculosis involves relatively inaccessible sites, and often, because of the vulnerability of the areas involved, much greater damage can be caused by fewer bacilli..In 2007 in the United States, 20% of newly reported cases of tuberculosis involved extrapulmonary sites only In order of frequency, the extrapulmonary sites most commonly involved in TB are the lymph nodes, pleura, genitourinary tract, bones and joints, meninges, peritoneum, and pericardium. …

Laryngeal Tuberculosis Presenting As Laryngeal Carcinoma, Anwar Suhail, Muhammad Sheharyar Ahmed, Zain-Ul-Abdeen Sobani, Shahzad Ghaffar

Section of Otolaryngology, Head & Neck Surgery

Tuberculosis (TB) accounts for the highest number of mortalities among infectious diseases worldwide. Laryngeal TB is an extremely rare presentation of TB. It has many similarities to laryngeal carcinoma, one of the three most common cancers among males in the city, with an age standardized rate of 8.6. The associated risk factors of laryngeal carcinoma i.e. smoking, paan, betel nut usage and alcohol use also tend to be concentrated in the same demographic background as that of TB, creating a diagnostic dilemma. We present a case of granulomatous laryngeal TB, in a 40 year old male, with characteristic presenting features …

Evaluation Of Radiological Findings In 160 Adult Patients With Tuberculous Meningitis, Kadri̇ye Yaşar, Fi̇li̇z Pehli̇vanoğlu, Ahmet Şengöz, Gönül Şengöz

Turkish Journal of Medical Sciences

To evaluate the radiological findings of 160 adult patients with tuberculous meningitis (TBM). Materials and methods: Using a standard data collection form, 160 patients with TBM who had been followed for 11 years were assessed retrospectively. Cranial imaging results were obtained by computed tomography (CT) and magnetic resonance imaging (MRI), and pulmonary findings were obtained by chest X-ray and CT. Tuberculomas were assessed with a nominal tuberculoma classification index (TCI) scale. Results: Of the 160 patients, 80 were males and the mean age was 32.18 ± 13.62 years (range: 14-78). On admission, 84% were in stages II or III; 27 …

Yellow, In Peril: How Public Health Discourse On Tuberculosis (Tb) Reveals, Refines, And Reinforces The Racial Stigmatization Of Asian Americans, Laura Dellplain

Honors Papers

In this paper, I argue that while public health discourse on tuberculosis may reveal existent epidemiological trends in and among particular social groups, the discursive framing of this data unnecessarily racializes the disease. More specifically, public health discourse uses frameworks of "othering" and an imagined transnationalism to reflect but also refine and reinforce historicized stigmas of Asian Americans as non-normative, perpetual outsiders, and disease carriers. I assert that this discursive raciliazation of TB superficially constructs a causal link between Asian Americans and the incidence of TB in America and consequently results in significant social and political costs for many Asian …

Resistance Patterns Of Mycobacterium Tuberculosis Isolates From Pulmonary Tuberculosis Patients In Nairobi, Perpetual Wangui Ndung’U, Samuel Kariuki, Zipporah Ng’Ang’A, Gunturu Revathi

Pathology, East Africa

Introduction: In Kenya, which ranks thirteenth of 27 high tuberculosis burden countries, diagnosis is based on Ziehl-Neelsen staining alone and patients are treated without information on sensitivity patterns. This study aimed to determine resistance patterns of Mycobacterium tuberculosis isolated from pulmonary samples.

Methodology: Pulmonary tuberculosis patients in Nairobi were randomly sampled after informed consent and recruited into the study using a structured questionnaire. Specimens were cultured in liquid and solid media, and drug susceptibility tests were performed for first-line drugs including (isoniazid, rifampin, streptomycin, ethambutol and pyrazinamide).

Results: Eighty-six (30%) of 286 isolates were resistant to at least one of …

An Epidemiological Model Of Rift Valley Fever With Spatial Dynamics, Tianchan Niu, Holly D. Gaff, Yiannis E. Papelis, David M. Hartley

Biological Sciences Faculty Publications

As a category A agent in the Center for Disease Control bioterrorism list, Rift Valley fever (RVF) is considered a major threat to the United States (USA). Should the pathogen be intentionally or unintentionally introduced to the continental USA, there is tremendous potential for economic damages due to loss of livestock, trade restrictions, and subsequent food supply chain disruptions. We have incorporated the effects of space into a mathematical model of RVF in order to study the dynamics of the pathogen spread as affected by the movement of humans, livestock, and mosquitoes. The model accounts for the horizontal transmission of …

Mycobacterial Iron Acquisition Systems, Christopher M. Jones

All ETDs from UAB

Iron is an essential nutrient for the vast majority of organisms; yet, the availability of iron is limited to microorganisms due to the insolubility of ferric hydroxides and to pathogens by iron withholding strategies of their hosts. Many bacteria produce small, high-affinity iron chelators called siderophores to scavenge iron from the environment. In addition, many bacterial pathogens have evolved mechanisms to steal host iron contained in heme, hemoglobin, or transferrin. Mycobacteria are unique genera of bacteria represented by the notorious pathogens Mycobacterium tuberculosis and Mycobacterium leprae, the causative agents of tuberculosis (TB) and leprosy, respectively. Tuberculosis remains a global health …

Investigation Of The Membrane Interactions Of Mycobacterium Tuberculosis Secreted Factors Esat-6 And Cfp-10, Joaquin A. De Leon

Open Access Theses & Dissertations

Mycobacterium tuberculosis is the causative agent of the infectious disease tuberculosis, infecting about one-third of human race. Infections are not vast in the United States when compared to many other countries, yet many cases seen in the United States are of those who have immigrated to the United States. The Hispanic/Latino population in the United States contributes to a large fraction of those infected with tuberculosis in the United States. During this study we purified recombinant Mycobacterium tuberculosis secreted factors ESAT-6 and CFP-10 from Escherichia coli. Here we have introduced a method in which we can refold and purify …

Correlation Of Cough Frequency With Treatment Efficacy In Pulmonary Tuberculosis Patients In Lima, Peru, Jesus Gutierrez

Master's Theses

No abstract provided.

Isoniazid Preventive Therapy In Correctional Facilities: A Systematic Review, H.A.A. Al-Darraji, A. Kamarulzaman, F.L. Altice

Research Publications (2011 to 2015)

No abstract provided.

Pharmacokinetic And Pharmacodynamic Studies Of A Novel Spectinamide Series Of Antituberculosis Agents, V. N. R. Pavan Kumar Vaddady

Theses and Dissertations (ETD)

Spectinamides are novel amide derivatives of the antibiotic spectinomycin that have emerged as a new class of agents to treat tuberculosis. These agents showed potent in vitro activity against Mycobacterium tuberculosis (MTB) compared to spectinomycin and in a preliminary in vivo study in interferon gamma (IFN‑γ) knockout mice, spectinamide Lee1329 reduced the lung bacillary load of TB comparable to streptomycin. We hypothesized that the application of an iterative pharmacokinetics and pharmacodynamics (PK/PD) guided approach would facilitate the optimization of these lead compounds suitable for further development.

A series of in vitro experiments including parallel artificial membrane permeability assay (PAMPA), microsomal …

Immune Modulation Of The Mycobacterium Tuberculosis Granulomatous Response, Kerry J. Welsh

Dissertations and Theses (Open Access)

Tuberculosis (TB) remains a major public health burden. The immunocompetant host responds to Mycobacterium tuberculosis (MTB) infection by the formation of granulomas, which initially prevent uncontrolled bacterial proliferation and dissemination. However, increasing evidence suggests that granuloma formation promotes persistence of the organism by physically separating infected cells from effector lymphocytes and by inducing a state of non-replicating persistence in the bacilli, making them resistant to the action of antibiotics. Additionally, immune-mediated tissue destruction likely facilitates disease transmission. The granulomatous response is in part due to mycobacterial glycolipid antigens. Therefore, studies were first undertaken to determine the innate mechanisms of mycobacterial …

Tuberkulosis Paru Di Palembang, Sumatera Selatan, Hery Unita Versitaria, Haryoto Kusnoputranto

Kesmas

Indonesia tercatat memiliki 304.787 penderita tuberkulosis yang menempatkannya pada peringkat ketiga terbanyak di dunia. Penyakit tuberkulosis merupakan penyebab kematian nomor 3 setelah penyakit kardiovaskuler dan penyakit saluran pernafasan pada semua kelompok usia serta nomor 1 dari golongan penyakit infeksi. Angka kepadatan hunian rumah di Kota Palembang 5,84 lebih tinggi daripada angka ideal kepadatan hunian rumah. Penelitian ini bertujuan mengetahui hubungan antara sumber penular serumah, faktor lingkungan dalam rumah, dan karakteristik individu terhadap kejadian tuberkulosis paru basil tahan asam (BTA) (+) di Kota Palembang. Penelitian yang menggunakan desain kasus kontrol ini membandingkan kelompok kasus (BTA(+)) dan kelompok kontrol (BTA (-)) yang …

The Effect Of Age On Clinical And Radiological Presentation In Patients With Pulmonary Tuberculosis In Baghdad, Hashim M.Al-Kadhimi, Haider Noori Dawood

Iraqi Postgraduate Medical Journal

ABSTRACT: BACKGROUND: Mycobacterium tuberculosis causes the most common type of human tuberculosis worldwide .The most common mode of transmission is by inhalation of droplet nuclei from expectorated respiratory secretions.Active infection is diagnosed by documenting the presence of M tuberculosis in respiratory secretions or other body fluids or tissues.Age is an important determinant of the risk for the disease .The risk may increase in the elderly OBJECTIVE: To compare the effect of age between elderly and younger on clinical and radiological presentation in patients with pulmonary tuberculosis in Iraq. PATIENTS AND METHODS: A prospective study was done for 251 patients with …

Does Normal Chest X Ray In Patients With Chronic Cough Exclude Pulmonary Tuberculosis?, Mohammad Yahya Abdulrazaq, Abdulla Janger Minshed

Iraqi Postgraduate Medical Journal

ABSTRACT: BACKGROUND: Tuberculosis is the second infection in causing deaths from infectious agent in the world, currently in Iraq approximately 67% of new cases of Tuberculosis involve the lung only ,cough is the most common symptom of pulmonary Tuberculosis , pulmonary Tuberculosis nearly always causes detectable abnormalities on chest film, but still atypical or absent radiologic findings can occur. OBJECTIVE: This study was designed to determine whether in patients with chronic cough normal chest X ray exclude pulmonary tuberculosis. PATIENTS AND METHODS: One hundred seventy two patients attending the respiratory clinic, complaining from chronic cough and they are suspected cases …

Targeted Drug-Resistance Testing Strategy For Multidrug-Resistant Tuberculosis Detection, Lima, Peru, 2005–2008, Gustavo E. Velásquez, Martin Yagui, J Peter Cegielski, Luis Asencios, Jaime Bayona, Cesar Bonilla, Hector O. Jave, Gloria Yale, Carmen Suárez, Sidney Atwood, Carmen C. Contreras, Sonya S. Shin

Dartmouth Scholarship

The Peruvian National Tuberculosis Control Program issued guidelines in 2006 specifying criteria for culture and drug-susceptibility testing (DST), including district-level rapid DST. All patients referred for culture and DST in 2 districts of Lima, Peru, during January 2005–November 2008 were monitored prospectively. Of 1,846 patients, 1,241 (67.2%) had complete DST results for isoniazid and rifampin; 419 (33.8%) patients had multidrug-resistant (MDR) TB at the time of referral. Among patients with new smear-positive TB, household contact and suspected category I failure were associated with MDR TB, compared with concurrent regional surveillance data. Among previously treated patients with smear-positive TB, adult household …

A Comparison Of Two Different Fluorochrome Stains For The Detection Of Acid-Fast Bacilli In Sputum Specimens*, Vi̇ldan Avkan Oğuz, Nurbanu Sezak, Aygün Öztop, Nur Yapar, Süheyla Sürücüoğlu, Ayşe Yüce

Turkish Journal of Medical Sciences

The early diagnosis of active tuberculosis still depends on the presence of acid-fast bacilli (AFB) in stained sputum smears. In this study, our aim was to investigate the efficiency and cost-effectiveness of two different fluorochrome stains. Materials and methods: A total of 1013 sputum specimens were collected from 642 patients. Three smears and cultures were prepared from each specimen. Double-blind and prospective laboratory procedures were performed. Slides were stained with a commercial auramine/acridine orange kit (Stain 1), an in-house preparation of auramine- rhodamine/KMnO4 (Stain 2) and a Ziehl-Neelsen stain (EZN). Results: Of the 1013 specimens, 101 were culture positive. Among …

The Prevalence Of Tuberculin Skin Test Positivity And The Effect Of Bcg Vaccinations On Tuberculin Induration Size In The Eastern Mediterranean Region Of Turkey, Ferda Kazanci, Ekrem Güler, Canan Eren Dağli, Mesut Gari̇pardiç, Mehmet Davutoğlu, Esen İspi̇roğlu, Hasan Çeti̇n Ekerbi̇çer, Hamza Karabi̇ber

Turkish Journal of Medical Sciences

To evaluate the prevalence of tuberculin skin test (TST) positivity in Kahramanmaraş and interpret the size of purified protein derivative (PPD) induration with respect to the number of Bacillus Calmette-Guerin (BCG) scars and other factors. Materials and methods: A total of 2979 school children between the ages of 7 and 17 years were evaluated. On the basis of socioeconomic levels, 11 schools were selected and categorized into 3 subgroups: schools in the suburbs of the city (Group 1), schools in the city center (Group 2), and private schools (Group 3). Children were injected with 5 TU/0.1 mL of PPD and …

Analogous Mechanisms Of Resistance To Benzothiazinones And Dinitrobenzamides In Mycobacterium Smegmatis, Ana Luisa Ribeiro, Giulia Degiacomi, Fanny Ewann, Silvia Buroni, Maria Loreto Incandela, Laurent R. Chiarelli, Giorgia Mori, Jaeseung Kim, Monica Contreras-Dominguez, Young-Sam Park, Sung-Jun Han, Priscille Brodin, Giovanna Valentini, Menico Rizzi, Giovanna Riccardi, Maria Rosalia Pasca

Faculty and Staff Publications

Tuberculosis is still a leading cause of death worldwide. The selection and spread of Mycobacterium tuberculosis multidrug-resistant (MDR-TB) and extensively drug-resistant strains (XDR-TB) is a severe public health problem. Recently, two different classes of chemical series, the benzothiazinones (BTZ) and the dinitrobenzamide (DNB) derivatives have been found to be highly active against M. tuberculosis, including XDR-TB strains. The target of BTZs is DprE1 protein which works in concert with DprE2 to form the heteromeric decaprenylphosphoryl-β-D-ribose 2'-epimerase, involved in Decaprenyl-Phospho-Arabinose (DPA) biosynthesis. Interestingly, it has been shown that the DNBs block the same pathway thus suggesting that both drugs could share …