86,666 research outputs found
Optimization of HIV and tuberculosis co-treatment in Tanzania : drug-drug interactions and clinical outcomes
No full textBackground: Sub-Saharan Africa has been greatly affected by the HIV epidemic, with an estimated 23.5 million people living with HIV/AIDS (PLWHA) residing within this region by the end of 2011, being the leading course of morbidity and mortality. Tanzania is one of the countries in this region with an HIV prevalence of 5.7% i.e approximately 2.7 million PLWHA. The most common opportunistic infection in sub-Saharan Africa is tuberculosis (TB). Currently HIV and TB are the leading cause of morbidity and mortality in Tanzania. The management of these two infections in individuals with the dual infection is challenging due to drug-drug interactions that could potentially lead to toxicities or ineffective treatment outcomes for one or both diseases. This thesis aims to describe the socio-demographic and clinical characteristics as well as the clinical outcomes of treatment.Methods: We first performed a baseline study of a clinical HIV infected population enrolled at the HIV care and treatment centre (CTC) at Muhimbili National Hospital between June 2004 and September 2008. Based on this clinical experience, a cohort of HIV infected patients, with or without TB who were HAART naïve with CD4 cell counts Results: Most patients presenting to the CTC had advanced immune deficiency. Significantly higher proportions were female patients. With the free access to HAART in the later years, patients presented earlier to the CTC in the course of HIV disease. For the co-infection cohort study a total of 255 HIV only patients and 231 HIV-TB patients were recruited. The HIV-TB patients had significantly lower body mass index, Karnofsky scores and haemoglobin compared to those with HIV only, despite similar baseline CD4 cell counts. Mortality was similar in both the HIV only and those with HIV-TB, being 10.9% (16 deaths/100person years) and 11.3% (17 deaths/100py) respectively with the predictors for mortality being advanced disease such as low CD4 counts, low baseline WBC, oral candidiasis and Kaposis sarcoma. HIV only patients had significantly higher plasma efavirenz concentrations compared to the HIV-TB patients 4 weeks after HAART initiation indicating an interaction with rifampicin. Female gender and those with CYP2B6*6/*6 genotype also had significantly higher plasma efavirenz concentrations. Pharmacogenetic variants play a role in plasma efavirenz concentrations and long-term efavirenz autoinduction. The proportion of patients with efavirenz concentrations below the therapeutic range (Conclusion: Patients enrolled at the CTCs are predominantly females, and present with advanced immune deficiency that ultimately puts them at a higher risk of dying. Pharmacogenetic variants influence efavirenz concentrations where slow metabolizers are at a higher risk of presenting with higher efavirenz concentrations, DILI and neuropsychiatric manifestations. The DILI seen in our setting is mild, transient and does not require treatment interruption. Patients using efavirenz alone are at a higher risk of developing neuropsychiatric manifestations compared to those who concomitantly use rifampicin. The WHO recommended efavirenz dosage of 600mg daily can be used with rifampicin among Tanzanian patients without compromise to their treatment outcomes.List of scientific papersI. Mugusi SF, Mwita JC, Francis JM, Aboud S, Bakari M, Aris EA, Swai AB, Mugusi FM, Pallangyo K, Sandstrom E. Effect of improved access to antiretroviral therapy on clinical characteristics of patients enrolled in the HIV care and treatment clinic, at Muhimbili National Hospital (MNH), Dar es Salaam, Tanzania. BMC Public Health. 2010 May 28;10:291. https://doi.org/10.1186/1471-2458-10-291 II. Mugusi SF, Ngaimisi E, Janabi MY, Mugusi FM, Minzi OM, Sasi PG, Bakari M, Lindquist L, Aklillu E, Sandstrom EG. Risk factors for mortality among HIV-positive patients with and without active tuberculosis in Dar es Salaam, Tanzania. Antivir Ther. 2012;17(2):265-74. https://doi.org/10.3851/IMP1956 III. Ngaimisi E, Mugusi S, Minzi OM, Sasi P, Riedel KD, Suda A, Ueda N, Janabi M, Mugusi F, Haefeli WE, Burhenne J, Aklillu E. Long-term efavirenz autoinduction and its effect on plasma exposure in HIV patients. Clin Pharmacol Ther. 2010 Nov;88(5):676-84. https://doi.org/10.1038/clpt.2010.172 IV. Mugusi S, Ngaimisi E, Janabi M, Minzi O, Bakari M, Riedel KD, Burhenne J, Lindquist L, Mugusi F, Sandstrom E, Aklillu E. Liver enzyme abnormalities and associated risk factors in HIV patients on efavirenz-based HAART with or without tuberculosis co-infection in Tanzania. PLoS One. 2012;7(7):e40180. https://doi.org/10.1371/journal.pone.0040180 V. Mugusi S, Ngaimisi E, Janabi M, Mugusi F, Minzi O, Aris E, Bakari M, Bertilsson L, Burhene J, Sandstrom E, Aklillu E. Neuropsychiatric manifestations among HIV-1 infected African patients receiving Efavirenz based HAART with or without Tuberculosis treatment containing Rifampicin. [Manuscript]</p
Variations on the Author
No full text“Variations on the Author” discusses two of Eduardo Coutinho’s recent films (Um Dia na Vida, from 2010, and Últimas Conversas, posthumously released in 2015) and their contribution to the general question of documentary authorship. The director’s filmography is characterized by a consistent yet self-effacing form of authorial self-inscription: Coutinho often features as an interviewer that rather than express opinions propels discourses; an interviewer that is good at listening. This mode of self-inscription characterizes him as an author who is not expressive but who is nonetheless markedly present on the screen. In Um Dia na Vida, however, Coutinho is completely absent form the image, while Últimas Conversas, on the contrary, includes a confessional prologue that moves the director from the margins to the center of his films. This article examines the ways in which these works stand out in the filmography of a director who offers new insights into the notion of cinematic authorship
A Trial of the Effect of Micronutrient Supplementation on Treatment Outcome, T Cell Counts, Morbidity, and Mortality in Adults with Pulmonary Tuberculosis.
No full textTuberculosis (TB) often coincides with nutritional deficiencies. The effects of micronutrient supplementation on TB treatment outcomes, clinical complications, and mortality are uncertain. We conducted a randomized, double-blind, placebo-controlled trial of micronutrients (vitamins A, B complex, C, and E, as well as selenium) in Dar es Salaam, Tanzania. We enrolled 471 human immunodeficiency virus (HIV)-infected and 416 HIV-negative adults with pulmonary TB at the time of initiating chemotherapy and monitored them for a median of 43 months. Micronutrients decreased the risk ofTB recurrence by 45% overall (95% confidence interval [CI], 7% to 67%; P = .02) and by 63% in HIV-infected patients (95% CI, 8% to 85%; P = .02). There were no significant effects on mortality overall; however, we noted a marginally significant 64% reduction of deaths in HIV-negative subjects (95% CI, -14% to 88%; P = .08). Supplementation increased CD3+ and CD4+ cell counts and decreased the incidence of extrapulmonary TB and genital ulcers in HIV-negative patients. Micronutrients reduced the incidence of peripheral neuropathy by 57% (95% CI, 41% to 69%; P < .001), irrespective of HIV status. There were no significant effects on weight gain, body composition, anemia, or HIV load. Micronutrient supplementation could improve the outcome in patients undergoing TB chemotherapy in Tanzania
[Newspaper Clipping: Author Claims Evidence of Second JFK Assassin #1]
No full textNewspaper article titled "Author Claims Evidence of Second JFK Assassin." The article states that author Richard J. Whalen concluded "that there is circumstantial evidence to support the theory of a second assassin in the shooting of President John F. Kennedy.
Also By The Same Author: AKTiveAuthor, a Citation Graph Approach to Name Disambiguation
No full textThe desire for definitive data and the semantic web drive for inference over heterogeneous data sources requires co-reference resolution to be performed on those data. In particular, name disambiguation is required to allow accurate publication lists, citation counts and impact measures to be determined. This paper describes a graph-based approach to author disambiguation on large-scale citation networks. Using self-citation, co-authorship and document source analyses, AKTiveAuthor clusters papers, achieving precision of 0.997 and recall of 0.818 over a test group of eight surname clusters
John F. Kennedy telegram to Roosevelt
No full textJersey Homesteads (later the Borough of Roosevelt) was established in the 1930s as an agro-industrial cooperative community. It was established specifically for urban Jewish garment workers, many of whom had emigrated from Europe. President John F. Kennedy sent a telegram to the citizens of Roosevelt, New Jersey, apologizing for not being able to attend the memorial dedication in honor of former President Franklin Delano Roosevelt. (Jersey Homesteads became Roosevelt in 1945 in honor of the president.) President Kennedy expressed his gratitude to the people of Roosevelt for constructing the memorial, and commented that it will serve as a constant reminder of Roosevelt's good works
Logarithmic variance profiles and the corresponding f-1 spectra of temperature fluctuations in turbulent Rayleigh-Bénard convection
No full textWe report experimental results for the temperature variance 2(z) and the corresponding frequency spectra P(f) in turbulent Rayleigh-Bénard convection (RBC) in a cylindrical sample of aspect ratioT= D/L = 1:00 (D = 1:12 m is the diameter and L = 1:12 m the height). The measurements were conducted in the Rayleigh-number range 1011 < Ra < 1:35 1014 and Pr ' 0:8. For Ra = 1:35x1014, 2(z) could be described well by a logarithmic dependence on the vertical position z in a range of z 1 < z < z 2 with z 1 ' 70 and z 2 = 0:1L. Here L=(2Nu) is the thickness of a thin thermal sublayer adjacent to the horizontal plate where the heat flux (denoted by the Nusselt number Nu) is carried mostly by thermal diffusion. In the log layer, we found that the temperature spectra had a significant frequency range over which P(f) f with close to 1. As Ra decreased, increased so that the log layer became thinner. At Ra = 2:05 1011, z 2 < z 1 and therefore there was no range for a log layer. Correspondingly, the temperature spectrum near the horizontal plate did not have the f1 scaling form either
Maine author Franklin F. Gould recalls his first glimpse of the outside world
No full textMaine author Franklin F. Gould recalls his first glimpse of the outside world as he relates how, as a young farm boy in the late 1800\u27s, he drove his father\u27s horses on an errand to an icebound river
A Case-Control Study of Factors Associated with Non-Adherent to Antiretroviral Therapy Among HIV Infected People in Pwani Region, Eastern Tanzania
No full textNon-adherence is one of the major causes of treatment failure which leads to increased morbidity and mortality caused by opportunistic infections. Optimal anti-retroviral therapy (ART) adherence is essential for maximal suppression of viral replication and long term survival of patients. In order to develop effective public health interventions in the context of scaling ART services to peripheral areas, it is important to evaluate factors associated with non-adherence among HIV-infected individuals in Pwani Region. The purpose of this study was to identify factors related to non-adherence to ART among HIV infected people in Pwani Region eastern of Tanzania. A case-control study was carried out at Tumbi Hospital and Chalinze Health Centre in Pwani Region in eastern Tanzania. A structured questionnaire was used to assess non-adherence and adherence to doses instruction and time schedule. Patients with less than 95% adherence were defined as cases while those with more than 95% adherence became controls. A structured questionnaire containing factors known to be associated with non-adherence to ART in similar settings was administered. Univariate and multivariate conditional logistic regression was performed to identify factors associated with non-adherence. A total of 79 cases and 237 controls matched by age and sex were studied. A high proportion of cases and controls (77.2% and 84.8%) had good knowledge of ART benefits, adherence and eligibility. Majority of cases (73.3%) and controls (69.2%) used public transport to access ART services. More than half of cases (53.2%) missed clinic appointments due to lack of bus fare or other reasons and was associated with ART non adherence (mOR 4.2, 95%CI, 2.2-8.1 and 2.1,95%CI 1.2-4.2). Disclosure to confidants only and failure to disclose HIV-test positive status were associated with non adherence (mOR 3.3, 95%CI 1.3-8.5 and 2.3, 95%CI 1.2-7.1). Alcohol use was associated with non adherence to ART (mOR 1.9, 95%CI 1.4-3.7). Patients who were not satisfied with providers were more likely to be non adherence to ART (mOR 2.0, 95%CI 1.2-3.8). In conclusion, these findings show that adherence is a process which is depended on local specific adherence factors. Adherence improvement strategies need to consider site specific adherence determinants, patient experiences and concern
Risk Factors for Anaemia Among HIV Infected Children Attending Care and Treatment Clinic at Muhimbili National Hospital in Dar es Salaam, Tanzania
No full textThere is paucity of data describing the risk factors for anaemia among HIV infected children in Tanzania. This cross sectional study was carried out to determine the contributing factors for anaemia among HIV-infected children attending Muhimbili National Hospital in Dar es Salaam. Both univariate and multivariate logistic regression analyses were performed to identify possible factors associated with anaemia in HIV-infected children. A total of 75 (44%) patients among 167 recruited HIV-infected children aged 6 months to 59 months of were found to be anaemic (Hg<11g/dl). Multivariate logistic regression demonstrated that not being on HAART (OR 3.40, 95%CI (1.20-9.60), having CD4% <25% (OR 2.30, 95%CI (1.20-34.60), having a history of tuberculosis (TB) (OR 3.23, 95%CI (1.10-9.70) and having hookworm infestation (OR 5.97, 95%CI (1.92-18.4) were independent risk factors for anaemia among HIV infected children. The analyses also showed that being HIV positive for ≥ 2.5 years resulted into a low risk of severe anaemia compared to being HIV positive for < 2.5 years. Taking multivitamins (OR 0.07, 95%, CI (0.020-0.30) and antihelminthics (OR 0.27, 95%CI (0.10-0.74) were also protective against anaemia in children. Similar factors (with exception of using antihelmintics) were associated with severe anaemia. In conclusion the factors associated with anaemia in HIV infected children were multifactorial in nature. Efforts to correct anaemia in HIV infected children should include use of HAART and treatment of infections such as TB and hookworms
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