1.  Title: Building laboratory infrastructure to support scale-up of HIV/AIDS treatment, care, and prevention: in-country experience. Author: Abimiku AG Author: Institute of Human Virology, University of Maryland School of Medicine PEPFAR Source: American Journal of Clinical Pathology. 2009 Jun;131(6):875-86. Abstract: An unprecedented influx of funds and support through large programs such as the Global Fund for AIDS, Malaria and Tuberculosis and the World Health Organization's and President's Emergency Plan for AIDS Relief (PEPFAR) has made it possible for more than 1 million persons in resource-limited settings to access AIDS treatment and several million more to be in care and prevention programs. Nevertheless, there remain major challenges that prevent AIDS drugs and care from reaching many more in need, especially in rural settings. The roll-out of a high-quality treatment, care, and prevention program depends on an effective and reliable laboratory infrastructure. This article presents a strategy used by the Institute of Human Virology (IHV)-University of Maryland and its affiliate IHV-Nigeria to establish a multifaceted, integrated tier laboratory program to support a PEPFAR-funded scale-up of its AIDS Care Treatment in Nigeria program, in collaboration with the Centers for Disease Control and Prevention and the Nigerian government, as a possible model for overcoming a key challenge that faces several resource-limited countries trying to roll out and scale-up their HIV/AIDS treatment, care, and prevention program. Language: English Keywords: NIGERIA | CRITIQUE | HIV INFECTIONS | CARE AND SUPPORT | TREATMENT | HIV PREVENTION | LABORATORY | EQUIPMENT AND SUPPLIES | LABORATORY EXAMINATIONS AND DIAGNOSES | TESTING | TUBERCULOSIS | INTEGRATED PROGRAMS | TRAINING ACTIVITIES | STANDARDS | QUALITY CONTROL | Developing Countries | Africa, Western | Africa, Sub Saharan | Africa | Viral Diseases | Diseases | Health Services | Delivery of Health Care | Health | Medical Procedures | Medicine | Examinations and Diagnoses | Measurement | Research Methodology | Infections | Programs | Organization and Administration | Training Programs | Education Document Number: 341766 |
| 2. Title: Prevalence of Candida species and potential risk factors for vulvovaginal candidiasis in Aligarh, India. Author: Ahmad A; Khan AU Source: European Journal of Obstetrics, Gynecology, and Reproductive Biology. 2009 May;144(1):68-71. Abstract: OBJECTIVES: The objectives were to determine the frequency of Candida species in women of different age groups as well as to suggest the criteria for the diagnosis of vulvovaginal candidiasis (VVC). STUDY DESIGN: A prospective study of vulvovaginal candidiasis was carried out using laboratory diagnosis, with the estimation of vaginal pH and the direct microscopic and biochemical examination of vaginal discharge/secretions. Vaginal cultures for Candida species were collected from 1050 women with vulvovaginal symptoms. RESULTS: Out of 1050 women, 215 (20.47%) were positive for Candida species. Of 215 women, 172 (80%) had pH within the normal range and 167 (77.67%) were showing yeast cells and mycelia on direct microscopic examination. Candida albicans accounted for 46.9% of cases, Candida glabrata 36.7%, Candida parapsilosis 10.2%, Candida tropicalis 2.8%, Candida krusei 1.4%, and Candida kiefer 1.9%. The frequency of culture positivity was related to pregnancy (P<0.001), an increase in parity (P<0.001), and use of oral contraceptives (P<0.001) and antibiotics (P<0.001). The most common signs and symptoms in 215 women with positive cultures were pruritus with or without vaginal discharge and vaginal erythema. CONCLUSION: Our study suggests that vulvovaginal candidiasis can only be diagnosed by using clinical criteria in correlation with vulvovaginal symptoms and Candida cultures. Language: English Keywords: INDIA | RESEARCH REPORT | PROSPECTIVE STUDIES | CLIENTS | CANDIDIASIS | RISK FACTORS | PREVALENCE | LABORATORY EXAMINATIONS AND DIAGNOSES | SIGNS AND SYMPTOMS | PRURITUS | VAGINITIS | Asia, Southern | Asia | Developing Countries | Studies | Research Methodology | Program Activities | Programs | Organization and Administration | Bacterial and Fungal Diseases | Infections | Diseases | Health | Measurement | Examinations and Diagnoses | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Dermatitis | Vaginal Abnormalities Document Number: 342002 |
| 3. Peer Reviewed Title: Prevalence of tuberculosis, HIV and respiratory symptoms in two Zambian communities: implications for tuberculosis control in the era of HIV. Author: Ayles H; Schaap A; Nota A; Sismanidis C; Tembwe R; De Haas P; Muyoyeta M; Beyers N Author: Peter Godfrey-Faussett for the ZAMSTAR Study Team Source: PloS One. 2009;4(5):e5602. Abstract: BACKGROUND: The Stop TB Partnership target for tuberculosis is to have reduced the prevalence of tuberculosis by 50% comparing 2015 to 1990. This target is challenging as few prevalence surveys have been conducted, especially in high burden tuberculosis and HIV countries. Current tuberculosis control strategies in high HIV prevalent settings are therefore based on limited epidemiological evidence and more evidence is needed from community-based surveys to inform improved policy formulation. METHODS AND FINDINGS: 8044 adults were sampled from 2 sub-districts (wards) in Lusaka province, Zambia. Questionnaires were used to screen for symptoms, respiratory samples were obtained for culture and oral secretions collected for HIV testing. 79 individuals were found to have Mycobacterium tuberculosis in their sputum, giving an adjusted overall prevalence of tuberculosis of 870/100,000 (95% CI 570-1160/100,000). The adjusted overall prevalence of HIV was 28.61% (95% CI 26.04-31.19). HIV- infection was significantly associated with prevalent tuberculosis (Adj OR 2.3, 95% CI 1.42-3.74) and the population attributable fraction of HIV for prevalent tuberculosis was 36%. Symptoms such as prolonged cough (adj OR 12.72, 95% CI 7.05-22.94) and fever (Adj OR 2.04, 95%CI 1.23-3.39), were associated with prevalent tuberculosis, but 8 (10%) individuals with prevalent tuberculosis denied having any symptoms at all and only 34 (43%) would have been classified as a TB suspect by current guidelines. CONCLUSIONS: Undiagnosed tuberculosis is a challenge for tuberculosis control and new approaches are needed if we are to reach international targets. Epidemiological studies can inform screening algorithms for both detection and prevention of active tuberculosis. Language: English Keywords: ZAMBIA | RESEARCH REPORT | SAMPLING STUDIES | ADULTS | TUBERCULOSIS | HIV INFECTIONS | RESPIRATORY INSUFFICIENCY | PREVALENCE | SCREENING | SIGNS AND SYMPTOMS | LABORATORY EXAMINATIONS AND DIAGNOSES | PREVENTION AND CONTROL | ANTIBIOTICS | Developing Countries | Africa, Southern | Africa, Sub Saharan | Africa | Studies | Research Methodology | Age Factors | Population Characteristics | Demographic Factors | Population | Infections | Diseases | Viral Diseases | Pulmonary Effects | Physiology | Biology | Measurement | Examinations and Diagnoses | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Drugs | Treatment Document Number: 342445 |
| 4. Title: Quantitative analysis of DHEA and androsterone in female urine: investigating the effects of menstrual cycle, oral contraception and training on exercise-induced changes in young women. Author: Bayle ML; Enea C; Goetinck P; Lafay F; Boisseau N; Dugue B; Flament-Waton MM; Grenier-Loustalot MF Source: Analytical and Bioanalytical Chemistry. 2009 Feb;393(4):1315-25. Abstract: Dehydroepiandrosterone (DHEA) and its metabolite androsterone (A) are natural steroids secreted in high quantities in human body. To assess the influence of oral contraceptives, menstrual cycle phase, and also physical exercise (acute and chronic such as training) on these metabolites excretions, a collection of 28 female urine specimens was organized. A three-extraction-step method was developed, and the analyses were performed by gas chromatography-mass spectrometry using deuterated 19-noretiocholanolone as the internal standard. Sample hydration state was found to be of great importance for kinetic studies, as it directly influenced the concentrations. No influence of menstrual cycle and training was found for androsterone and DHEA. However, oral contraceptive intake lowered DHEA excretion in urine and A seems to be slightly affected by exercise. Language: English Keywords: FRANCE | RESEARCH REPORT | CLINICAL RESEARCH | WOMEN | ATHLETES | MENSTRUAL CYCLE | ORAL CONTRACEPTIVES | FITNESS | DEHYDROEPIANDROSTERONE | ANALYSIS | LABORATORY EXAMINATIONS AND DIAGNOSES | PHYSIOLOGY | Developed Countries | Europe, Western | Europe | Research Methodology | Demographic Factors | Population | Population Characteristics | Menstruation | Reproduction | Contraceptive Methods | Contraception | Family Planning | Health | Androgens | Hormones | Endocrine System | Biology | Examinations and Diagnoses | Medical Procedures | Medicine | Health Services | Delivery of Health Care Document Number: 330963 |
| 5. Peer Reviewed Title: Estimation of the predictive role of plasma viral load on CD4 decline in HIV-1 subtype C-infected subjects in India. Author: Ding M; Tarwater P; Rodriguez M; Chatterjee R; Ratner D; Yamamura Y; Roy P; Mellors J; Neogi D; Chen Y; Gupta P Source: JAIDS. Journal of Acquired Immune Deficiency Syndromes. 2009 Feb 1;50(2):119-25. Abstract: BACKGROUND: Plasma viral load has been shown to be a meaningful prognostic marker for disease progression in untreated, HIV-1 subtype B-infected subjects in United States and Western Europe and therefore used as a prognostic marker for disease progression. Because of high expenses of commercially available viral load assays, the role of viral load in disease progression has not been evaluated in HIV-1 subtype C-infected patients in India. METHODS: We developed an inexpensive real-time reverse transcriptase-polymerase chain reaction assay to quantify viral load in plasma of HIV-1 subtype C-infected subjects from India and used it in a longitudinal analysis of viral load and CD4 cell number in HIV-infected subjects from Calcutta, India. RESULTS: The real-time reverse transcriptase-polymerase chain reaction assay can quantify plasma viral load with a linear range of detection from 10 to 10 HIV-1 RNA copies per input. Longitudinal analysis of viral load in a cohort of 39 subjects over an average period of approximately 3 years indicates that 1-log increase in HIV-1 RNA level was associated with a decline of 67 CD4 cell count. Furthermore, HIV-1 RNA level between 500 and 50,000 copies per milliliter would predict a 12.9% decrease in CD4 cell count per year, whereas HIV-1 RNA levels above 50,000 copies HIV-1 RNA per milliliter would predict a 25.3% decrease in CD4 cells per year. In addition, we estimated that the mean incubation period of disease development, as defined by the loss of CD4 below 200, is 8.2 years. CONCLUSION: Our report on the level of viral load on predicting CD4 decline in Indian subjects with HIV-1 provides an additional important tool to the physicians for treating and planning a therapeutic strategy to control HIV-1 infection in India. Language: English Keywords: INDIA | RESEARCH REPORT | METHODOLOGICAL STUDIES | CLINICAL RESEARCH | GENETIC TECHNIQUES | ESTIMATION TECHNIQUES | EVALUATION INDEXES | PERSONS LIVING WITH HIV/AIDS | HEALTH STATUS INDEXES | HIV INFECTIONS | COST EFFECTIVENESS | LABORATORY EXAMINATIONS AND DIAGNOSES | IMMUNITY, CELLULAR | Developing Countries | Asia, Southern | Asia | Research Methodology | Examinations and Diagnoses | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Quantitative Evaluation | Evaluation | Persons Living With HIV/AIDS | Viral Diseases | Diseases | Immunity | Immune System | Physiology | Biology Document Number: 330366 |
| 6. Peer Reviewed Title: Association of age at first sex with HIV-1, HSV-2, and other sexual transmitted infections among women in northern Tanzania. Author: Ghebremichael M; Larsen U; Paintsil E Source: Sexually Transmitted Diseases. 2009 Sep;36(9):570-576. Abstract: The authors examined the association between age at first sex and the prevalence of sexually transmitted infections (STIs), including HIV-1 and HSV-2, in women in Moshi urban district, northern Tanzania. A total of 2,019 women aged 20 to 44 were randomly selected in a two-stage sampling, and they provided information on demographics and sexual behaviors. Blood and urine samples were drawn for STI testing. Women who had their first sexual intercourse between ages 18 and 19 (OR = 0.66; 95% CI = 0.50-0.86) or 20+ (OR = 0.46; 95% CI = 0.36-0.60) were less likely to have STIs, including HIV-1 and HSV-2, than were women who had their first intercourse before their 18th birthday. Early age at first sex was associated with having a regular noncohabiting partner, female circumcision, and coercion at first intercourse. Language: English Keywords: TANZANIA | RESEARCH REPORT | SAMPLING STUDIES | WOMEN | FIRST INTERCOURSE | HIV INFECTIONS | SEXUALLY TRANSMITTED DISEASES | INCIDENCE | SIGNS AND SYMPTOMS | LABORATORY EXAMINATIONS AND DIAGNOSES | RISK FACTORS | FEMALE GENITAL CUTTING | Developing Countries | Africa, Eastern | Africa, Sub Saharan | Africa | Studies | Research Methodology | Demographic Factors | Population | Sex Behavior | Behavior | Viral Diseases | Diseases | Reproductive Tract Infections | Infections | Measurement | Examinations and Diagnoses | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Harmful Traditional Practices | Traditional Health Practices | Culture | Sociocultural Factors Document Number: 339905 |
| 7. Peer Reviewed Title: A piece of my mind. The quiet storm. Author: Heysell SK Source: JAMA. 2009 Jul 1;302(1):13-4. Abstract: XDR-TB (extensively drug resistant tuberculosis) is a devastating plight that proves fatal in more than 85% of cases, and is a major concern in 55 countries. This is an account of two physicians’ journey from Tuegla Ferry, South Africa to the AIDS and TB affected area of the KwaZulu-Natal Province, and their exchange with an HIV positive, and possibly TB infected, mother and child. Faced with limited immediate access to dependable, low-cost, and time appropriate diagnostics, an unlikely success story emerges. Language: English Keywords: SOUTH AFRICA | CRITIQUE | HIV INFECTIONS | TUBERCULOSIS | EPIDEMICS | LABORATORY EXAMINATIONS AND DIAGNOSES | PROGRAM ACCESSIBILITY | TREATMENT | DRUG RESISTANCE | FUNDS | HOSPITALS | TIME FACTORS | Developing Countries | Africa, Southern | Africa, Sub Saharan | Africa | Viral Diseases | Diseases | Infections | Examinations and Diagnoses | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Program Evaluation | Programs | Organization and Administration | Financial Activities | Economic Factors | Health Facilities | Population Dynamics | Demographic Factors | Population Document Number: 341916 |
| 8. Peer Reviewed Title: Routine offering of HIV testing to hospitalized pediatric patients at university teaching hospital, Lusaka, Zambia: acceptability and feasibility. Author: Kankasa C; Carter RJ; Briggs N; Bulterys M; Chama E; Cooper ER; Costa C; Spielman E; Katepa-Bwalya M; M'soka T; Ou CY; Abrams EJ Source: Journal of Acquired Immune Deficiency Syndromes. 2009 Jun 1;51(2):202-8. Abstract: OBJECTIVES: The difficulties diagnosing infants and children with HIV infection have been cited as barriers to increasing the number of children receiving antiretroviral therapy worldwide. Design: We implemented routine HIV antibody counseling and testing for pediatric patients hospitalized at the University Teaching Hospital, a national reference center, in Lusaka, Zambia. We also introduced HIV DNA polymerase chain reaction (PCR) testing for early infant diagnosis. METHODS: Caregivers/parents of children admitted to the hospital wards were routinely offered HIV counseling and testing for their children. HIV antibody positive (HIV+) children <18 months of age were tested with PCR for HIV DNA. RESULTS: From January 1, 2006, to June 30, 2007, among 15,670 children with unknown HIV status, 13,239 (84.5%) received counseling and 11,571 (87.4%) of those counseled were tested. Overall, 3373 (29.2%) of those tested were seropositive. Seropositivity was associated with younger age: 69.6% of those testing HIV antibody positive were <18 months of age. The proportion of counseled children who were tested increased each quarter from 76.0% in January to March 2006 to 88.2% in April to June 2007 (P < 0.001). From April 2006 to June 2007, 1276 PCR tests were done; 806 (63.2%) were positive. The rate of PCR positivity increased with age from 22% in children <6 weeks of age to 61% at 3-6 months and to 85% at 12-18 months (P < 0.001). CONCLUSIONS: Routine counseling and antibody testing of pediatric inpatients can identify large numbers of HIV-seropositive children in high prevalence settings. The high rate of HIV infection in hospitalized infants and young children also underscores the urgent need for early infant diagnostic capacity in high prevalence settings. Language: English Keywords: ZAMBIA | RESEARCH REPORT | INFANT | CLIENTS | HIV TESTING | COUNSELING | HOSPITALS | CHILD HEALTH SERVICES | LABORATORY EXAMINATIONS AND DIAGNOSES | IMPLEMENTATION | PROGRAM ACCEPTABILITY | Developing Countries | Africa, Southern | Africa, Sub Saharan | Africa | Youth | Age Factors | Population Characteristics | Demographic Factors | Population | Program Activities | Programs | Organization and Administration | Examinations and Diagnoses | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Clinic Activities | Health Facilities | Maternal-Child Health Services | Primary Health Care | Program Evaluation Document Number: 341754 |
| 9. Title: Association of genital mycoplasmas including Mycoplasma genitalium in HIV infected men with nongonococcal urethritis attending STD & HIV clinics. Author: Manhas A; Sethi S; Sharma M; Wanchu A; Kanwar AJ; Kaur K; Mehta SD Source: Indian Journal of Medical Research. 2009 Mar;129(3):305-10. Abstract: BACKGROUND & OBJECTIVE: Acute nongonococcal urethritis (NGU) is one of the commonest sexually transmitted infections affecting men. The role of genital mycoplasmas including Mycoplasma genitalium in HIV infected men with NGU is still not known. The aim of this study was to determine the isolation pattern/detection of genital mycoplasma including M. genitalium in HIV infected men with NGU and to compare it with non HIV infected individuals. METHODS: One hundred male patients with NGU (70 HIV positive, 30 HIV negative) were included in the study. Urethral swabs and urine samples obtained from patients were subjected to semi-quantitative culture for Mycoplasma hominis and Ureaplasama urealyticum, whereas M. genitalium was detected by PCR from urine. The primers MgPa1 and MgPa3 were selected to identify 289 bp product specific for M. genitalium. Chalmydia trachomatis antigen detection was carried out by ELISA. RESULTS: M. genitalium and M. hominis were detected/isolated in 6 per cent of the cases. M. genitalium was more common amongst HIV positive cases (7.1%) as compared to HIV negative cases (3.3%) but difference was not statistically significant. Co-infection of C. trachomatis and U. urealyticum was found in two HIV positive cases whereas, C. trachomatis and M. hominis were found to be coinfecting only one HIV positive individual. M. genitalium was found to be infecting the patients as the sole pathogen. INTERPRETATION & CONCLUSION: Patients with NGU had almost equal risk of being infected with M. genitalium, U. urealyticum or M. hominis irrespective of their HIV status. M.genitalium constitutes one of the important causes of NGU besides other genital mycoplasmas. Language: English Keywords: INDIA | RESEARCH REPORT | COMPARATIVE STUDIES | CLIENTS | PERSONS LIVING WITH HIV/AIDS | MEN | SEXUALLY TRANSMITTED DISEASES | UROGENITAL EFFECTS | BACTERIAL AND FUNGAL DISEASES | LABORATORY EXAMINATIONS AND DIAGNOSES | LABORATORY PROCEDURES | Asia, Southern | Asia | Developing Countries | Studies | Research Methodology | Program Activities | Programs | Organization and Administration | HIV Infections | Viral Diseases | Diseases | Demographic Factors | Population | Reproductive Tract Infections | Infections | Urogenital System | Physiology | Biology | Examinations and Diagnoses | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health Document Number: 341926 |
| 10. Title: Implementation of the thin layer agar method for diagnosis of smear-negative pulmonary tuberculosis in a setting with a high prevalence of human immunodeficiency virus infection in Homa Bay, Kenya. Author: Martin A; Munga Waweru P; Babu Okatch F; Amondi Ouma N; Bonte L; Varaine F; Portaels F Source: Journal of Clinical Microbiology. 2009 Aug;47(8):2632-4. Abstract: The objective of this study was to evaluate the performance of a low-cost method, the thin layer agar (TLA) method, for the diagnosis of smear-negative patients. This prospective study was performed in Homa Bay District Hospital in Kenya. Out of 1,584 smear-negative sputum samples, 212 (13.5%) were positive by culture in Lowenstein-Jensen medium (LJ) and 220 (14%) were positive by the TLA method. The sensitivities of LJ and TLA were 71% and 74%, respectively. TLA could become an affordable method for the diagnosis of smear-negative tuberculosis in resource-limited settings, with results available within 2 weeks. Language: English Keywords: KENYA | RESEARCH REPORT | PREVALENCE | PROSPECTIVE STUDIES | INCIDENCE | LABORATORY EXAMINATIONS AND DIAGNOSES | TESTING | CLIENTS | TUBERCULOSIS | HIV | IMPLEMENTATION | Africa, Eastern | Africa, Sub Saharan | Africa | Developing Countries | Measurement | Research Methodology | Studies | Examinations and Diagnoses | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Program Activities | Programs | Organization and Administration | Infections | Diseases | HIV Infections | Viral Diseases Document Number: 342984 |
| 11. Title: The Tanzania experience: clinical laboratory testing harmonization and equipment standardization at different levels of a tiered health laboratory system. Author: Massambu C; Mwangi C Source: American Journal of Clinical Pathology. 2009 Jun;131(6):861-6. Abstract: The rapid scale-up of the care and treatment programs in Tanzania during the preceding 4 years has greatly increased the demand for quality laboratory services for diagnosis of HIV and monitoring patients during antiretroviral therapy. Laboratory services were not in a position to cope with this demand owing to poor infrastructure, lack of human resources, erratic and/or lack of reagent supply and commodities, and slow manual technologies. With the limited human resources in the laboratory and the need for scaling up the care and treatment program, it became necessary to install automated equipment and train personnel for the increased volume of testing and new tests across all laboratory levels. With the numerous partners procuring equipment, the possibility of a multitude of equipment platforms with attendant challenges for procurement of reagents, maintenance of equipment, and quality assurance arose. Tanzania, therefore, had to harmonize laboratory tests and standardize laboratory equipment at different levels of the laboratory network. The process of harmonization of tests and standardization of equipment included assessment of laboratories, review of guidelines, development of a national laboratory operational plan, and stakeholder advocacy. This document outlines this process. Language: English Keywords: TANZANIA | CRITIQUE | HIV INFECTIONS | AIDS | ANTIRETROVIRAL THERAPY | LABORATORY | PROGRAM EVALUATION | PLANNING | EQUIPMENT AND SUPPLIES | LABORATORY EXAMINATIONS AND DIAGNOSES | TESTING | STANDARDIZATION | LOGISTICS | Developing Countries | Africa, Eastern | Africa, Sub Saharan | Africa | Viral Diseases | Diseases | HIV | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Programs | Organization and Administration | Examinations and Diagnoses | Measurement | Research Methodology | Data Adjustment | Management Document Number: 341767 |
| 12. Peer Reviewed Title: Effect of levonorgestrel and mifepristone on endometrial receptivity markers in a three-dimensional human endometrial cell culture model. Author: Meng CX; Andersson KL; Bentin-Ley U; Gemzell-Danielsson K; Lalitkumar PG Source: Fertility and Sterility. 2009 Jan;91(1):256-64. Abstract: OBJECTIVE: To investigate the effect of levonorgestrel and mifepristone on the expression of endometrial receptivity markers in a three-dimensional endometrial construct. DESIGN: In vitro study. SETTING: University hospital and research laboratory. PATIENT(S): Twelve fertile donors. INTERVENTION(S): Timed endometrial biopsy. MAIN OUTCOME MEASURE(S): Examine the effect of levonorgestrel along with another well-studied fertility-regulating drug, mifepristone, on the expression of endometrial receptivity factors in a three-dimensional stromal and epithelial cell coculture model by immunohistochemistry. RESULT(S): Both epithelial and stromal cells of in vitro endometrial construct showed the presence of estrogen receptor-alpha, estrogen receptor-beta, progesterone receptors-(A+B), vascular endothelial growth factor, leukemia inhibitory factor, interleukin-1 beta, and cyclooxygenase-2, whereas the expression of progesterone receptor-B (AR), integrin alpha(V)beta(3,) and MUC1 were confined to epithelialcells. Mifepristone up-regulated expression of epithelial estrogen receptor-beta and progesterone receptor-B and down-regulated stromal vascular endothelial growth factor and surface molecules MUC1 and integrin alpha(V)beta(3) as observed in vivo. Levonorgestrel had no effect on the expression of endometrial receptivity markers studied. CONCLUSION(S): This in vitro model expresses progesterone-regulated endometrial receptivity factors seen in the physiologic condition. Treatment with levonorgestrel did not affect the expression of these endometrial receptivity markers in contrast to mifepristone. This in vitro model holds the potential to study endometrial receptivity, the embryo-endometrial interaction, and develop new agents for fertility control. Language: English Keywords: SWEDEN | RESEARCH REPORT | IN VITRO | LABORATORY EXAMINATIONS AND DIAGNOSES | LEVONORGESTREL | RU-486 | DECIDUAL CELL REACTION | FERTILITY | Europe, Northern | Europe | Developed Countries | Clinical Research | Research Methodology | Examinations and Diagnoses | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Contraceptive Agents, Progestin | Contraceptive Agents, Female | Contraceptive Agents | Contraception | Family Planning | Hormone Antagonists | Hormones | Endocrine System | Physiology | Biology | Cytologic Effects | Population Dynamics | Demographic Factors | Population Document Number: 329592 |
| 13. Title: Serodeconversion of HIV antibody-positive AIDS patients following treatment with V-1 Immunitor. Author: Metadilogkul O; Jirathitikal V; Bourinbaiar AS Source: Journal of Biomedicine and Biotechnology. 2009;2009:934579. Abstract: It is extremely rare when HIV seropositive adult patients experience spontaneous loss of antibodies, that is, seroreversion. The disappearance of HIV antibodies was occasionally attributed to iatrogenic intervention-serodeconversion. Such interventions include: HAART; oral interferon; Chinese herbal remedies; and therapeutic AIDS vaccines derived from pooled blood. Oral therapeutic, alloimmune AIDS vaccine, V-1 Immunitor (V1), was administered to 60000 HIV-positive Thai patients. The administration of V1 resulted in serodeconversion among 23 individuals. The patient group consisted of 9 females (39%) and 14 males (61%) including two 2-year-old boys. The age range was 2-58 years with mean/median 29/29.3 years. Patients were tested seropositive for HIV at least once before being enrolled on V1. The duration of treatment until discovery of seronegative status ranged between 2 weeks and 15 months with average/median 7.2/8 months. Time to seronegativity was correlated with baseline disease stage (R = 0.62; P = .002). The seronegative status was positively associated with V1-induced undetectable or low viral load (R = 0.65; P = .0008). The odds ratio analysis comparing the outcome of our study with published surveys of diagnostic accuracy of laboratory tests suggested that the probability of HIV antibody testing error was remote (P < .000001). The possible causes responsible for this unusual phenomenon are discussed. Language: English Keywords: THAILAND | RESEARCH REPORT | LABORATORY EXAMINATIONS AND DIAGNOSES | PERSONS LIVING WITH HIV/AIDS | HIV TESTING | ANTIBODIES | TREATMENT | Developing Countries | Asia, Southeastern | Asia | Examinations and Diagnoses | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | HIV Infections | Viral Diseases | Diseases | Immunologic Factors | Immunity | Immune System | Physiology | Biology Document Number: 329746 |
| 14. Title: Assessment of HIV-positive in-patients using the International Classification of Functioning, Disability and Health (ICF) at Chris Hani Baragwanath Hospital, Johannesburg. Author: Myezwa H; Stewart A; Musenge E; Nesara P Source: African Journal of AIDS Research. 2009 Apr;8(1):93-105. Abstract: The International Classification of Functioning, Disability and Health (ICF) short-version checklist was used to assess the impairments, activity limitations and participation restrictions experienced by a sample of HIV-positive in-patients admitted to Chris Hani Baragwanath Hospital in Johannesburg, South Africa. Laboratory tests, observation and review of patients' medical records were used to complete the ICF Checklist. Eighty patients were assessed (23 males and 57 females). Common impairments related to the following functions: digestive, metabolic and endocrine systems (83.9%); sensory (83.5%); haematological, immunological and respiratory systems (82.5%); neuromusculoskeletal movement (73.8%); mental (72.6%); energy and drive (75%); sleep (71%); emotional (62%); and muscle power (75%). Activity limitations were present in the area of mobility (56.4%), major life areas (55.1%), and community, social and civic life (50%). Associations found among impairments, activity limitations and participation restrictions were that patients with sensory problems were five-times more likely to have problems in self-care than people without sensory problems. Patients with impairments in the digestive, genitourinary and neuromusculoskeletal systems experienced problems with general tasks (confidence interval [CI]: 4.05-103.03; p < 0.01). Patients with cardiovascular, haematological, immunological and respiratory system problems were 14-times more likely to have problems with execution of general tasks (odds ratio [OR] 14.06, CI: 2.75-71.94; p = 0.002). Activities of participation restriction, difficulties with general tasks and demands (OR 9.68, CI: 1.20-77.92), interpersonal relationships (OR 3.62, CI: 1.09-12.00), domestic life (OR 3.97, CI: 1.12-14.16), and community, social and civic life (OR 4.13, CI: 1.05-16.20) were closely associated with barriers in obtaining products for personal use and using technology. Understanding the prevalence and associations of disability and function in the course of HIV disease may serve as a baseline for developing appropriate and context-sensitive rehabilitation interventions and management strategies for people living with HIV or AIDS. Language: English Keywords: SOUTH AFRICA | RESEARCH REPORT | CLASSIFICATION | CLIENTS | PERSONS LIVING WITH HIV/AIDS | HOSPITALS | HEALTH STATUS INDEXES | LABORATORY EXAMINATIONS AND DIAGNOSES | SIGNS AND SYMPTOMS | Developing Countries | Africa, Southern | Africa, Sub Saharan | Africa | Research Methodology | Program Activities | Programs | Organization and Administration | HIV Infections | Viral Diseases | Diseases | Health Facilities | Delivery of Health Care | Health | Examinations and Diagnoses | Medical Procedures | Medicine | Health Services Document Number: 341291 |
| 15. Peer Reviewed Title: Pulmonary tuberculosis among women with cough attending clinics for family planning and maternal and child health in Dar Es Salaam, Tanzania. Author: Ngadaya ES; Mfinanga GS; Wandwalo ER; Morkve O Source: BMC Public Health. 2009 Aug 3;9(1):278. Abstract: ABSTRACT: BACKGROUND: Tuberculosis (TB) case detection in women has remained low in developing world. This study was conducted to determine the proportion of smear positive TB among women with cough regardless of the duration attending family Planning (FP) and Maternal and child health (MCH) clinics in Dar es Salaam. METHODS: We conducted a cross sectional study in all three municipal hospitals of Dar es Salaam, between October 2007 and June 2008. All women with cough attending FP and MCH clinics were screened for TB by smear microscopy. Pearson chi- square was used to compare group difference for categorical variables. Risk factors for smear positive were estimated by logistics regression with 95% confidence intervals (CI) given for odds ratios indicating statistically significant relationship if the CI did not include one. RESULTS: We enrolled a total of 749 TB suspects. Five hundred and twenty nine patients (70.6%) were from MCH clinics. Mean (SD) age was 27.6 (5.2) years. A total of 616 (82.2%) patients were coughing for less than two weeks as compared to 133 (17.8%), who coughed for two or more weeks. Among 616 TB suspects, 14 (2.3%) were smear positive TB patients, and of the 133 who had coughed for two or more weeks, 13 (9.8%) were smear positive TB patients. Risk factors associated with smear positive results were having attended more than one visit to any facility prior to diagnosis (OR=6.8; 95%CI 2.57- 18.0) and having HIV/AIDS (OR= 4.4; 95%CI 1.65-11.96). Long duration of cough was not a risk factor for being smear positive (OR=1.6; 95%CI 0.59-4.49). CONCLUSION: The proportion of smear positive TB patients among women with cough attending MCH and FP was 3.8%. Visits to any health facility prior to Diagnosis and HIV infection were risk for having a smear positive TB. Language: English Keywords: TANZANIA | RESEARCH REPORT | CROSS SECTIONAL ANALYSIS | WOMEN | FAMILY PLANNING CENTERS | FAMILY PLANNING CLINIC ATTENDANCE | MATERNAL-CHILD HEALTH SERVICES | HOSPITALS | TUBERCULOSIS | SIGNS AND SYMPTOMS | LABORATORY EXAMINATIONS AND DIAGNOSES | Developing Countries | Africa, Eastern | Africa, Sub Saharan | Africa | Research Methodology | Demographic Factors | Population | Health Facilities | Delivery of Health Care | Health | Family Planning Program Evaluation | Family Planning Programs | Family Planning | Primary Health Care | Health Services | Infections | Diseases | Examinations and Diagnoses | Medical Procedures | Medicine Document Number: 342421 |
| 16. Peer Reviewed Title: Reproductive tract infections in northern Vietnam: health providers' diagnostic dilemmas. Author: Nguyen MH; Gammeltoft T; Christoffersen SV; Tran TT; Rasch V Source: Women and Health. 2009 Mar-May;49(2-3):229-45. Abstract: Research was conducted on reproductive tract infections among women obtaining induced abortions at Ph[image omitted]-[image omitted] hospital in Haiphong City, a major maternity hospital in northern Vietnam. The research aimed to explore how clinicians and lab-technicians diagnose reproductive tract infections and the difficulties they experience in establishing exact diagnoses. A combination of both quantitative and qualitative research methodologies was employed. The quantitative research involved 748 abortion-seeking women; the qualitative research was conducted with 10 doctors and 10 lab-technicians providing reproductive health services. A marked tendency was observed among both clinicians and lab-technicians to overdiagnose reproductive tract infections and to prescribe antibiotics routinely. Social, cultural, and clinical factors associated with the tendency to overdiagnose reproductive tract infections included: inadequate training of health staff, lack of equipment, and cultural assumptions regarding the overwhelming prevalence of reproductive tract infections in Vietnamese women, especially among those who receive abortion services. Misconceptions of reproductive tract infections led to substantial over-diagnosis and unnecessary treatment of reproductive tract infections in this hospital. To enhance reproductive tract infection care, providers need to be sensitized to the social and medical consequences of their own cultural perceptions and to increase their awareness of the risks associated with overuse of antibiotics. Language: English Keywords: VIETNAM | RESEARCH REPORT | CLINICAL RESEARCH | FOCUS GROUPS | ABORTION | PROVIDERS WITH CLIENTS | REPRODUCTIVE TRACT INFECTIONS | PREVALENCE | PHYSICAL EXAMINATIONS AND DIAGNOSES | LABORATORY EXAMINATIONS AND DIAGNOSES | ANTIBIOTICS | INTERVIEWS | PERCEPTION | Asia, Southeastern | Asia | Developing Countries | Research Methodology | Data Collection | Fertility Control, Postconception | Family Planning | Health Services | Delivery of Health Care | Health | Infections | Diseases | Measurement | Examinations and Diagnoses | Medical Procedures | Medicine | Drugs | Treatment | Psychological Factors | Behavior Document Number: 342405 Notification |
| 17. Peer Reviewed Title: Reproductive tract infections in women seeking abortion in Vietnam. Author: Nguyen MH; Kurtzhals J; Do TT; Rasch V Source: BMC Women's Health. 2009;9:1. Abstract: BACKGROUND: Women requesting abortion are at increased risk of developing RTI complications. However, RTI control in many resource-poor countries including Vietnam have been faced with logistical and methodological problems due to lack of standardized definitions of RTIs, lack of well-validated diagnostic criteria, lack of accurate laboratory tests, and lack of diagnostic equipment and skills. This article investigates the prevalence of RTIs among Vietnamese abortion-seeking women, to evaluate the available diagnostic techniques, and to assess antibiotic resistance among aetiological agents of RTI. METHOD: The study was conducted in Phu-San hospital (PSH) from December 2003 through April 2004 among 748 abortion clients. A structured questionnaire was used to collect data on socio-economic and reproductive characteristics. Specimens were collected for laboratory analyses of chlamydia, gonorrhoea, trichomoniasis, vaginal candidiasis (VC), bacterial vaginosis (BV) and syphilis. To assess the validity of the obtained results, the study was repeated among 100 women and the duplicate samples were analysed at PSH and Copenhagen University Hospital (CUH). RESULTS: In all 54% of the women were diagnosed as having an RTI, including 3.3% with sexually transmitted infections. Endogenous infections were most prevalent (VC 34% and BV 12%) followed by chlamydia (1.3%) and trichomoniasis (0.7%). The sensitivity of culture for VC and BV was 30% and 88%, respectively, when tests in PSH were measured against tests in CUH. Antibiotic resistance was common among bacterial isolates. CONCLUSION: RTIs are common among women seeking abortion. The presence of RTIs is associated with an increased risk of developing iatrogenic infections, routine administration of prophylactic antibiotic to all women undergoing abortion should be considered. However, the choice of routine prophylactic antibiotics should be based on relevant surveillance data of antibiotic resistance. Moreover, since the accuracy of diagnosis is doubtful and to address the problem of under-diagnosed and treated RTIs new investment in diagnostic facilities with simple performed microscopy or improved rapid tests should also be taken into consideration. Language: English Keywords: VIETNAM | RESEARCH REPORT | QUESTIONNAIRES | WOMEN | ABORTION | REPRODUCTIVE TRACT INFECTIONS | SCREENING | LABORATORY EXAMINATIONS AND DIAGNOSES | ANTIBIOTICS | TREATMENT | Asia, Southeastern | Asia | Developing Countries | Demographic Factors | Population | Fertility Control, Postconception | Family Planning | Infections | Diseases | Examinations and Diagnoses | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Drugs Document Number: 341239 Notification |
| 18. Peer Reviewed Title: Comparison of T-SPOT.TB assay and tuberculin skin test for the evaluation of young children at high risk for tuberculosis in a community setting. Author: Nicol MP; Davies MA; Wood K; Hatherill M; Workman L; Hawkridge A Source: Pediatrics. 2009 Jan;123(1):38-43. Abstract: OBJECTIVE: We wished to compare the sensitivity of an enzyme-linked immunospot assay (T-SPOT.TB; Oxford Immunotec, Oxford, United Kingdom) and the tuberculin skin test for the detection of tuberculosis infection in very young children being evaluated for active tuberculosis in a rural community setting. METHODS: Children with a history of exposure to tuberculosis and children presenting to a local clinic or hospital with symptoms suggesting tuberculosis were admitted to a dedicated case verification ward. T-SPOT.TB testing was performed, and children were evaluated with a clinical examination, a tuberculin skin test, chest radiographs, and cultures of induced sputum and gastric lavage specimens. The diagnosis was determined by using a clinical algorithm. RESULTS: A total of 243 children (median age: 18 months) were recruited, of whom 214 (88%) had interpretable T-SPOT.TB results. Children > or =12 months of age were more likely than younger children to have positive T-SPOT.TB results, whereas tuberculin skin test results were unaffected by age. The sensitivity of the T-SPOT.TB was no better than that of the tuberculin skin test for culture-confirmed tuberculosis (50% and 80%, respectively) and was poorer for the combined group of culture-confirmed and clinically probable tuberculosis (40% and 52%, respectively). For the 50 children clinically categorized as not having tuberculosis, the specificity of both the T-SPOT.TB and the tuberculin skin test was 84%. CONCLUSIONS: For young children presenting in a community setting after exposure to tuberculosis or with symptoms suggesting tuberculosis, T-SPOT.TB cannot be used to exclude active disease. The sensitivity of this assay may be impaired for very young children. Language: English Keywords: SOUTH AFRICA | RESEARCH REPORT | METHODOLOGICAL STUDIES | CLINICAL RESEARCH | COMPARATIVE STUDIES | CHILDREN | COMMUNITY | TUBERCULOSIS | TESTING | COMMUNITY HEALTH SERVICES | LABORATORY EXAMINATIONS AND DIAGNOSES | DERMATOLOGICAL EFFECTS | PHYSICAL EXAMINATIONS AND DIAGNOSES | Africa, Southern | Africa, Sub Saharan | Africa | Developing Countries | Research Methodology | Studies | Youth | Age Factors | Population Characteristics | Demographic Factors | Population | Residence Characteristics | Population Distribution | Geographic Factors | Infections | Diseases | Measurement | Primary Health Care | Health Services | Delivery of Health Care | Health | Examinations and Diagnoses | Medical Procedures | Medicine | Physiology | Biology Document Number: 328039 |
| 19. Title: Two vs. three sputum samples for microscopic detection of tuberculosis in a high HIV prevalence population. Author: Noeske J; Dopico E; Torrea G; Wang H; Van Deun A Source: International Journal of Tuberculosis and Lung Disease. 2009 Jul;13(7):842-7. Abstract: SETTING: A busy urban hospital in Cameroon. OBJECTIVES: To compare the yield in bacteriologically proven tuberculosis (TB) cases examining two morning vs. three spot-morning-spot sputum specimens (MM vs. SMS) by direct microscopy for acid-fast bacilli (AFB). DESIGN: Repeated temporal cross-over between MM and SMS sampling for successive TB suspects, using culture as gold standard. RESULTS: A total of 799 suspects were screened using the MM strategy, identifying 223 smear-positives, and 808 suspects with the SMS strategy, yielding 236 smear-positives. Of the MM, 256 were culture-positive, of whom 195 (76%) were smear-positive. For SMS, these figures were respectively 281 and 206 (73%), a non-significant difference. The MM and SMS strategies also detected respectively 28 and 30 smear-positive cases not confirmed by culture. No cases were lost to treatment with either strategy. CONCLUSIONS: In this population with a high prevalence of human immunodeficiency virus (HIV) with late case presentation, smear microscopy of two morning specimens detected at least as many positive cases as the classical strategy, and no cases were lost before treatment. Two specimens for initial TB suspect screening can thus be recommended, also without excessive workload. Comparative studies in populations presenting with paucibacillary sputum are needed to determine the equivalent quality and yield of an alternative strategy with two spot specimens at consultation. Language: English Keywords: CAMEROON | RESEARCH REPORT | COMPARATIVE STUDIES | CLIENTS | TUBERCULOSIS | LABORATORY EXAMINATIONS AND DIAGNOSES | HIV INFECTIONS | PREVALENCE | SCREENING | WHO | STANDARDS | Developing Countries | Africa, Western | Africa, Sub Saharan | Africa | Studies | Research Methodology | Program Activities | Programs | Organization and Administration | Infections | Diseases | Examinations and Diagnoses | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Viral Diseases | Measurement | UN | International Agencies | Organizations | Political Factors | Sociocultural Factors Document Number: 342823 |
| 20. Title: Approaches to tuberculosis screening and diagnosis in people with HIV in resource-limited settings. Author: Reid MJ; Shah NS Source: Lancet Infectious Diseases. 2009 Mar;9(3):173-84. Abstract: Tuberculosis is the main cause of morbidity and mortality in people living with HIV/AIDS worldwide. Early diagnosis and treatment is essential to addressing the dual epidemic of tuberculosis and HIV. Increasing recognition of the importance of integrating tuberculosis services--including screening--into HIV care has led to global policies and the beginnings of implementation of joint activities at the national level. However, debate remains about the best methods of screening for pulmonary tuberculosis among people living with HIV/AIDS in resource-limited settings. Mycobacterial culture, the gold standard for tuberculosis diagnosis, is too slow and complex to be a useful screening test in such settings. More widely available methods, such as symptom screening, sputum smear microscopy, chest radiography, and tuberculin skin testing have important shortcomings, especially in people living with HIV/AIDS. However, until simpler, cheaper, and more sensitive diagnostics for tuberculosis are available in peripheral healthcare settings, a strategy must be developed that uses current evidence to combine available screening tools. Language: English Keywords: DEVELOPING COUNTRIES | CRITIQUE | RECOMMENDATIONS | EVALUATION | PERSONS LIVING WITH HIV/AIDS | TUBERCULOSIS | SCREENING | COMPLICATIONS | EXAMINATIONS AND DIAGNOSES | INTEGRATED PROGRAMS | LABORATORY EXAMINATIONS AND DIAGNOSES | TIME FACTORS | SIGNS AND SYMPTOMS | PHYSICAL EXAMINATIONS AND DIAGNOSES | COST EFFECTIVENESS | HIV Infections | Viral Diseases | Diseases | Infections | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Programs | Organization and Administration | Population Dynamics | Demographic Factors | Population | Evaluation Indexes | Quantitative Evaluation Document Number: 330983 |
| 21. Peer Reviewed Title: Herpes simplex virus type 2 antibody detection performance in Kisumu, Kenya, using the Herpeselect ELISA, Kalon ELISA, Western blot and inhibition testing. Author: Smith JS; Bailey RC; Westreich DJ; Maclean I; Agot K; Ndinya-Achola JO; Hogrefe W; Morrow RA; Moses S Source: Sexually Transmitted Infections. 2009 Apr;85(2):92-6. Abstract: BACKGROUND: In certain parts of Africa, type-specific herpes simplex virus type 2 (HSV-2) ELISAs may have limited specificity. To date, no study has been conducted to validate HerpeSelect and Kalon type-specific HSV-2 ELISAs using both the Western blot and recombinant gG ELISA inhibition testing as reference standards. METHODS: A total of 120 men who were HIV seronegative (aged 18-24 years) provided blood samples. HSV-2 IgG serum antibodies were detected using four different methods: HerpeSelect HSV-2 ELISA (n = 120), Kalon HSV-2 ELISA (n = 120), University of Washington Western blot (n = 101) and a recombinant inhibition test (n = 93). RESULTS: HSV-2 seroprevalence differed significantly by HSV-2 detection method, ranging from 24.8% with the Western blot to 69.8% with the HerpeSelect ELISA. Using the Western blot as the reference standard, the HerpesSelect had the highest sensitivity for HSV-2 antibody detection (100%) yet lowest specificity (40%). Similar results were obtained using the inhibition test as the reference standard. The sensitivity and specificity of the Kalon test versus the Western blot were 92% and 79%, respectively, and 80% and 82% versus the inhibition test. Using the inhibition test as the reference standard, the sensitivity of the Western blot appeared low (49%). CONCLUSIONS: In men in western Kenya who were HIV seronegative, the HerpeSelect and Kalon type-specific ELISAs had high sensitivities yet limited specificities using the Western blot as reference standard. Overall, the Kalon ELISA performed better than the HerpeSelect ELISA in these young men from Kisumu. Further understanding is needed for the interpretation of HSV-2 inhibition or ELISA test positive/ Western blot seronegative results. Before HSV-2 seropositivity may be reliably reported in selected areas of Africa, performance studies of HSV-2 serological assays in individual geographical areas are recommended. Language: English Keywords: KENYA | RESEARCH REPORT | COMPARATIVE STUDIES | YOUTH | MEN | HERPES GENITALIS | ANTIBODIES | HEMATOLOGIC TESTS | LABORATORY PROCEDURES | LABORATORY EXAMINATIONS AND DIAGNOSES | Africa, Eastern | Africa, Sub Saharan | Africa | Developing Countries | Studies | Research Methodology | Age Factors | Population Characteristics | Demographic Factors | Population | Sexually Transmitted Diseases | Reproductive Tract Infections | Infections | Diseases | Immunologic Factors | Immunity | Immune System | Physiology | Biology | Examinations and Diagnoses | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health Document Number: 341910 |
| 22. Title: The WHO/PEPFAR collaboration to prepare an operations manual for HIV prevention, care, and treatment at primary health centers in high-prevalence, resource-constrained settings: defining laboratory services. Author: Spira T; Lindegren ML; Ferris R; Habiyambere V; Ellerbrock T Source: American Journal of Clinical Pathology. 2009 Jun;131(6):887-94. Abstract: The expansion of HIV/AIDS care and treatment in resource-constrained countries, especially in sub-Saharan Africa, has generally developed in a top-down manner. Further expansion will involve primary health centers where human and other resources are limited. This article describes the World Health Organization/President's Emergency Plan for AIDS Relief collaboration formed to help scale up HIV services in primary health centers in high-prevalence, resource-constrained settings. It reviews the contents of the Operations Manual developed, with emphasis on the Laboratory Services chapter, which discusses essential laboratory services, both at the center and the district hospital level, laboratory safety, laboratory testing, specimen transport, how to set up a laboratory, human resources, equipment maintenance, training materials, and references. The chapter provides specific information on essential tests and generic job aids for them. It also includes annexes containing a list of laboratory supplies for the health center and sample forms. Language: English Keywords: DEVELOPING COUNTRIES | CRITIQUE | WHO | HIV PREVENTION | CARE AND SUPPORT | TREATMENT | PRIMARY HEALTH CARE | HEALTH FACILITIES | PROCEDURES | LABORATORY | LABORATORY EXAMINATIONS AND DIAGNOSES | TESTING | QUALITY CONTROL | UN | International Agencies | Organizations | Political Factors | Sociocultural Factors | HIV Infections | Viral Diseases | Diseases | Health Services | Delivery of Health Care | Health | Medical Procedures | Medicine | Organization and Administration | Equipment and Supplies | Examinations and Diagnoses | Measurement | Research Methodology Document Number: 341765 |
| 23. Peer Reviewed Title: Evaluation of multiplex real-time PCR for detection of Haemophilus ducreyi, Treponema pallidum, herpes simplex virus type 1 and 2 in the diagnosis of genital ulcer disease in the Rakai District, Uganda. Author: Suntoke TR; Hardick A; Tobian AA; Mpoza B; Laeyendecker O; Serwadda D; Opendi P; Gaydos CA; Gray RH; Wawer MJ; Quinn TC; Reynolds SJ Source: Sexually Transmitted Infections. 2009 Apr;85(2):97-101. Abstract: OBJECTIVE: To develop a real-time PCR assay that reliably and accurately detects the predominant sexually transmitted aetiological agents of genital ulcer disease (GUD) (Haemophilus ducreyi, Treponema pallidum and herpes simplex virus type 1 (HSV-1) and type 2 (HSV-2)) and to assess the use of real-time PCR diagnostic testing in a rural African field site. METHODS: Two multiplex real-time PCR reactions were used to detect H ducreyi/and HSV-1/HSV-2 in ulcer swabs from 100 people with symptomatic genital ulcers in rural Rakai, Uganda. Results were compared with syphilis, HSV-1 and HSV-2 serology. RESULTS: Of 100 GUD samples analysed from 43 HIV positive and 57 HIV negative individuals, 71% were positive for one or more sexually transmitted infection (STI) pathogens by real-time PCR (61% for HSV-2, 5% for T pallidum, 3% for HSV-1, 1% for H ducreyi and 1% for dual H ducreyi/HSV-2). The frequency of HSV in genital ulcers was 56% (32/57) in HIV negative individuals and 77% (33/43) in HIV positive individuals (p = 0.037). Assay reproducibility was evaluated by repeat PCR testing in the USA with 96% agreement (kappa = 0.85). CONCLUSIONS: STI pathogens were detected in the majority of GUD swab samples from symptomatic patients in Rakai, Uganda, by real-time PCR. HSV-2 was the predominant cause of genital ulcers. Real-time PCR technology can provide sensitive, rapid and reproducible evaluation of GUD aetiology in a resource-limited setting. Language: English Keywords: UGANDA | RURAL AREAS | RESEARCH REPORT | CLIENTS | CHANCROID | HERPES GENITALIS | SYPHILIS | LABORATORY EXAMINATIONS AND DIAGNOSES | GENITAL EFFECTS, FEMALE | GENITAL EFFECTS, MALE | HEMATOLOGIC TESTS | LABORATORY PROCEDURES | Africa, Eastern | Africa, Sub Saharan | Africa | Developing Countries | Geographic Factors | Population | Program Activities | Programs | Organization and Administration | Sexually Transmitted Diseases | Reproductive Tract Infections | Infections | Diseases | Examinations and Diagnoses | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Genitalia, Female | Genitalia | Urogenital System | Physiology | Biology | Genitalia, Male Document Number: 341909 |
| 24. Peer Reviewed Title: Description of a large island-wide outbreak of dengue in Puerto Rico, 2007. Author: Tomashek KM; Rivera A; Munoz-Jordan JL; Hunsperger E; Santiago L; Padro O; Garcia E; Sun W Source: American Journal of Tropical Medicine and Hygiene. 2009 Sep;81(3):467-74. Abstract: Dengue is a mosquito-borne viral disease that affects 40% of the world's population. Nearly four million U.S. citizens live in dengue-endemic areas; the most affected population resides in Puerto Rico. Data from a dengue surveillance system were used to describe all suspected cases reported in Puerto Rico in 2007. Rates of infection per 10,000 residents were calculated by age, sex, and residence. Rates and clinical outcomes were compared with those from outbreaks in 1994-1995 and 1998. In 2007, 10,508 suspected cases were reported; 52.5% persons were hospitalized, 31.8% reported hemorrhage, 2.2% had dengue hemorrhage fever, and 44 died. A total of 3,293 (33.0%) of processed specimens were laboratory positive for dengue virus (DENV); DENV-3 (1,342, 61.7%) and DENV-2 (677, 31.1%) were detected most often. The overall incidence of laboratory-positive dengue was 8.6 infections per 10,000 population. Rates were highest among persons 10-14 years of age (19.0), followed by persons 15-19 years of age (17.9) and infants (10.9). Higher rates of hospitalization and hemorrhage were reported in 2007 than in 1994-1995 or 1998. United States citizens residing in Puerto Rico are at risk of acquiring dengue. Data suggest that the severity is worsening, and persons 10-19 years of age and infants continue to be most affected. Language: English Keywords: PUERTO RICO | UNITED STATES OF AMERICA | RESEARCH REPORT | DATA ANALYSIS | INCIDENCE | INFANT | DENGUE | FEVER | BLEEDING | LABORATORY EXAMINATIONS AND DIAGNOSES | Caribbean | Americas | Developed Countries | North America | Research Methodology | Measurement | Youth | Age Factors | Population Characteristics | Demographic Factors | Population | Viral Diseases | Diseases | Body Temperature | Physiology | Biology | Signs and Symptoms | Examinations and Diagnoses | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health Document Number: 342872 |
| 25. Title: Performance of FASTPlaqueTB and a modified protocol in a high HIV prevalence community in South Africa. Author: Trollip AP; Albert H; Mole R; Marshall T; van Cutsem G; Coetzee D Source: International Journal of Tuberculosis and Lung Disease. 2009 Jun;13(6):791-3. Abstract: Modifications in the FASTPlaqueTB test protocol have resulted in an increase in the analytical limits of detection. This study investigated whether the performance of a modified prototype was able to increase the detection of smear-negative, culture-positive sputum samples as compared to the first generation FASTPlaqueTB test. Modifications to the FASTPlaqueTB did result in increased detection of smear-negative samples, but this was associated with a decrease in the specificity of the test. Before the FASTPlaqueTB can be considered as a viable replacement for smear microscopy and culture for the identification of tuberculosis, further work is required to resolve the performance issues identified in this study. Language: English Keywords: SOUTH AFRICA | RESEARCH REPORT | CLINICAL RESEARCH | COMPARATIVE STUDIES | CLIENTS | TUBERCULOSIS | LABORATORY EXAMINATIONS AND DIAGNOSES | LABORATORY PROCEDURES | HIV INFECTIONS | Developing Countries | Africa, Southern | Africa, Sub Saharan | Africa | Research Methodology | Studies | Program Activities | Programs | Organization and Administration | Infections | Diseases | Examinations and Diagnoses | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Viral Diseases Document Number: 342164 |
| 26. Peer Reviewed Title: Performance of serological tests for syphilis in sexually transmitted diseases clinics in Guangxi Autonomous Region, China: implications for syphilis surveillance and control. Author: Yin YP; Wei WH; Wang HC; Zhu BY; Yu YH; Chen XS; Peeling RW; Cohen MS Source: Sexual Health. 2009 Mar;6(1):5-9. Abstract: BACKGROUND: China is experiencing a growing syphilis epidemic. Individuals are currently screened and cases are confirmed using traditional serological testing methods. METHODS: A total of 11 558 serum specimens from patients at 14 sexually transmitted diseases (STD) clinics at provincial, prefecture and county levels in Guangxi Autonomous Region were tested at local clinics using the toluidine red unheated serum test (TRUST) and the SD Bioline Syphilis 3.0 Treponema Pallidum (SD-TP) test and then transported to the National STD Reference Laboratory for TRUST and confirmatory Treponema pallidum particle assay (TPPA) testing. RESULTS: In local clinics, 13.2% of specimens were TRUST positive and 12.8% were TRUST and SD-TP positive. At the Reference Laboratory, 15.4% of specimens were TRUST positive and 11.8% were TRUST and TPPA positive. Local clinics showed a significantly higher prevalence of active syphilis compared with results from the Reference Laboratory (12.8 v. 11.8%, chi(2) = 4.59, P = 0.03). The local TRUST tests had consistent results with Reference Laboratory tests qualitatively among 96.2% of the specimens and quantitatively among 95.5% of the specimens. The algorithm of TRUST screening and then SD-TP confirmation among positive TRUST specimens at local STD clinics had 96.6% sensitivity and 99.3% specificity in diagnosing active syphilis compared with the 'gold standard' based on TRUST and TPPA positivity at the Reference Laboratory (positive predictive value 95.1% and negative predictive value 99.5%). CONCLUSION: The TRUST screening and SD-TP confirmation in combination can be used at local STD clinics for the efficient diagnosis of serologically active syphilis. However, continuing capacity building and quality assurance remain critical in ensuring the quality of syphilis diagnosis at local clinics. Language: English Keywords: CHINA | RESEARCH REPORT | CLIENTS | SYPHILIS | SCREENING | DISEASE TRANSMISSION CONTROL | CLINIC ACTIVITIES | LABORATORY EXAMINATIONS AND DIAGNOSES | PREVALENCE | Asia, Eastern | Asia | Developing Countries | Program Activities | Programs | Organization and Administration | Sexually Transmitted Diseases | Reproductive Tract Infections | Infections | Diseases | Examinations and Diagnoses | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Prevention and Control | Measurement | Research Methodology Document Number: 341692 |
| 27. Peer Reviewed Title: Markers for predicting mortality in untreated HIV-infected children in resource-limited settings: A meta-analysis. Author: Cross Continents Collaboration for Kids (3Cs4kids) Analysis and Writing Committee Source: AIDS. 2008 Jan 2;22(1):97-105. Abstract: The objectives were to evaluate the prognostic value of selected laboratory and growth markers on the short-term risk of mortality in untreated HIV-infected children in resource-limited settings. A meta-analysis of individual longitudinal data on children aged 12 months onwards from 10 studies (nine African, one Brazilian in the 3Cs4kids collaboration). Methods: The risk of death within 12 months based on age and the most recent measurements of laboratory and growth markers was estimated using Poisson regression models, adjusted for cotrimoxazole prophylaxis use and study effects. A total of 2510 children contributed 357 deaths during 3769 child-years-at-risk, with 81% follow-up occurring after start of cotrimoxazole. At first measurement, median age was 4.0 years (interquartile range, 2.2-7.0 years), median CD4% was 15% and weight-for-age z-score -1.9. CD4% and CD4 cell count were the strongest predictors of mortality, followed by weight-for-age and haemoglobin. After adjusting for these markers,the effects of total lymphocyte count and BMI-for-age were relatively small. Young children who were both severely malnourished and anaemic had high mortality regardless of CD4 values, particularly those aged 1-2 years. By contrast, high CD4% or CD4 cell count values predicted low mortality level amongst either children older than 5 years or those younger with neither severe malnutrition nor anaemia. CD4 measurements are the most important indicator of mortality and wider access to affordable tests is needed in resource-limited settings. Evaluation of antiretroviral initiation in children also needs to consider weight-for-age and haemoglobin. Prevention and treatment of malnutrition and anaemia is integral to HIV paediatric care and could improve survival. (author's) Language: English Keywords: DEVELOPING COUNTRIES | RESEARCH REPORT | METHODOLOGICAL STUDIES | ESTIMATION TECHNIQUES | LONGITUDINAL STUDIES | STATISTICAL REGRESSION | EVALUATION INDEXES | INFANT | PERSONS LIVING WITH HIV/AIDS | INFANT MORTALITY | GROWTH | RISK ASSESSMENT | LABORATORY EXAMINATIONS AND DIAGNOSES | HEMOGLOBIN LEVEL | HIV INFECTIONS | Research Methodology | Studies | Data Analysis | Quantitative Evaluation | Evaluation | Youth | Age Factors | Population Characteristics | Demographic Factors | Population | Persons Living With HIV/AIDS | Viral Diseases | Diseases | Mortality | Population Dynamics | Child Development | Biology | Examinations and Diagnoses | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Hemic System | Physiology Document Number: 322744 |
28.  Title: Self-sampling for RTIs is valid, feasible, acceptable. Author: Population Council Source: Population Briefs. 2008 Aug;14(1):5. Abstract: Globally, new cases of syphilis, gonorrhea, chlamydia, and trichomoniasis total 340 million each year. Sexually transmitted infections (STIs) and other reproductive tract infections (RTIs) are major causes of severe illness, infertility, obstetric complications, and infant illness. They may also increase transmission of HIV. Gonorrhea and chlamydia are 50 to 300 percent more prevalent among women than among men. Correctly diagnosing and treating RTIs in women is thus a public health imperative. However, reaching this goal usually requires a clinic visit and a pelvic examination, which may deter some women. Population Council researchers investigated the acceptability and feasibility of home-based self-sampling for STIs in Brazil and South Africa. In South Africa, researchers also looked at the validity of using self-sampling in a clinic setting to diagnose RTIs. Language: English Keywords: BRAZIL | SOUTH AFRICA | METHODOLOGICAL STUDIES | RECOMMENDATIONS | CLINICAL TRIALS | WOMEN IN DEVELOPMENT | REPRODUCTIVE TRACT INFECTIONS | SELF CARE | PHYSICAL EXAMINATIONS AND DIAGNOSES | COST EFFECTIVENESS | SIGNS AND SYMPTOMS | VALIDITY | SEXUALLY TRANSMITTED DISEASES | LABORATORY EXAMINATIONS AND DIAGNOSES | Developing Countries | South America, Eastern | South America | Latin America | Americas | Africa, Southern | Africa, Sub Saharan | Africa | Clinical Research | Research Methodology | Economic Development | Economic Factors | Infections | Diseases | Treatment | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Examinations and Diagnoses | Evaluation Indexes | Quantitative Evaluation | Evaluation | Measurement Document Number: 328292 |
| 29. Peer Reviewed Title: Febrile status, malarial parasitaemia and gastro-intestinal helminthiases in schoolchildren resident at different altitudes, in south-western Cameroon. Author: Achidi EA; Apinjoh TO; Mbunwe E; Besingi R; Yafi C Source: Annals of Tropical Medicine and Parasitology. 2008;102(2):103-118. Abstract: In the many areas where human malaria and helminthiases are co-endemic, schoolchildren often harbour the heaviest infections and suffer much of the associated morbidity, especially when co-infected. In one such area, the Buea district, in south-western Cameroon, two cross-sectional surveys, together covering 263 apparently healthy schoolchildren aged 4-12 years, were recently conducted. The prevalences of fever, malarial parasitaemia and intestinal helminth infections, the seroprevalences of anti-Plasmodium falciparum IgG and IgE and antiglycosylphosphatidylinositol (anti-GPI) IgG, plasma concentrations of total IgE, and the incidence of anaemia were all investigated. The mean (S.D.) age of the study children was 7.56 (1.82) years. Overall, 156 (59.3%) of the children were found parasitaemic, with a geometric mean parasitaemia of 565 parasites/ml. Parasitaemia and fever were significantly associated (P = 0.042). The children who lived at low altitude, attending schools that lay 400-650 m above sealevel, had significantly higher parasitaemias than their high-altitude counterparts (P less than 0.01). At low altitude, the children attending government schools had significantly higher parasitaemias than their mission-school counterparts (P = 0.010). Of the 31 children (11.9%) found anaemic, 22 (70.4%) had mild anaemia and none had severe anaemia. A significant negative correlation (r = -0.224; P = 0.005) was observed between haemoglobin concentration and level of parasitaemia. Infection with Plasmodium appeared to reduce erythrocyte counts (P = 0.045), a condition that was exacerbated by co-infection with helminths (P = 0.035). Plasma concentrations of total IgE were higher in the children found to be excreting helminth eggs than in those who appeared helminth-free, while levels of anti-P. falciparum IgE were higher in the children with low-grade parasitaemias than in those with more intense parasitaemias. Levels of anti-GPI IgG increased with age and were relatively high in the children who lived at lowaltitude and in those who were aparasitaemic. The survey results confirm that asymptomatic malarial parasitaemia frequently co-exists with helminth infections in schoolchildren and indicate links with fever, altitude and school type. Immunoglobulin E may play a role in immune protection against helminthiasis whereas anti-GPI antibodies may be important in the development of antimalarial immunity in such children. In Cameroon, as in other areas with endemic malaria, control programmes to reduce the prevalences of infections with intestinal helminths and malarial parasites in schoolchildren, which may effectively reduce the incidence of anaemia, are clearly needed. (author's) Language: English Keywords: CAMEROON | RESEARCH REPORT | CROSS SECTIONAL ANALYSIS | CHILD | ALTITUDE | INFECTIONS | MORBIDITY | FEVER | MALARIA | SIGNS AND SYMPTOMS | ANEMIA | LABORATORY EXAMINATIONS AND DIAGNOSES | IMMUNOLOGIC FACTORS | Developing Countries | Africa, Western | Africa, Sub Saharan | Africa | Research Methodology | Youth | Age Factors | Population Characteristics | Demographic Factors | Population | Environment | Diseases | Body Temperature | Physiology | Biology | Parasitic Diseases | Examinations and Diagnoses | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Immunity | Immune System Document Number: 325068 |
| 30. Peer Reviewed Title: Predictors of persistent cytologic abnormalities after treatment of cervical intraepithelial neoplasia in Soweto, South Africa: a cohort study in a HIV high prevalence population. Author: Adam Y; van Gelderen CJ; de Bruyn G; McIntyre JA; Turton DA; Martinson NA Source: BMC Cancer. 2008;8:211. Abstract: BACKGROUND: In the presence of both HIV infection and cervical intraepithelial neoplasia (CIN), the risk of cancer development despite treatment may be greater. We investigated clinical predictors of persistent cytological abnormalities in women who had had a large loop excision of the transformation zone (LLETZ). METHODS: Women with high grade squamous intraepithelial lesions or worse (HSIL), less severe abnormalities which persisted and any abnormality in women who are HIV-infected, were referred to the colposcopy clinic. HIV infection was ascertained by self-report. A LLETZ was performed on all patients with HSIL or higher on Papanicolaou (Pap) smear or colposcopy, LSIL or higher in patients who are HIV-infected, where the colposcopy is inadequate, and when there was a discrepancy between colposcopy and cytology by one or more grades. Women with abnormal follow-up smears were compared to those with normal smears. We examined the association between abnormal follow-up smears and demographic and clinical predictors using logistic regression RESULTS: The median time between LLETZ and first follow-up Pap smear was rather short at 122 days. Persistent cytological abnormalities occurred in 49% of our patients after LLETZ. Predictors of persistence included the presence of disease at both margins and HIV infection. Among the latter, disease at the excision margins and CD4+ cell count were important predictors. In these women, disease at the endocervical margin, both margins, and disease only at the ectocervical margin were associated with increased odds of persistent abnormalities on follow-up cervical smear. CONCLUSION: We showed extremely high risk of cytological abnormality at follow-up after treatment more so in patients with incomplete excision and in the presence of immunocompromise. It remains uncertain whether recurrent CIN is a surrogate marker for invasive cervical cancer. Language: English Keywords: SOUTH AFRICA | RESEARCH REPORT | |