Impact of expanded antiretroviral use on incidence and prevalence of tuberculosis in children with HIV in Kenya. Antiretroviral therapy (ART) reduces pulmonary tuberculosis (PTB) in human immunodeficiency virus (HIV) infected children. Recent ART recommendations have increased the number of children on ART. A prospective cohort study including HIV-infected children aged 6 weeks to 14 years was conducted in Kenya. The primary outcome measure was clinically diagnosed TB. Study participants were screened for prevalent TB at enrollment using Kenya's national guidelines and followed at monthly intervals to detect incident TB. Predictors of TB were assessed using logistic regression and Cox proportional hazards regression.
Changes in the timing of antiretroviral therapy initiation in HIV-infected patients with tuberculosis in Uganda: a study of the diffusion of evidence into practice in the global response to HIV/AIDS. We aimed to determine the extent to which emerging evidence and changing guidelines regarding timing of antiretroviral therapy (ART) among HIV-infected patients with tuberculosis (TB) influenced "real world" clinical practice in Uganda. Methods. We evaluated ART-naïve, HIV-infected adults starting TB therapy at two HIV clinics in Uganda between August 26, 2006 and September 29, 2012. We used multivariate regression to calculate associations between four calendar periods reflecting publication of seminal clinical studies or changes in guidelines and timing of ART after TB therapy initiation.
Helicobacter pylori: Evidence-Based Review with a Focus on Immigrant Populations. Helicobacter pylori has been causally linked to a number of diseases, including peptic ulcer disease, gastric adenocarcinoma, mucosa-associated lymphoid tissue lymphoma, and dyspepsia. It is the most prevalent bacterial pathogen in humans, and while the overall prevalence in the United States is about 30 %, the distribution is heterogeneous amongst different ethnic groups. Recent immigrants from high prevalence areas such as Korea, Japan, and China bear an increased burden of its disease and complications.
Integrating Clinical Services for HIV, Tuberculosis, and Cryptococcal Disease in the Developing World: A Step Forward with 2 Novel Diagnostic Tests. The success of antiretroviral therapy (ART) programs in the developing world is limited by the lack of adequate diagnostic tests to screen for life-threatening opportunistic infections such as tuberculosis (TB) and cryptococcal disease. Furthermore, there is an increasing need for implementation research in measuring the effectiveness of currently available rapid diagnostic tests. The recently developed lateral flow assays for both cryptococcal disease and TB have the potential to improve care and greatly reduce the time to initiation of ART among individuals who need it the most. However, we caution that the data on feasibility and effectiveness of these assays are limited and such research agendas must be prioritized.
Global Health Educational Engagement-A Tale of Two Models. Global health learning experiences for medical students sit at the intersection of capacity building, ethics, and education. This article provides a rich comparison between two global health educational models and aims to inform future efforts to standardize global health education curricula.
County jail as a novel site for obstetrics and gynecology resident education. Obstetrics and gynecology residents benefit from providing care to diverse patient populations and increasing their awareness of the social determinants of health. To describe and evaluate an outpatient rotation for obstetrics and gynecology residents at a county jail.
Toll-like receptor 7 mediates early innate immune responses to malaria. Innate immune recognition of malaria parasites is the critical first step in the development of the host response. At present, Toll-like receptor 9 (TLR9) is thought to play a central role in sensing malaria infection. However, we and others have observed that Tlr9-/- mice, in contrast to mice deficient in the downstream adaptor, Myeloid differentiation primary response gene 88 (MYD88), exhibit few deficiencies in immune function during early infection with the malaria parasite Plasmodium chabaudi, implying that another MYD88-dependent receptor also contributes to the anti-malarial response. Here we use candidate-based screening to identify TLR7 as a key sensor of early P. chabaudi infection. We show that TLR7 mediates a rapid systemic response to infection through induction of cytokines such as type I interferons (T1IFN), interleukin 12, and interferon gamma. TLR7 is also required for induction of T1IFN by other species and strains of Plasmodium, including an etiological agent of human disease, P. falciparum, suggesting that malaria parasites harbor a common pathogen-associated molecular pattern (PAMP) recognized by TLR7. In contrast to the non-redundant requirement for TLR7 in early immune activation, sensing through both TLR7 and TLR9 were required for pro-inflammatory cytokine production and immune cell activation during the peak of parasitemia. Our findings indicate that TLR7 plays a central role in early immune activation during malaria infection, whereas TLR7 and TLR9 contribute combinatorially to immune responses as infection progresses.
Current treatment and outcome for childhood acute leukemia in Tanzania. In order to understand the disparity in childhood leukemia survival in low-income countries (LICs) compared to high-income countries (HICs), we evaluated the resources available at Tanzania's national pediatric oncology ward, and clinical characteristics, disease course and outcomes of children diagnosed with acute leukemia from 2008 through 2010.
Association of self-reported race with AIDS death in continuous HAART users in a cohort of HIV-infected women in the United States. To assess the association of race with clinical outcomes in HIV-positive women on continuous HAART. Prospective study that enrolled women from 1994 to 1995 and 2001 to 2002. Women's Interagency HIV Study, a community-based cohort in five US cities. One thousand, four hundred and seventy-one HIV-positive continuous HAART users. Times to AIDS and non-AIDS death and incident AIDS-defining illness (ADI) after HAART initiation.
Prevalence of dementia subtypes in a developing country: a clinicopathological study. To assess the distribution of dementia subtypes in Brazil using a population-based clinicopathological study. Brains from deceased individuals aged ≥50 years old were collected after the next of kin signed an informed consent form and provided information through standardized questionnaires. Post-mortem clinical diagnoses were established in consensus meetings, and only cases with moderate or severe dementia or without cognitive impairment were included in the analysis. Immunohistochemical neuropathological examinations were performed following the universally accepted guidelines. A diagnosis of Alzheimer's disease was made when there were at least both a moderate density of neuritic plaques (Consortium to Establish a Register for Alzheimer's disease B or C) and Braak stage III for neurofibrillary tangle distribution. For the diagnosis of vascular dementia, at least three zones or strategic areas had to be affected by infarcts, lacunae, or microinfarcts.
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