302 research outputs found
Feminist Researcher Wishes to Meet Romantic Subject: The “Case” of Mrs. F.
No full textThis article addresses a long-standing gap between theorists and critics in the growing field of Love Studies between those who see heterosexual romantic love as a positive subset of caring love and those feminists who reject it as regressive for women in particular. Opposing definitions of romantic love as either an ideal of equality in heterosexual relations, or an obstacle to, even regression from, that equality, seem challenging for some feminists to reconcile. The article argues instead for a situational approach to understanding the place of love in heterosexual Western women’s lives, specifically through biography and autobiography, as a way to bypass the roadblock of entrenched ideologies. To illustrate, the author explores the relationship between two contrasting personal narratives of courtship: that of Mrs. F., the author’s former research subject, whose traditional romantic narrative structured her life story as told to the author, and that of the author herself, whose personal and professional view has been critical of the ideology of romantic love. The objective of the article is to use life narrative, situated in a particular time and location, to disrupt the uniformity of abstract and enduring ideological discourses of romance, and in doing so, to contribute to a more nuanced feminist understanding of romantic love
Epidemiology of Buruli ulcer in the Mapé Basin of Cameroon
Get PDFBuruli ulcer (BU) is a neglected tropical disease of the skin and subcutaneous tissue caused by Mycobacterium ulcerans. The disease has been reported from over 30 countries with most cases coming from West Africa. While it is commonly accepted that BU is not acquired by human-to-human transmission both the environmental reservoir of the pathogen and the mode of transmission to humans remain to be identified. Clinically BU presents with a wide range of forms which includes non-ulcerative lesions and ulcers with undermined edges. Much of the pathology of a M. ulcerans infection is believed to be caused by its unique ability to produce the macrolide toxin called mycolactone which causes tissue necrosis and local immunosuppression. BU can be diagnosed by microscopy, polymerase chain reaction (PCR), culturing and histology, however due to lack of access to laboratory facilities, cases are often diagnosed based on clinical symptoms only. Historically, BU was treated using wide scale excision, but since 2004 the WHO recommends the use of streptomycin and rifampicin daily for 8 weeks to treat the infection.
In the framework of this PhD thesis we have established a new BU field research site in the Mapé Basin of Cameroon and studied various aspects of BU epidemiology, differential diagnosis and transmission at this location. As a basis for our research, we conducted an exhaustive house-by-house survey for BU, leprosy and yaws in the Bankim Health District. Following the survey we closely monitored and studied all BU cases detected in the region. By supporting local laboratory diagnosis with real time-PCR (RT-PCR) and culturing, we were able to identify and describe a case of cutaneous tuberculosis which was initially diagnosed as BU. This patient highlighted the importance of further support to improve clinical differential diagnosis of BU in remote endemic areas. Eighty-eight of all the RT-PCR confirmed BU cases identified in the Mapé Basin in the course of our research were studied in detail. By mapping the patients’ homes we were able to describe the distribution of BU in the area and to identify highly endemic communities. Based on the population age data collected in the survey we were also able to compute the age adjusted cumulative incidence rate of BU, revealing that children below the age of five were underrepresented among cases of BU. By analysing serological responses of patients and community members from BU endemic areas in the Mapé Basin and Ghana against an immunodominant antigen of M. ulcerans, we have observed a similar late onset of seroconversion, indicating that BU transmission intensifies when preschool children start moving further away from home. To identify potential sites of M. ulcerans transmission, we screened sites of environmental contact at the homes and farms of laboratory confirmed BU patients for the presence of M. ulcerans DNA. In this analysis we identified three RT-PCR positive permanent village water sites and by studying one of these sites longitudinally in great detail we obtained evidence that M. ulcerans can persist in underwater detritus. This niche of M. ulcerans may represent an environmental reservoir and a source of infection of the pathogen. To further elucidate BU transmission pathways we have generated a set of clinical isolates of M. ulcerans from the Mapé Basin for a phylogeographic analysis of the distribution of the currently circulating haplotypes of M. ulcerans based on whole genome sequencing. By the routine culturing from clinical specimens and the evaluation of different transport media and decontamination methods we were further able to develop an optimized protocol for the primary isolation of M. ulcerans after long term storage of samples.
Our interdisciplinary research approach including biomedical and social science research elements, including future behavioural studies in young children, may eventually help to elucidate transmission and to improve control of BU
Epidemiology of Mycobacterium ulcerans disease in the Bankim Health Distrit of Cameroon and monitoring of the healing process of Buruli Ulcer lesions
Get PDFBuruli ulcer (BU) is a necrotizing skin disease caused by Mycobacterium ulcerans which, if untreated, can lead to extensive tissue destruction and ulceration. The disease has been reported from over 30 countries with the highest prevalence in West Africa. Generally it is assumed that M. ulcerans is acquired from environmental sources, but BU is considered a “mysterious disease” because the natural reservoir and the mode of transmission are still not identified. Clinically BU presents with a spectrum of forms ranging from non-ulcerative lesions to large ulcers. The gold standard for diagnosing BU is IS2404 qPCR, which is a sophisticated technology not applicable in the field, where BU is often diagnosed on the basis of clinical signs and symptoms only. Direct microscopic smear examination after Ziehl-Neelsen staining, which has a low sensitivity, is the only point-of-care laboratory diagnostic method currently available. Since 2004, the WHO recommends to treat BU with a combination of streptomycin and rifampicin daily for 8 weeks. While this specific treatment is highly effective in killing the bacteria, healing of large ulcers may require long periods of time.
The Bankim Health District (HD) in the Mapé dam basin of Cameroon has been recently identified as BU endemic area and a new BU field research site was established by us in 2010. Within the framework of this thesis, we have contributed to strengthening of the local BU treatment and research site by the implementation of a surveillance and documentation system to promote a continuous case detection and follow up of patients, to investigate the pathway of transmission and to perform a comprehensive spatio-temporal distribution analysis of BU in the area.
Local clinical and microscopic diagnosis was re-confirmed by qPCR, bacterial culture and histopathology performed in Basel. The in-depth analysis on 148 qPCR confirmed cases underlined that BU is a pediatric disease in Africa and that the lesions occur mainly at the limbs with no differences amongst males and females. We obtained information on the exact geographical origin of 136 qPCR positive BU patients through mapping of their houses and farms. Results revealed for the majority of patients residence or agricultural activities close to the Mbam river. Sites of environmental contact of BU patients were screened to search for potential reservoirs of M. ulcerans. At one village water site, DNA of M. ulcerans, was persistently found over more than 2 years, indicating that the pathogen may persist in detritus.
Because some of the BU lesions healed very fast, while others showed an impaired healing process, we analyzed tissue samples in detail for the presence of wound healing and scarring biomarkers. Using the histopathological approach, we evaluated the use of markers of cell activation, myofibroblast formation and matrix deposition for the monitoring of the healing of BU lesions. While α-smooth muscle actin-positive myofibroblasts were not found in untreated lesions, they emerged during the healing process. These cells produced abundant extracellular matrix proteins, such as procollagen 1 and tenascin and were found in fibronectin rich areas. After antibiotic treatment many cells, including myofibroblasts, revealed an activated phenotype. Healing wounds showed dermal tissue remodelling by apoptosis, and increased cytokeratin 16 expression in the epidermis.
Taken together, the results described in this thesis were obtained by a multidisciplinary approach. They contribute to our understanding of BU epidemiology and transmission, as well as of pathogenesis, wound healing and may eventually help to improve diagnosis, treatment and prevention of BU
Corrigendum
No full textCorrected citationUen S, Fimmers R, Weisser B. Balta O. Nickenig G. Mengden T. 2008. ST segment depression in hypertensive patients: A Comparison of exercise test versus Holter ECG. Vascular Health Risk Manage, 4(5):1073–1080.NoteDr. Thomas Mengden was omitted as senior author and Dr. Johannes Baulmann was included as an author in the original publication.Read the original articl
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