Male,Mobile, and Moneyed: Loss to Follow-Up vs. Transfer of Care in an Urban African Antiretroviral Treatment Clinic

Objectives

The purpose of this study was to analyze characteristics, reasons for transferring, and reasons for discontinuing care among patients defined as lost to follow-up (LTFU) from an antiretroviral therapy (ART) clinic in Nairobi, Kenya.

Design

The study used a prospective cohort of patients who participated in a randomized, controlled ART adherence trial between 2006 and 2008.

Methods

Participants were followed from pre-ART clinic enrollment to 18 months after ART initiation, and were defined as LTFU if they failed to return to clinic 4 weeks after their last scheduled visit. Reasons for loss were captured through phone call or home visit. Characteristics of LTFU who transferred care and LTFU who did not transfer were compared to those who remained in clinic using log-binomial regression to estimate risk ratios.

Results

Of 393 enrolled participants, total attrition was 83 (21%), of whom 75 (90%) were successfully traced. Thirty-seven (49%) were alive at tracing and 22 (59%) of these reported having transferred their antiretroviral care. In the final model, transfers were more likely to have salaried employment [Risk Ratio (RR), 2.7; 95% confidence interval (CI), 1.2-6.1; p=0.020)] and pay a higher monthly rent (RR, 5.8; 95% CI, 1.3-25.0; p=0.018) compared to those retained in clinic. LTFU who did not transfer care were three times as likely to be men (RR, 3.1; 95% CI, 1.1-8.1; p=0.028) and nearly 4 times as likely to have a primary education or less (RR, 3.8; 95% CI, 1.3-10.6; p=0.013). Overall, the most common reason for LTFU was moving residence, predominantly due to job loss or change in employment.

Conclusion

A broad definition of LTFU may include those who have transferred their antiretroviral care and thereby overestimate negative effects on ART continuation. Interventions targeting men and considering mobility due to employment may improve retention in urban African ART clinics.

Clinical Trials

The study’s ClinicalTrials.gov identifier is NCT00273780.     

Description of Spadella valsalinae sp. nov., a neo-endemic benthic chaetognath from Northern Adriatic Sea (Croatia) with remarks on its morphology, phylogeny and biogeography

We describe a new chaetognath species, Spadella valsalinae sp. nov., discovered and collected in the Northern Adriatic Sea (Pula, Croatia). S. valsalinae sp. nov. is a benthic species living at 10–12 m depth attached to the surface of roughly sorted sediment. The cosmopolitan, seagrass-inhabiting species Spadella cephaloptera Busch, 1851 was also recorded in the sampling area. Characters from comparative morphology and molecular phylogeny based on SSU rRNA (18S) sequences support a sister group relationship of S. valsalinae sp. nov. with Spadella lainezi and Spadella ledoyeri. Thus, S. valsalinae sp. nov. represents the first member in the ‘Spadella ledoyeri' complex that is not a troglophilic species. By comparison with the various known European Spadella species, we defined a specific set of morphological characters, such as the number, shape and mutual proportions of the teeth, the lateral fins, the corona ciliata, the seminal vesicles, as well as the presence of ventral adhesive papillae, which is unique for S. valsalinae sp. nov. The biogeography of Spadella members in the Mediterranean Sea and the Eastern Atlantic as well as their phylogenetic relationships are discussed, with the focus on processes of neo-endemism in an epeiric area like, for instance, the Northern Adriatic Sea.     

Increased Oxidative Stress and Altered Levels of Nitric Oxide and Peroxynitrite in Tunisian Patients with Chronic Obstructive Pulmonary Disease: Correlation with Disease Severity and Airflow Obstruction

This study was aimed to evaluate the oxidant–antioxidant imbalance in the pathogenesis of chronic obstructive pulmonary disease (COPD) in Tunisians. We assessed 16 parameters related to the oxidative status that include malondialdehyde (MDA), total protein carbonyls (PCs), and advanced oxidation protein products (AOPP). We also examined the activity of glutathione peroxydase (GSH-Px), catalase, and superoxide dismutase (SOD) in the plasma and erythrocytes. Levels of total thiols, reduced glutathione (GSH), total antioxidant status (TAS), hydrogen peroxide, ascorbic acid, iron, and protein sulfhydryls were determined using spectrophotometry. We also evaluated the level of nitric oxide (NO) and peroxynitrite in plasma from COPD patients and healthy controls. Estimation of DNA damage was determined using the comet assay. Pulmonary functional tests were performed by body plethysmography. Levels of MDA, PC, DNA damage, and AOPP were significantly increased while total thiols, GSH, and TAS were decreased in COPD patients. GSH-Px activity was higher in COPD patients while no difference was found for catalase and SOD. We also observed a lower level of NO and peroxynitrite in COPD patients. Decreased levels of peroxynitrite were found to correlate with disease progression, as well as with forced expiratory volume in 1 s/forced vital capacity among COPD patients. Multivariate analysis revealed that NO is associated with pathological pathways that help to predict patient outcome independently of the degree of airflow obstruction. These results indicate the presence of a systemic oxidative stress and highlight the importance of NO and peroxynitrite as major effectors in COPD development and airflow obstruction.     

Residual Disease and HPV Persistence after Cryotherapy for Cervical Intraepithelial Neoplasia Grade 2/3 in HIV-Positive Women in Kenya

Objective

To assess residual cervical intraepithelial neoplasia (CIN) 2/3 disease and clearance of high-risk (hr) human papillomavirus (HPV) infections at 6 months after cryotherapy among HIV-positive women.

Design

Follow-up study.

Methods

79 HIV-positive women received cryotherapy for CIN2/3 in Nairobi, Kenya, and underwent conventional cytology 6 months later. Biopsies were performed on high grade cytological lesions and hrHPV was assessed before (cervical cells and biopsy) and after cryotherapy (cells).

Results

At 6 months after cryotherapy CIN2/3 had been eliminated in 61 women (77.2%; 95% Confidence Interval, (CI): 66.4–85.9). 18 women (22.8%) had residual CIN2/3, and all these women had hrHPV at baseline. CD4 count and duration of combination antiretroviral therapy (cART) were not associated with residual CIN2/3. CIN3 instead of CIN2 was the only significant risk factor for residual disease (odds ratio, OR vs CIN2 = 4.3; 95% CI: 1.2–15.0) among hrHPV-positive women after adjustment for age and HPV16 infection. Persistence of hrHPV types previously detected in biopsies was found in 77.5% of women and was associated with residual CIN2/3 (OR = 8.1, 95% CI: 0.9–70). The sensitivity, specificity, and negative predictive value of hrHPV test in detecting residual CIN2/3 were 0.94, 0.36, and 0.96 respectively.

Conclusions

Nearly one quarter of HIV-positive women had residual CIN2/3 disease at 6 months after cryotherapy, and the majority had persistent hrHPV. CD4 count and cART use were not associated with residual disease or hrHPV persistence. The value of hrHPV testing in the detection of residual CIN2/3 was hampered by a low specificity.     

Public and healthcare providers awareness of Coronavirus (COVID-19) in Qassim Region,Saudi Arabia

BackgroundThe rapid and extensive spread of the COVID-19 pandemic has become a major cause of concern for both general public and healthcare profession.ObjectiveThe aim of this study is to analyze and evaluate the awareness of both the general public and healthcare providers in Qassim region in Saudi Arabia.MethodA cross-sectional study was conducted randomly in different shopping malls in Qassim region from 10th of February to 10th of March 2020. All participants have answered the designed questionnaire. The structured questionnaire recorded demographics and awareness of both public participants as well as health care providers.ResultA total of 130 participants have answered the designed questionnaire, out of which 67participants were males (58.5%) and 54 were females (41.5%). Overall, 129 (99%) out of the 130 participants are aware of COVID-19, and 116 (90%) have recognize it as a respiratory disease and 100% of the participants have recognized it as a contagious disease. Around 94% of the participants were able to recognize the correct incubation period of the virus. Participants of the age group 20–40 showed higher awareness level than other age groups (P value = 0.005). In addition, government employees showed higher awareness level than other profession groups (P = 0.039). Results showed significant positive correlation between the recognition of high-risk groups, reliable source of information, infection symptoms, disease prevention and available treatments.ConclusionGeneral public and health care professionals from Qassim Region showed adequate awareness of COVID-19. However, there is a strong need to implement periodic educational interventions and training programs on infection control practices for COVID-19 across all healthcare professions.     

Comparison of pistachio hull essential oils from different Tunisian localities

Pistachio (Pistacia vera L.) fruit is well known for its oleaginous and edible seed. Less information is available about the hull constituted by the epicarp and the mesocarp. This part of the fruit contains an essential oil that can be valorized. Tunisia is one of the countries cultivating pistachio trees. This work presents essential oil composition of pistachio hulls (Mateur variety) from different geographical localities: Grombalia (North-East), Kairouan (Middle) and Sfax (Middle-East). Yields were more important in Sfax samples (0.53% on a dry weight basis). Alpha-terpinolene was the major compound for Grombalia fruits (35.7%), whereas Kairouan and Sfax samples where characterized by alpha-pinene (42.5 and 43.8% respectively). For all samples, monoterpene hydrocarbons predominated (more than 79.8% of the essential oil).     

Variations in the essential oil composition from different parts of Coriandrum sativum L. cultivated in Tunisia

Essential oils obtained by hydrodistillation from different organs (flowers, leaves, stems and roots) of Tunisian coriander (Coriandrum sativum L.) was analyzed. GC and GC-MS analysis enabled us to identify 64 compounds and revealed great qualitative and quantitative differences between the analyzed parts. In all organs, the main compound was (E)-2-dodecenal, followed by (E)-2-tridecenal, gamma-cadinene, (Z)-myroxide, neryl acetate and eugenol. Multivariate analysis (PCA) revealed a high similarity in the essential oils composition between upper leaves and flowers in one hand and basal leaves, roots and stems on the other hand. Further, it has been reported an organ-dependant distribution of essential oil compounds.     

Relation of neuropeptide Y gene expression and genotyping with hypertension in chronic kidney disease

ObjectivesThe prognosis of high-risk patients might be greatly ameliorated using genetic predisposition risk factors. Sympathetic activity and innate immunity related to neuropeptide Y function may be related to dyslipidemia and atherosclerosis. The aim of this study is to detect the correlation between Neuropeptide Y (NPY) SNP rs16147 and its gene expression in chronic kidney disease with and without hypertension.MethodsThis study carried out on 150 subjects who were divided into 3 main groups group (I) 50 CKD patients with hypertension, group (II) 50 CKD patients without hypertension and group (III) 50 healthy individuals. Carotid intima media thickness (CIMT) was measured by Ultrasound. Kidney function test and lipid profile were performed. Genotyping and gene expression of neuropeptide Y (NPY) were performed using real time PCR.ResultsThere was a significant increase in number and percentage of CC genotype and C allele of NPY SNP distribution in CKD patients with and without hypertension when compared to controls. A significant association was found between CC genotype and C allele and the risk of CKD with hypertension with odd ratio 3.26 and 1.77, respectively. There is a significant positive correlation between NPY gene expression level and CIMT among chronic kidney disease patients with highest level of TC, LDLc and CIMT among CC genotype of NPY gene.ConclusionA significant association was found between CC genotype and C allele of NPY at rs16147 with increase NPY gene expression and risk of developing hypertension in CKD.     

Quantitative Characterization of E-selectin Interaction with Native CD44 and P-selectin Glycoprotein Ligand-1 (PSGL-1) Using a Real Time Immunoprecipitation-based Binding Assay

Selectins (E-, P-, and L-selectins) interact with glycoprotein ligands to mediate the essential tethering/rolling step in cell transport and delivery that captures migrating cells from the circulating flow. In this work, we developed a real time immunoprecipitation assay on a surface plasmon resonance chip that captures native glycoforms of two well known E-selectin ligands (CD44/hematopoietic cell E-/L-selectin ligand and P-selectin glycoprotein ligand-1) from hematopoietic cell extracts. Here we present a comprehensive characterization of their binding to E-selectin. We show that both ligands bind recombinant monomeric E-selectin transiently with fast on- and fast off-rates, whereas they bind dimeric E-selectin with remarkably slow on- and off-rates. This binding requires the sialyl Lewis x sugar moiety to be placed on both O- and N-glycans, and its association, but not dissociation, is sensitive to the salt concentration. Our results suggest a mechanism through which monomeric selectins mediate initial fast on and fast off kinetics to help capture cells out of the circulating shear flow; subsequently, tight binding by dimeric/oligomeric selectins is enabled to significantly slow rolling.     

Metabolomics of fecal extracts detects altered metabolic activity of gut microbiota in ulcerative colitis and irritable bowel syndrome

(1)H NMR spectroscopy of aqueous fecal extracts has been used to investigate differences in metabolic activity of gut microbiota in patients with ulcerative colitis (UC) (n = 13), irritable bowel syndrome (IBS) (n = 10), and healthy controls (C) (n = 22). Up to four samples per individual were collected over 2 years giving a total of 124 samples. Multivariate discriminant analysis, based on NMR data from all three groups, was able to predict UC and C group membership with good sensitivity and specificity; classification of IBS samples was less successful and could not be used for diagnosis. Trends were detected toward increased taurine and cadaverine levels in UC with increased bile acid and decreased branched chain fatty acids in IBS relative to controls; changes in short chain fatty acids and amino acids were not significant. Previous PCR-denaturing gradient gel electrophoresis (PCR-DGGE) analysis of the same fecal material had shown alterations of the gut microbiota when comparing UC and IBS groups with controls. Hierarchical cluster analysis showed that DGGE profiles from the same individual were stable over time, but NMR spectra were more variable; canonical correlation analysis of NMR and DGGE data partly separated the three groups and revealed a correlation between the gut microbiota profile and metabolite composition.