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Naidoo K, Khathi A. The Potential Role of Gossypetin in the Treatment of Diabetes Mellitus and Its Associated Complications: A Review. Int J Mol Sci 2023; 24:17609. [PMID: 38139436 PMCID: PMC10743819 DOI: 10.3390/ijms242417609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Revised: 12/14/2023] [Accepted: 12/15/2023] [Indexed: 12/24/2023] Open
Abstract
Type 2 diabetes mellitus (T2DM) is a metabolic disorder caused by insulin resistance and dysfunctional beta (β)-cells in the pancreas. Hyperglycaemia is a characteristic of uncontrolled diabetes which eventually leads to fatal organ system damage. In T2DM, free radicals are continuously produced, causing extensive tissue damage and subsequent macro-and microvascular complications. The standard approach to managing T2DM is pharmacological treatment with anti-diabetic medications. However, patients' adherence to treatment is frequently decreased by the side effects and expense of medications, which has a detrimental impact on their health outcomes. Quercetin, a flavonoid, is a one of the most potent anti-oxidants which ameliorates T2DM. Thus, there is an increased demand to investigate quercetin and its derivatives, as it is hypothesised that similar structured compounds may exhibit similar biological activity. Gossypetin is a hexahydroxylated flavonoid found in the calyx of Hibiscus sabdariffa. Gossypetin has a similar chemical structure to quercetin with an extra hydroxyl group. Furthermore, previous literature has elucidated that gossypetin exhibits neuroprotective, hepatoprotective, reproprotective and nephroprotective properties. The mechanisms underlying gossypetin's therapeutic potential have been linked to its anti-oxidant, anti-inflammatory and immunomodulatory properties. Hence, this review highlights the potential role of gossypetin in the treatment of diabetes and its associated complications.
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Affiliation(s)
| | - Andile Khathi
- Department of Human Physiology, School of Laboratory Medicine and Medical Sciences, University of KwaZulu-Natal, Durban 4000, South Africa;
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Marcus R, C P, Gill K, Smith P, Rouhani S, Mendelsohn A, Mendel E, Lince-Deroche N, Naidoo K, Ahmed N, Stirrup O, Roseleur J, Leuner R, Meyer-Rath G, Bekker LG. Acceptability, feasibility and cost of point of care testing for sexually transmitted infections among South African adolescents where syndromic management is standard of care. BMC Health Serv Res 2023; 23:1078. [PMID: 37817160 PMCID: PMC10566254 DOI: 10.1186/s12913-023-10068-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Accepted: 09/25/2023] [Indexed: 10/12/2023] Open
Abstract
BACKGROUND Young people (YP) in southern Africa are at substantial risk of HIV and sexually transmitted infections (STIs). Despite the epidemiological and biological link between STIs and HIV transmission and acquisition, infections such as Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) remain widely undiagnosed. Syndromic STI management is the standard of care in low- and middle-income countries (LMICs) despite a high prevalence of asymptomatic infections. We conducted an observational study to explore the acceptability, feasibility, and cost of a STI test-and-treat service for YP in Cape Town. METHODS YP attending a mobile clinic (MC) and a youth centre clinic (YC) were offered STI screening. Urine testing for CT and NG using a 90-min molecular point-of-care (POC) test on the GeneXpert platform was conducted and treatment provided. Data were collated on demographics, sexual behaviour, presence of symptoms, uptake of same-day treatment, prevalence of CT/NG, and service acceptability. RESULTS Three hundred sixty six participants were enrolled (median age 20, 83% female).57% (209/366) of participants tested positive for either CT (126/366, 34%) or NG (57/366, 16%) or co-infection (26/366, 7%). Clinical symptoms were a poor predictor of GeneXpert diagnosed CT or NG, with a sensitivity of 46.8% and 54.0% for CT and NG respectively. Although half of participants initially chose to receive same day results and treatment, only a third waited for results on the day. The majority of participants (91%) rated the service highly via a post-visit acceptability questionnaire. CONCLUSION Curable STIs are highly prevalent in this population. STI screening using POC testing was feasible and acceptability was high. The study provides further impetus for moving policy beyond syndromic management of STIs in South Africa.
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Affiliation(s)
- Rebecca Marcus
- Desmond Tutu HIV Centre, University of Cape Town, Cape Town, South Africa.
- North Middlesex University Hospital, London, UK.
| | - Pike C
- Desmond Tutu HIV Centre, University of Cape Town, Cape Town, South Africa
| | - K Gill
- Desmond Tutu HIV Centre, University of Cape Town, Cape Town, South Africa
| | - P Smith
- Desmond Tutu HIV Centre, University of Cape Town, Cape Town, South Africa
| | - S Rouhani
- Desmond Tutu HIV Centre, University of Cape Town, Cape Town, South Africa
| | - A Mendelsohn
- Desmond Tutu HIV Centre, University of Cape Town, Cape Town, South Africa
| | - E Mendel
- Desmond Tutu HIV Centre, University of Cape Town, Cape Town, South Africa
| | - N Lince-Deroche
- Health Economics and Epidemiology Research Office, University of the Witwatersrand, Johannesburg, South Africa
| | - K Naidoo
- Desmond Tutu HIV Centre, University of Cape Town, Cape Town, South Africa
| | - N Ahmed
- Desmond Tutu HIV Centre, University of Cape Town, Cape Town, South Africa
- Mortimer Market Centre, Central North West London NHS Trust, London, UK
| | - O Stirrup
- Institute for Global Health, University College London, London, UK
| | - J Roseleur
- Health Economics and Epidemiology Research Office, University of the Witwatersrand, Johannesburg, South Africa
| | - R Leuner
- Health Economics and Epidemiology Research Office, University of the Witwatersrand, Johannesburg, South Africa
| | - G Meyer-Rath
- Health Economics and Epidemiology Research Office, University of the Witwatersrand, Johannesburg, South Africa
- Department of Global Health, School of Public Health, Boston University, Massachusetts, USA
| | - L G Bekker
- Desmond Tutu HIV Centre, University of Cape Town, Cape Town, South Africa
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Perumal R, Naidoo K, Naidoo A, Padayatchi N. Clinical impact of plasma concentrations of first-line antituberculosis drugs. S Afr Med J 2023; 113:148-153. [PMID: 36876350 PMCID: PMC10613123 DOI: 10.7196/samj.2023.v113i3.16761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Indexed: 03/06/2023] Open
Abstract
BACKGROUND The clinical significance of low antituberculosis (anti-TB) drug concentrations has not been fully elucidated. OBJECTIVES To investigate the clinical consequences of first-line drug concentrations in adult patients with drug-susceptible pulmonary TBin South Africa (SA). METHOD We conducted a pharmacokinetic study nested within the control arm of the Improving Treatment Success (IMPRESS) trial(NCT02114684) in Durban, SA. During the first 2 months of treatment, participants received weight-based dosing of first-line anti-TBdrugs (rifampicin, isoniazid, pyrazinamide and ethambutol), and had plasma drug concentrations measured at 2 and 6 hours after drugadministration during the 8th week of treatment. Intermediate (8 weeks), end-of-treatment (6 months) and follow-up TB outcomes wereassessed using World Health Organization criteria. RESULTS We measured plasma drug concentrations on available samples in 43 participants. Peak drug concentrations were below thetherapeutic range in 39/43 (90.7%) for rifampicin, 32/43 (74.4%) for isoniazid, 27/42 (64.3%) for pyrazinamide and 5/41 (12.2%) forethambutol. At the end of the intensive phase of treatment (week 8), 20.9% (n=9/43) of participants remained culture positive. We did notfind a relationship between the concentrations of first-line drugs and treatment outcomes at week 8. All participants were cured at the endof treatment, and there were no relapses during the 12-month follow-up period. CONCLUSION Treatment outcomes were favourable despite low drug concentrations as defined by current reference thresholds.
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Affiliation(s)
- R Perumal
- Centre for the AIDS Programme of Research in South Africa (CAPRISA), Nelson R Mandela School of Medicine, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa; Medical Research Council-CAPRISA HIV-TB Pathogenesis and Treatment Research Unit, Doris Duke Medical Research Institute, University of KwaZulu-Natal, Durban, South Africa.
| | - K Naidoo
- Centre for the AIDS Programme of Research in South Africa (CAPRISA), Nelson R Mandela School of Medicine, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa; Medical Research Council-CAPRISA HIV-TB Pathogenesis and Treatment Research Unit, Doris Duke Medical Research Institute, University of KwaZulu-Natal, Durban, South Africa.
| | - A Naidoo
- Centre for the AIDS Programme of Research in South Africa (CAPRISA), Nelson R Mandela School of Medicine, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa.
| | - N Padayatchi
- Centre for the AIDS Programme of Research in South Africa (CAPRISA), Nelson R Mandela School of Medicine, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa 2 Medical Research Council-CAPRISA HIV-TB Pathogenesis and Treatment Research Unit, Doris Duke Medical Research Institute, University of KwaZulu-Natal, Durban, South Africa.
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Plön S, Roussouw N, Uren R, Naidoo K, Siebert U, Cliff G, Bouwman H. Elements in muscle tissue of three dolphin species from the east coast of South Africa. Mar Pollut Bull 2023; 188:114707. [PMID: 36860028 DOI: 10.1016/j.marpolbul.2023.114707] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Revised: 02/01/2023] [Accepted: 02/03/2023] [Indexed: 06/18/2023]
Abstract
We investigated elemental concentrations in muscle tissue of three species of dolphins incidentally bycaught off the KwaZulu-Natal coastline, South Africa. Thirty-six major, minor and trace elements were analysed in Indian Ocean humpback dolphin Sousa plumbea (n = 36), Indo-Pacific bottlenose dolphin Tursiops aduncus (n = 32) and the Common dolphin Delphinus delphis (n = 8). Significant differences in concentration between the three species were observed for 11 elements (cadmium, iron, manganese, sodium, platinum, antimony, selenium, strontium, uranium, vanadium and zinc). Mercury concentrations (maximum 29 mg/kg dry mass) were generally higher than those reported for coastal dolphin species found elsewhere. Our results reflect a combination of species differences in habitat, feeding ecology, age, and possibly species physiology and exposure to pollution levels. This study confirms the high organic pollutant concentrations documented previously for these species from the same location, and provides a well-founded case for the need to reduce pollutant sources.
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Affiliation(s)
- S Plön
- Bayworld Centre for Research and Education (BCRE), Port Elizabeth, South Africa; Medical Virology, Institute of Pathology, Stellenbosch University, South Africa.
| | - N Roussouw
- Bayworld Centre for Research and Education (BCRE), Port Elizabeth, South Africa
| | - R Uren
- Research Unit: Environmental Sciences and Management, North-West University, Potchefstroom, South Africa
| | - K Naidoo
- KwaZulu-Natal Sharks Board (KZNSB), Umhlanga Rocks, South Africa
| | - U Siebert
- Institute for Terrestrial and Aquatic Wildlife (ITAW), University of Veterinary Medicine, Hannover, Germany
| | - G Cliff
- KwaZulu-Natal Sharks Board (KZNSB), Umhlanga Rocks, South Africa; School of Life Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - H Bouwman
- Research Unit: Environmental Sciences and Management, North-West University, Potchefstroom, South Africa
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Thomas H, Naidoo K, Engel-Hills P. Resilience from the perspective of diagnostic radiography students. Radiography (Lond) 2023; 29:56-61. [PMID: 36327515 DOI: 10.1016/j.radi.2022.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Revised: 09/30/2022] [Accepted: 10/03/2022] [Indexed: 11/13/2022]
Abstract
INTRODUCTION Resilience is a concept associated with the ability to overcome, adapt, and recover from stressors. The radiography profession is known to be stressful, and one can reason that radiographers must be resilient in order to cope with the clinical environment. Research shows there are varied understandings of resilience. However, little is known about the concept of resilience specifically as it relates to the perspectives of diagnostic radiography students within the clinical workplace. This paper reports on one aspect of a comprehensive study of resilience amongst radiography students. The objective of this paper is, therefore, to present the exploration of the concept of resilience drawing from the data gathered from first-year diagnostic radiography students. METHODS A qualitative, explorative, descriptive and contextual approach was adopted for this study. Qualitative data was collected through focus group interviews. A purposive sampling method was employed, selecting from first-year diagnostic radiography students at a University of Technology (UoT) in the Western Cape, South Africa. Interviews were audio-recorded transcribed and thematically analysed. Data was collected until saturation was reached. RESULTS The meaning of resilience as explained from the perspective of radiography students included three subthemes namely: (1) fundamentals of resilience; (2) external protective factors and (3) internal protective factors. CONCLUSION This study demonstrated that radiography students associated resilience with positive attributes. Furthermore, the study identified various resilience enhancement strategies to better support diagnostic radiography students in the clinical environment like supportive radiographers and talking to peers. IMPLICATIONS FOR PRACTICE The identification of resilience enhancement strategies is important as it will assist with the introduction of curriculum renewal initiatives tailored to support first-year diagnostic radiography students as they develop their resilience to stressors in the clinical environment.
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Affiliation(s)
- H Thomas
- Cape Peninsula University of Technology, Medical Imaging and Therapeutic Sciences, Bellville, 7530, South Africa.
| | - K Naidoo
- Cape Peninsula University of Technology, Medical Imaging and Therapeutic Sciences, Bellville, 7530, South Africa
| | - P Engel-Hills
- Cape Peninsula University of Technology, Medical Imaging and Therapeutic Sciences, Bellville, 7530, South Africa
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Repana D, Shanmugalingam T, Gerrard G, Foot N, Kulkarni A, Naidoo K, Talukdar S, Snape K, Hanson H, Quigley K, Mokretar K, Du Parcq P, Ferguson B, Sarker D, Murugaesu N. 31P Liquid biopsies in clinical practice. Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.09.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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7
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Roussouw N, van Vliet T, Naidoo K, Rossouw G, Plön S. Histomorphological stratification of blubber of three dolphin species from sub-tropical waters. J Morphol 2022; 283:1411-1424. [PMID: 36059247 DOI: 10.1002/jmor.21511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Revised: 08/11/2022] [Accepted: 08/24/2022] [Indexed: 11/11/2022]
Abstract
Blubber is a highly specialised and dynamic tissue unique to marine mammals and presents a reflection of the individuals' nutrition, environment, and life history traits. Few studies have investigated the histomorphology of cetacean blubber in sub-tropical environments. The aim of this study was to investigate the blubber histomorphology of three different dolphin species off the sub-tropical KwaZulu-Natal coast, South Africa, using adipocyte cell size, number and density. Blubber tissue samples from the saddle area of 43 incidentally bycaught animals (4 Sousa plumbea, 36 Tursiops aduncus and 3 Delphinus delphis) were used to compare cell parameters between blubber layers. Samples were divided into upper third (corresponding to the superficial layer closest to the epidermis), middle third, and lower third (corresponding to the deep layer). For T. aduncus, factors potentially affecting blubber histomorphology, such as sex, age class and season, were also assessed. Our results showed that no stratification was present in S. plumbea, which could be ascribed to the species' warmer inshore habitat, large body size and apparent lower mobility. For T. aduncus and D. capensis, however, blubber stratification was determined, characterised by a gradual transition of cell size, number and density between layers rather than clearly defined layers. Significant differences in adipocyte cell number and density were found for different sexes and age classes of T. aduncus. However, there were no significant differences between seasons, which was attributed to the small temperature differences between seasons. This study represents the first investigation on odontocete blubber histomorphology in subtropical waters. It is recommended that future studies investigate blubber lipid content, while also taking into consideration the reproductive status of the females and the temperature range of their study area. It is hoped that our results, in conjunction with histopathology and other health indicators, could assist in assessing health and body condition. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- N Roussouw
- Bayworld Centre for Research and Education (BCRE), Port Elizabeth, South Africa
| | - T van Vliet
- Nelson Mandela University, Port Elizabeth, South Africa
| | - K Naidoo
- Research and Monitoring Division, KwaZulu-Natal Sharks Board (KZNSB), Umhlanga, KwaZulu-Natal, South Africa
| | - G Rossouw
- Nelson Mandela University, Port Elizabeth, South Africa
| | - S Plön
- Bayworld Centre for Research and Education (BCRE), Port Elizabeth, South Africa.,Department of Pathology, Stellenbosch University, South Africa
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Naidoo K, Ramruthan J, Reddy M, Reddy M, Lancaster R. A third-line antiretroviral therapy register to track patient clinical and virological outcomes. S Afr Med J 2022; 112:511. [PMID: 36214397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Indexed: 06/16/2023] Open
Abstract
In 2021, South Africa (SA) had an estimated 7.8 million people living with HIV, of whom 5.6 million were receiving antiretroviral therapy (ART),[1] with 3.4 million on first-line ART, 145 000 on second-line ART (SLART) and >700 on third-line ART (TLART).
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Affiliation(s)
- K Naidoo
- Centre for the AIDS Programme of Research in South Africa (CAPRISA), Durban, South Africa; MRC-CAPRISA HIV-TB Pathogenesis and Treatment Research Unit, Doris Duke Medical Research Institute, University of KwaZulu-Natal, Durban, South Africa.
| | - J Ramruthan
- Centre for the AIDS Programme of Research in South Africa (CAPRISA), Durban, South Africa.
| | - M Reddy
- Essential Medicine Consulting, Durban, South Africa.
| | - M Reddy
- Essential Medicine Consulting, Durban, South Africa.
| | - R Lancaster
- Essential Drugs Programme, Affordable Medicines Directorate, National Department of Health, Pretoria, South Africa.
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Perumal R, Arodola-Oladoyinbo O, Naidoo A, Kawuma AN, Naidoo K, Gengiah TN, Chirehwa M, Padayatchi N, Denti P. Altered drug exposures of first-line TB drugs in a moxifloxacin-containing treatment regimen. Int J Tuberc Lung Dis 2022; 26:766-774. [PMID: 35898135 DOI: 10.5588/ijtld.21.0702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND: Pharmacokinetic variability arising from drug-drug interactions and pharmacogenetics may influence the effectiveness of treatment regimens for TB. The Improving Treatment Success Trial compared the WHO-recommended standard treatment in TB patients with an experimental regimen substituting ethambutol with moxifloxacin (MFX) in Durban, South Africa.METHODS: Non-linear mixed-effects modelling was used to investigate the population pharmacokinetics of rifampicin (RIF), isoniazid (INH) and pyrazinamide (PZA). A total of 25 single-nucleotide polymorphisms, including pregnane-X-receptor, were selected for analysis.RESULTS: TB drug concentrations were available in a subset of 101 patients: 58 in the MFX arm and 43 in the control arm. Baseline characteristics were well-balanced between study arms: median age and weight were respectively 36 years and 57.7 kg; 75.2% of the patients were living with HIV. Although weight-based drug dosing was the same in the two arms, we found that RIF exposure was increased by 19.3%, INH decreased by 19% and PZA decreased by 19.2% when administered as part of the MFX-containing regimen. Genetic variation in pregnane-X-receptor (rs2472677) was associated with a 25.3% reduction in RIF exposure.CONCLUSION: Optimised weight-based TB treatment dosing is essential when RIF, INH and PZA are co-administered with fluoroquinolones. The reduction in RIF exposure associated with pharmacogenetic variation is worrying.
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Affiliation(s)
- R Perumal
- Centre for the AIDS Programme of Research in South Africa, Nelson R Mandela School of Medicine, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa, South African Medical Research Council-Centre for the AIDS Programme of Research in South Africa HIV-TB Pathogenesis and Treatment Research Unit, Doris Duke Medical Research Institute, University of KwaZulu-Natal, Durban, South Africa
| | - O Arodola-Oladoyinbo
- Division of Clinical Pharmacology, Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - A Naidoo
- Centre for the AIDS Programme of Research in South Africa, Nelson R Mandela School of Medicine, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa, South African Medical Research Council-Centre for the AIDS Programme of Research in South Africa HIV-TB Pathogenesis and Treatment Research Unit, Doris Duke Medical Research Institute, University of KwaZulu-Natal, Durban, South Africa
| | - A N Kawuma
- Division of Clinical Pharmacology, Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - K Naidoo
- Centre for the AIDS Programme of Research in South Africa, Nelson R Mandela School of Medicine, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa, South African Medical Research Council-Centre for the AIDS Programme of Research in South Africa HIV-TB Pathogenesis and Treatment Research Unit, Doris Duke Medical Research Institute, University of KwaZulu-Natal, Durban, South Africa
| | - T N Gengiah
- Centre for the AIDS Programme of Research in South Africa, Nelson R Mandela School of Medicine, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa, South African Medical Research Council-Centre for the AIDS Programme of Research in South Africa HIV-TB Pathogenesis and Treatment Research Unit, Doris Duke Medical Research Institute, University of KwaZulu-Natal, Durban, South Africa
| | - M Chirehwa
- Division of Clinical Pharmacology, Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - N Padayatchi
- Centre for the AIDS Programme of Research in South Africa, Nelson R Mandela School of Medicine, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa, South African Medical Research Council-Centre for the AIDS Programme of Research in South Africa HIV-TB Pathogenesis and Treatment Research Unit, Doris Duke Medical Research Institute, University of KwaZulu-Natal, Durban, South Africa
| | - P Denti
- Division of Clinical Pharmacology, Department of Medicine, University of Cape Town, Cape Town, South Africa
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Hudson L, Engel-Hills P, Davidson F, Naidoo K. Radiography lecturers' understanding of a socially responsive curriculum. Radiography (Lond) 2022; 28:684-689. [PMID: 35724473 DOI: 10.1016/j.radi.2022.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2022] [Revised: 05/03/2022] [Accepted: 06/03/2022] [Indexed: 10/18/2022]
Abstract
INTRODUCTION In health professions education (HPE), focus is placed on developing clinically competent practitioners who can function within their professional scope in a broad range of health care contexts. In this study, the authors investigated diagnostic radiography lecturers' understanding of how students become socially responsive. The concept of 'critical consciousness' was explored as an intervention of being a transformer in the local environment. This places focus on learning and teaching that aims to develop radiography graduates who are critically conscious, such that they can take up the challenges of healthcare in their environment, in addition to being clinically competent in their field. The study under discussion therefore sought to find out how radiography lecturers understand a socially responsive curriculum at a University of Technology in the South African context. METHOD A qualitative, exploratory design was used where curriculum documents were reviewed and from which stimulus points were identified for a semi-structured focus group interview with radiography lecturers followed by five individual interviews. All interviews were audio-recorded, transcribed, coded and analysed through a process of thematic analysis. RESULTS Four dominant themes emerged from the analysis, namely i) diverse understandings of critical consciousness, ii) becoming a reflective practitioner, iii) a need for curriculum transformation and iv) emerging pedagogies. CONCLUSION Critical reflection by both the radiography students and lecturers is key to developing social awareness and critical consciousness which could drive critical motivation and critical action to effect social change. It is recommended that the current curriculum should be reviewed and transformed to include constructive reflective practice. IMPLICATIONS FOR PRACTICE Dedicated time should be scheduled, in the curriculum, to allow students and lecturers to engage in meaningful constructive reflection to enhance socially responsive practice.
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Affiliation(s)
- L Hudson
- Faculty of Health and Wellness Sciences, Cape Peninsula University of Technology, Office H041, Ground Floor, New Science Building, Bellville Campus, Robert Sobukwe Road, Bellville 7530, South Africa.
| | - P Engel-Hills
- Faculty of Health and Wellness Sciences & Professional Education Research Institute, Cape Peninsula University of Technology, Bellville Campus, PO Box 1906, Bellville 7535, South Africa.
| | - F Davidson
- Department of Medical Imaging and Therapeutic Sciences, Cape Peninsula University of Technology, New Health Science Building, Bellville Campus, PO Box 1906, Bellville 7535, South Africa.
| | - K Naidoo
- Department of Medical Imaging and Therapeutic Sciences, Cape Peninsula University of Technology, New Health Science Building, Bellville Campus, PO Box 1906, Bellville 7535, South Africa.
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Naidoo K, Spijkerman S, Wyngaard J, De Menezes-Williams H, Janse van Rensburg C. A cross-sectional observational study of endotracheal intubation and extubation practices among doctors treating adult COVID-19 and suspected COVID-19 patients in South Africa. S Afr Med J 2022; 112:13517. [PMID: 35140003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Accepted: 02/02/2022] [Indexed: 06/14/2023] Open
Abstract
BACKGROUND Patients with severe COVID-19 may require endotracheal intubation. Unique adjustments to endotracheal intubation and extubation practices are necessary to decrease the risk of SARS-CoV-2 transmission to healthcare workers (HCWs) while avoiding complications of airway management. OBJECTIVES To investigate the practice of endotracheal intubation and extubation, resources available and complications encountered by clinicians performing endotracheal intubation and extubation of COVID-19 and suspected COVID-19 patients in South Africa (SA). METHOD A cross-sectional observational study was conducted during the initial surge of COVID-19 cases in SA. Data were collected by means of a self-administered questionnaire completed by clinicians in the private and public healthcare sectors after performing an endotracheal intubation and/or extubation of a patient with confirmed or suspected COVID-19. RESULTS Data from 135 endotracheal intubations and 45 extubations were collected. Anaesthetists accounted for 87.0% (n=120) of the study participants, specialist clinicians in their respective fields for 59.4% (n=82), and public HCWs for 71.0% (n=98). Cases from Gauteng Province made up 76.8% (n=106) of the database. Haemoglobin desaturation was the most frequent complication encountered during endotracheal intubation (40.0%; n=54). Endotracheal intubations performed at private healthcare institutions were associated with a significantly lower complication rate of 17.5% (n=7) compared with 52.6% (n=50) in the public healthcare sector (p<0.001). Endotracheal intubations performed in theatre had the lowest complication rate of 10.4% (n=5; p<0.001). Propofol was used in 90 endotracheal intubations (66.7%), and its use was associated with fewer complications relative to other induction agents. Minimising the number of intubation attempts (p=0.009) and the use of checklists (p=0.013) significantly reduced the frequency of complications encountered during endotracheal intubation. Intravenous induction technique, neuromuscular blocking agent used, intubating device used and time at which intubation was performed did not affect the incidence of complications. The majority of endotracheal extubations were uncomplicated (88.9%). CONCLUSIONS The study provides valuable insight into the resources used by clinicians and complications encountered when endotracheal intubations and/or extubations were performed. Data from this study may be used to guide future clinical practice and research, especially in resource-limited settings.
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Affiliation(s)
- K Naidoo
- Department of Anaesthesiology, School of Medicine, Faculty of Health Sciences, University of Pretoria, South Africa.
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12
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Naidoo K, Ngubane PS, Khathi A. Investigating the Effects of Diet-Induced Pre-Diabetes on the Functioning of Calcium-Regulating Organs in Male Sprague Dawley Rats: Effects on Selected Markers. Front Endocrinol (Lausanne) 2022; 13:914189. [PMID: 35898447 PMCID: PMC9309376 DOI: 10.3389/fendo.2022.914189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Accepted: 06/10/2022] [Indexed: 11/13/2022] Open
Abstract
Derangements to the functioning of calcium-regulating organs have been associated with type 2 diabetes mellitus (T2DM), a condition preceded by pre-diabetes. Type 2 diabetes has shown to promote renal calcium wastage, intestinal calcium malabsorption and increased bone resorption. However, the changes to the functioning of calcium-regulating organs in pre-diabetes are not known. Subsequently, the effects of diet-induced pre-diabetes on the functioning of calcium-regulating organs in a rat model for pre-diabetes was investigated in this study. Male Sprague Dawley rats were separated into two groups (n=6, each group): non-pre-diabetic (NPD) group and a diet-induced pre-diabetic (DIPD) group for 20 weeks. After the experimental period, postprandial glucose and HOMA-IR were analysed in addition to plasma and urinary calcium concentrations. Gene expressions of intestinal vitamin D (VDR), intestinal calbindin-D9k, renal 1-alpha hydroxylase and renal transient receptor potential vanilloid 5 (TRPV5) expressions in addition to plasma osteocalcin and urinary deoxypyridinoline concentrations were analysed at week 20. The results demonstrated significantly increased concentrations of postprandial glucose, HOMA-IR and urinary calcium in addition to unchanged plasma calcium levels in the DIPD group by comparison to NPD. Renal TRPV5, renal 1-alpha hydroxylase, intestinal VDR and intestinal calbindin-D9k expressions were increased in the DIPD group by comparison to NPD. Furthermore, plasma osteocalcin levels were increased and urine deoxypyridinoline levels were decreased in the DIPD group by comparison to NPD. These observations may suggest that calcium-regulating organs compensate for the changes to calcium homeostasis by inducing increased renal calcium reabsorption, increased intestinal calcium absorption and decreased bone resorption followed by increased bone formation.
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Dapaah G, Hille J, Whittaker J, Dittrich CM, Ebrahim AK, Merven M, Naidoo K, Loock J, Afrogheh A. THE PREVALENCE OF HPV POSITIVE OROPHARYNGEAL SQUAMOUS CELL CARCINOMA AT A MAJOR REFERRAL CENTER IN SOUTHERN AFRICA. Oral Surg Oral Med Oral Pathol Oral Radiol 2021. [DOI: 10.1016/j.oooo.2021.03.068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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14
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Padayatchi N, Bionghi N, Osman F, Naidu N, Ndjeka N, Master I, Brust JCM, Naidoo K, Ramjee A, O Donnell M. Treatment outcomes in patients with drug-resistant TB-HIV co-infection treated with bedaquiline and linezolid. Int J Tuberc Lung Dis 2021; 24:1024-1031. [PMID: 33126934 DOI: 10.5588/ijtld.20.0048] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND: Bedaquiline (BDQ) has not been extensively studied among patients co-infected with HIV drug-resistant tuberculosis (DR-TB). We compared treatment outcomes in DR-TB patients treated with BDQ- and linezolid (LZD) containing regimens to historic controls treated with second-line injectable-containing regimens.METHODS: Retrospective cohort study of consecutive DR-TB patients initiated on BDQ- and LZD-containing regimens at a TB referral hospital in KwaZulu-Natal, South Africa. Participants were prospectively followed through 24 months for treatment outcome and adverse events. Outcomes were compared to a historic control cohort of DR-TB HIV patients enrolled at the same facility prior to BDQ introduction.RESULTS: Adult DR-TB patients initiating BDQ between January 2014 and November 2015 were enrolled (n = 151). The majority of patients were female (52%), HIV co-infected (77%) and on antiretroviral therapy (100%). End of treatment outcomes included cure (63%), TB culture conversion (83%), completion (0.7%), loss to follow-up (15%), treatment failure (5%), and death (17%). Compared to historic controls (n = 105), patients treated with BDQ experienced significantly higher TB culture conversion and cure, with significantly lower mortality. Adverse effects were common (92%), and most frequently attributed to LZD (24.1%). QT segment prolongation was common but without clinical sequelae.CONCLUSION: Treatment with BDQ- and LZD-containing regimens was associated with improved treatment outcomes and survival in DR-TB HIV patients.
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Affiliation(s)
- N Padayatchi
- Centre for the AIDS Programme of Research in South Africa, Nelson R Mandela School of Medicine, College of Health Sciences, Medical Research Council-Centre for the AIDS Program of Research in South Africa HIV-TB Pathogenesis and Treatment Research Unit, Doris Duke Medical Research Institute, University of KwaZulu-Natal, Congella, South Africa
| | - N Bionghi
- Columbia University College of Physicians and Surgeons, New York, NY, USA
| | - F Osman
- Centre for the AIDS Programme of Research in South Africa, Nelson R Mandela School of Medicine, College of Health Sciences, Medical Research Council-Centre for the AIDS Program of Research in South Africa HIV-TB Pathogenesis and Treatment Research Unit, Doris Duke Medical Research Institute, University of KwaZulu-Natal, Congella, South Africa
| | - N Naidu
- Centre for the AIDS Programme of Research in South Africa, Nelson R Mandela School of Medicine, College of Health Sciences, Medical Research Council-Centre for the AIDS Program of Research in South Africa HIV-TB Pathogenesis and Treatment Research Unit, Doris Duke Medical Research Institute, University of KwaZulu-Natal, Congella, South Africa
| | - N Ndjeka
- National TB Programme, South African National Department of Health, Pretoria
| | - I Master
- King DinuZulu Medical Complex, Sydenham, South Africa
| | - J C M Brust
- Divisions of General Internal Medicine and Infectious Diseases, Albert Einstein College of Medicine & Montefiore Medical Center, Bronx, NY
| | - K Naidoo
- Centre for the AIDS Programme of Research in South Africa, Nelson R Mandela School of Medicine, College of Health Sciences, Medical Research Council-Centre for the AIDS Program of Research in South Africa HIV-TB Pathogenesis and Treatment Research Unit, Doris Duke Medical Research Institute, University of KwaZulu-Natal, Congella, South Africa
| | - A Ramjee
- Centre for the AIDS Programme of Research in South Africa, Nelson R Mandela School of Medicine, College of Health Sciences, Medical Research Council-Centre for the AIDS Program of Research in South Africa HIV-TB Pathogenesis and Treatment Research Unit, Doris Duke Medical Research Institute, University of KwaZulu-Natal, Congella, South Africa
| | - M O Donnell
- Centre for the AIDS Programme of Research in South Africa, Nelson R Mandela School of Medicine, College of Health Sciences, Medical Research Council-Centre for the AIDS Program of Research in South Africa HIV-TB Pathogenesis and Treatment Research Unit, Doris Duke Medical Research Institute, University of KwaZulu-Natal, Congella, South Africa, Division of Pulmonary, Allergy, and Critical Care Medicine, Columbia University Medical Center, New York, NY, Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
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15
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Langton AK, Ayer J, Griffiths TW, Rashdan E, Naidoo K, Caley MP, Birch-Machin MA, O'Toole EA, Watson REB, Griffiths CEM. Distinctive clinical and histological characteristics of atrophic and hypertrophic facial photoageing. J Eur Acad Dermatol Venereol 2020; 35:762-768. [PMID: 33275818 PMCID: PMC7986784 DOI: 10.1111/jdv.17063] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Accepted: 10/27/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND Photoageing describes complex cutaneous changes which occur following chronic exposure to solar ultraviolet radiation (UVR). Amongst White Northern Europeans, facial photoageing appears as distinct clinical phenotypes: 'hypertrophic' photoageing (HP) and 'atrophic' photoageing (AP). Deep, coarse wrinkles predominate in individuals with HP, whereas those with AP have relatively smooth, unwrinkled skin with pronounced telangiectasia. AP individuals have an increased propensity for developing keratinocyte cancers. OBJECTIVES To investigate whether histological differences underlie these distinct phenotypes of facial photoageing. METHODS Facial skin biopsies were obtained from participants with AP (10 M, 10 F; mean age: 78.7 years) or HP (10 M, 10 F; mean age: 74.5 years) and were assessed histologically and by immunohistochemistry. RESULTS Demographic characterization revealed 95% of AP subjects, as compared to 35% with HP, were Fitzpatrick skin type I/II; of these, 50% had a history of one or more keratinocyte cancers. There was no history of keratinocyte cancers in the HP cohort. Analysis of UVR-induced mitochondrial DNA damage confirmed that all volunteers had received similar lifetime cumulative doses of sun exposure. Histologically, male AP had a significantly thicker epidermis than did AP females or those of either sex with HP. HP facial skin exhibited severe solar elastosis, whereas in AP facial skin, solar elastosis was apparent only in females. Loss of papillary dermal fibrillin-rich microfibrils occurred in all HP and AP female subjects, but not in AP males. Furthermore, male AP had a significant reduction in collagen VII at the dermal-epidermal junction than did AP females or those of either sex with HP. CONCLUSIONS This study provides further evidence that AP and HP represent distinct clinical and histological entities. Knowledge of these two phenotypes is clinically relevant due to the increased prevalence of keratinocyte cancers in those - particularly males - with the AP phenotype.
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Affiliation(s)
- A K Langton
- Centre for Dermatology Research, The University of Manchester & Salford Royal NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK.,NIHR Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
| | - J Ayer
- Centre for Dermatology Research, The University of Manchester & Salford Royal NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
| | - T W Griffiths
- Centre for Dermatology Research, The University of Manchester & Salford Royal NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
| | - E Rashdan
- Dermatological Sciences, Translational and Clinical Research Institute, Medical School, Newcastle University, Newcastle upon Tyne, UK
| | - K Naidoo
- Dermatological Sciences, Translational and Clinical Research Institute, Medical School, Newcastle University, Newcastle upon Tyne, UK.,Dermatology Department, James Cook University Hospital, Middlesbrough, UK
| | - M P Caley
- Centre for Cell Biology and Cutaneous Research, Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - M A Birch-Machin
- Dermatological Sciences, Translational and Clinical Research Institute, Medical School, Newcastle University, Newcastle upon Tyne, UK
| | - E A O'Toole
- Centre for Cell Biology and Cutaneous Research, Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - R E B Watson
- Centre for Dermatology Research, The University of Manchester & Salford Royal NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK.,NIHR Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
| | - C E M Griffiths
- Centre for Dermatology Research, The University of Manchester & Salford Royal NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK.,NIHR Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
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16
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Sunpath H, Hatlen TJ, Moosa MYS, Murphy RA, Siedner M, Naidoo K. Urgent need to improve programmatic management of patients with HIV failing first-line antiretroviral therapy. Public Health Action 2020; 10:163-168. [PMID: 33437682 DOI: 10.5588/pha.20.0052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Accepted: 11/04/2020] [Indexed: 11/10/2022] Open
Abstract
Introduction Delayed identification and response to virologic failure in case of first-line antiretroviral therapy (ART) in resource-limited settings is a threat to the health of HIV-infected patients. There is a need for the implementation of an effective, standardized response pathway in the public sector. Discussion We evaluated published cohorts describing virologic failure on first-line ART. We focused on gaps in the detection and management of treatment failure, and posited ways to close these gaps, keeping in mind scalability and standardization. Specific shortcomings repeatedly recorded included early loss to follow-up (>20%) after recognized first-line ART virologic failure; frequent delays in confirmatory viral load testing; and excessive time between the confirmation of first-line ART failure and initiation of second-line ART, which exceeded 1 year in some cases. Strategies emphasizing patient tracing, resistance testing, drug concentration monitoring, adherence interventions, and streamlined response pathways for those failing therapy are further discussed. Conclusion Comprehensive, evidence-based, clinical operational plans must be devised based on findings from existing research and further tested through implementation science research. Until this standard of evidence is available and implemented, high rates of losses from delays in appropriate switch to second-line ART will remain unacceptably common and a threat to the success of global HIV treatment programs.
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Affiliation(s)
- H Sunpath
- Centre for AIDS Program of Research, University of KwaZulu-Natal, Durban.,Infectious Diseases Unit, Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa
| | - T J Hatlen
- Division of HIV, Lundquist Institute for Biomedical Innovation at Harbor-University of California Los Angeles Medical Center, Torrance, CA
| | - M-Y S Moosa
- Infectious Diseases Unit, Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa
| | - R A Murphy
- Division of Infectious Diseases, Lundquist Institute for Biomedical Innovation at Harbor-University of California Los Angeles Medical Center, Torrance, CA
| | - M Siedner
- Massachusetts General Hospital, Boston, MA, USA
| | - K Naidoo
- Centre for AIDS Program of Research, University of KwaZulu-Natal, Durban.,HIV-TB Pathogenesis and Treatment Research Unit, Medical Research Council-Centre for the AIDS Programme of Research in South Africa, Doris Duke Medical Research Institute, University of KwaZulu-Natal, Durban, South Africa
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Perumal R, Naidoo K, Naidoo A, Ramachandran G, Requena-Mendez A, Sekaggya-Wiltshire C, Mpagama SG, Matteelli A, Fehr J, Heysell SK, Padayatchi N. A systematic review and meta-analysis of first-line tuberculosis drug concentrations and treatment outcomes. Int J Tuberc Lung Dis 2020; 24:48-64. [PMID: 32005307 PMCID: PMC10622255 DOI: 10.5588/ijtld.19.0025] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Low serum concentrations of first-line tuberculosis (TB) drugs have been widely reported. However, the impact of low serum concentrations on treatment outcome is less well studied. A systematic search of MEDLINE/Pubmed and the Cochrane Central Register of Controlled Trials up to 31 March 2018 was conducted for articles describing drug concentrations of first-line TB drugs and treatment outcome in adult patients with drug-susceptible TB. The search identified 3073 unique publication abstracts, which were reviewed for suitability: 21 articles were acceptable for inclusion in the qualitative analysis comprising 13 prospective observational cohorts, 4 retrospective observational cohorts, 1 case-control study and 3 randomised controlled trials. Data for meta-analysis were available for 15 studies, 13 studies of rifampicin (RMP), 10 of isoniazid (INH), 8 of pyrazinamide (PZA) and 4 of ethambutol (EMB). This meta-analysis revealed that low PZA concentration appears to increase the risk of poor outcomes (8 studies, n = 2727; RR 1.73, 95%CI 1.10-2.72), low RMP concentrations may slightly increase the risk of poor outcomes (13 studies, n = 2753; RR 1.40, 95%CI 0.91-2.16), whereas low concentrations of INH (10 studies, n = 2640; RR 1.32, 95%CI 0.66-2.63) and EMB (4 studies, n = 551; RR 1.12, 95%CI 0.41-3.05) appear to make no difference to treatment outcome. There was no significant publication bias or between-study heterogeneity in any of the analyses. The potential clinical impact of low concentrations of PZA and RMP warrants further evaluation. Also, comprehensive assessments of the complex pharmacokinetic-pharmacodynamic relationships in the treatment of TB are urgently needed.
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Affiliation(s)
- R Perumal
- Centre for the AIDS Programme of Research in South Africa, Nelson R Mandela School of Medicine, College of Health Sciences, Medical Research Council-CAPRISA HIV-TB Pathogenesis and Treatment Research Unit, Doris Duke Medical Research Institute, University of KwaZulu-Natal, Durban, Department of Pulmonology and Critical Care, Groote Schuur Hospital, University of Cape Town, South Africa
| | - K Naidoo
- Centre for the AIDS Programme of Research in South Africa, Nelson R Mandela School of Medicine, College of Health Sciences, Department of Pulmonology and Critical Care, Groote Schuur Hospital, University of Cape Town, South Africa
| | - A Naidoo
- Centre for the AIDS Programme of Research in South Africa, Nelson R Mandela School of Medicine, College of Health Sciences
| | - G Ramachandran
- Department of Biochemistry and Clinical Pharmacology, National Institute for Research in Tuberculosis, Chennai, India
| | - A Requena-Mendez
- Infectious Diseases Institute, College of Health Sciences, Makerere University, Uganda
| | | | | | - A Matteelli
- Kibong'oto Infectious Diseases Hospital, Siha, Kilimanjaro, Tanzania
| | - J Fehr
- Department of Infectious and Tropical Diseases, WHO Collaborating Centre for TB/HIV and TB Elimination, University of Brescia, Brescia, Italy
| | - S K Heysell
- Department of Public Health, Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Switzerland
| | - N Padayatchi
- Centre for the AIDS Programme of Research in South Africa, Nelson R Mandela School of Medicine, College of Health Sciences, Department of Pulmonology and Critical Care, Groote Schuur Hospital, University of Cape Town, South Africa
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Rolls S, Chowdhury MM, Cooper S, Cousen P, Flynn AM, Ghaffar SA, Green CM, Haworth A, Holden C, Johnston GA, Naidoo K, Orton DI, Reckling C, Sabroe RA, Scorer M, Stone NM, Thompson D, Wakelin S, Wilkinson M, Buckley DA. Recommendation to include hydroxyethyl (meth)acrylate in the British baseline patch test series. Br J Dermatol 2019; 181:811-817. [PMID: 30703264 DOI: 10.1111/bjd.17708] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/25/2019] [Indexed: 12/25/2022]
Abstract
BACKGROUND (Meth)acrylates are potent sensitizers and a common cause of allergic contact dermatitis (ACD). The frequency of (meth)acrylate ACD has increased with soaring demand for acrylic nails. A preliminary audit has suggested a significant rate of positive patch tests to (meth)acrylates using aimed testing in patients providing a clear history of exposure. To date, (meth)acrylates have not been routinely tested in the baseline patch test series in the U.K. and Europe. OBJECTIVES To determine whether inclusion of 2-hydroxyethyl methacrylate (2-HEMA) 2% in petrolatum (pet.) in the baseline series detects cases of treatable (meth)acrylate ACD. METHODS During 2016-2017, 15 U.K. dermatology centres included 2-HEMA in the extended baseline patch test series. Patients with a history of (meth)acrylate exposure, or who tested positive to 2-HEMA, were selectively tested with a short series of eight (meth)acrylate allergens. RESULTS In total 5920 patients were consecutively patch tested with the baseline series, of whom 669 were also tested with the (meth)acrylate series. Overall, 102 of 5920 (1·7%) tested positive to 2-HEMA and 140 (2·4%) to at least one (meth)acrylate. Had 2-HEMA been excluded from the baseline series, (meth)acrylate allergy would have been missed in 36 of 5920 (0·6% of all patients). The top (meth)acrylates eliciting a positive reaction were 2-HEMA (n = 102, 1·7%), 2-hydroxypropyl methacrylate (n = 61, 1·0%) and 2-hydroxyethyl acrylate (n = 57, 1·0%). CONCLUSIONS We recommend that 2-HEMA 2% pet. be added to the British baseline patch test series. We also suggest a standardized short (meth)acrylate series, which is likely to detect most cases of (meth)acrylate allergy.
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Affiliation(s)
- S Rolls
- Royal United Hospital Bath, Bath, U.K
| | | | - S Cooper
- Oxford University Hospital, Oxford, U.K
| | - P Cousen
- South Tees Hospital NHS Foundation Trust, Middlesbrough, U.K
| | - A M Flynn
- South Infirmary Victoria University Hospital, Cork, Ireland
| | | | | | - A Haworth
- Portsmouth Hospital NHS Trust, Portsmouth, U.K
| | - C Holden
- Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, U.K
| | | | - K Naidoo
- South Tees Hospital NHS Foundation Trust, Middlesbrough, U.K
| | | | - C Reckling
- Kent and Canterbury Hospital, Canterbury, U.K
| | - R A Sabroe
- Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, U.K
| | - M Scorer
- Leicester Royal Infirmary, Leicester, U.K
| | - N M Stone
- Royal Gwent and Nevill Hall Hospitals, Newport, U.K
| | - D Thompson
- Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, U.K
| | - S Wakelin
- Imperial College Healthcare NHS Trust, London, U.K
| | - M Wilkinson
- Leeds Teaching Hospital NHS Trust, Leeds, U.K
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Rolls S, Chowdhury M, Cooper S, Cousen P, Flynn A, Ghaffar S, Green C, Haworth A, Holden C, Johnston G, Naidoo K, Orton D, Reckling C, Sabroe R, Scorer M, Stone N, Thompson D, Wakelin S, Wilkinson M, Buckley D. Patch testing hydroxyethyl (meth)acrylate. Br J Dermatol 2019. [DOI: 10.1111/bjd.18395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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20
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Rolls S, Chowdhury M, Cooper S, Cousen P, Flynn A, Ghaffar S, Green C, Haworth A, Holden C, Johnston G, Naidoo K, Orton D, Reckling C, Sabroe R, Scorer M, Stone N, Thompson D, Wakelin S, Wilkinson M, Buckley D. 羟乙基(甲基)丙烯酸酯斑贴测试. Br J Dermatol 2019. [DOI: 10.1111/bjd.18406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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21
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Thomas L, Naidoo K, Darné S. Zinc deficiency and severe protein-energy malnutrition in a child with atopic eczema. Clin Exp Dermatol 2019; 44:215-217. [DOI: 10.1111/ced.13634] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/05/2017] [Indexed: 11/27/2022]
Affiliation(s)
- L. Thomas
- Department of Dermatology; The James Cook University Hospital; Middlesbrough North Yorkshire UK
| | - K. Naidoo
- Department of Dermatology; The James Cook University Hospital; Middlesbrough North Yorkshire UK
| | - S. Darné
- Department of Dermatology; The James Cook University Hospital; Middlesbrough North Yorkshire UK
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22
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Sunpath H, Hatlen TJ, Naidu KK, Msimango P, Adams RN, Moosa MYS, Marconi VC, Murphy RA, Gandhi RT, Pillay S, Siedner M, Naidoo K. Targeting the third '90': introducing the viral load champion. Public Health Action 2018; 8:225-231. [PMID: 30775284 DOI: 10.5588/pha.18.0063] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2018] [Accepted: 11/05/2018] [Indexed: 11/10/2022] Open
Abstract
Objective: To move closer to achieving the third target of the UNAIDS 90-90-90 goals, we prospectively implemented a viral load (VL) champion (VLC) program aimed at enhancing VL monitoring and recognition of treatment failure. Design: Three clinics in eThekwini, Kwa-Zulu Natal (low-, medium- and high-volume, encompassing 9184 patients overall) were each assigned a VLC. We employed a descriptive analysis (chart audit) to compare the pre-intervention period to a 1-year post-intervention period. The number of patients with a VL test performed 6 and 12 months after the intervention was calculated as a proportion of VL tests due at those time points (VL completion rate). Results: The pre-implementation VL completion rate at the three sites was respectively 68% (140/205 patients), 54% (84/155 patients) and 64% (323/504 patients), and the 6-month post-implementation completion rate increased to 83% (995/1194 patients), 90% (793/878 patients) and 99% (3101/3124 patients) (P < 0.0001 for each site). VL completion rates remained significantly higher at 12 months post-implementation, with an average cumulative VL completion rate of >90% across all facilities. Conclusion: We demonstrate a successful, multifaceted, quality-improvement intervention centered on a clinic-level VLC which, taken to scale, has important implications for attaining the third UNAIDS 90-90-90 target.
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Affiliation(s)
- H Sunpath
- Centre for Aids Program of Research, University of Kwa Zulu-Natal, Durban, South Africa.,Infectious Diseases Unit, Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa
| | - T J Hatlen
- Division of Infectious Diseases, Los Angeles Biomedical Research Institute, Harbor-UCLA Medical Center, Torrance, California, USA
| | - K K Naidu
- MatCH (Maternal Adolescent and Child Health), School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
| | - P Msimango
- Ethekwini Health District Office, Department of Health, Kwa-Zulu Natal, Durban, South Africa
| | - R N Adams
- Medical Research Council-CAPRISA HIV-TB Pathogenesis and Treatment Research Unit, Doris Duke Medical Research Institute, University of KwaZulu-Natal, Durban, South Africa
| | - M-Y S Moosa
- Infectious Diseases Unit, Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa
| | - V C Marconi
- Emory University School of Medicine and Rollins School of Public Health, Atlanta, Georgia, USA
| | - R A Murphy
- Division of Infectious Diseases, Los Angeles Biomedical Research Institute, Harbor-UCLA Medical Center, Torrance, California, USA
| | - R T Gandhi
- Harvard Medical School, Boston, Massachusetts, USA
| | - S Pillay
- Division of Medical Microbiology and Immunology, National Health Laboratory Services Tygerberg Hospital, Stellenbosch University, Tygerberg, South Africa
| | - M Siedner
- Massachusetts General Hospital, Boston, Massachusetts, USA
| | - K Naidoo
- Centre for Aids Program of Research, University of Kwa Zulu-Natal, Durban, South Africa.,Medical Research Council-CAPRISA HIV-TB Pathogenesis and Treatment Research Unit, Doris Duke Medical Research Institute, University of KwaZulu-Natal, Durban, South Africa
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Naidoo K, Tighe I, Barrett P, Bajaj V. Acitretin as a successful treatment for Hailey–Hailey disease. Clin Exp Dermatol 2018; 44:450-452. [DOI: 10.1111/ced.13762] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/12/2018] [Indexed: 11/27/2022]
Affiliation(s)
- K. Naidoo
- Department of Dermatological Sciences Faculty of Medical Sciences the Medical School Newcastle University Newcastle upon Tyne UK
- Department of DermatologyUniversity Hospital of North DurhamDurhamUK
| | - I. Tighe
- Department of Dermatological Sciences Faculty of Medical Sciences the Medical School Newcastle University Newcastle upon Tyne UK
| | - P. Barrett
- Department of Histopathology University Hospital of North Durham Durham UK
| | - V. Bajaj
- Department of DermatologyUniversity Hospital of North DurhamDurhamUK
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24
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Naidoo K, De Vasconcellos K, Skinner DL. Procalcitonin kinetics in the first 48 hours of ICU admission is associated with higher mortality in critically ill patients with community-acquired pneumonia in a setting of high HIV prevalence. Southern African Journal of Anaesthesia and Analgesia 2018. [DOI: 10.1080/22201181.2018.1514787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- K Naidoo
- Department of Anaesthesiology and Critical Care, University of KwaZulu-Natal, Durban, South Africa
| | - K De Vasconcellos
- Department of Anaesthesiology and Critical Care, University of KwaZulu-Natal, Durban, South Africa
| | - DL Skinner
- Department of Anaesthesiology and Critical Care, University of KwaZulu-Natal, Durban, South Africa
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Abstract
BACKGROUND: The South African dietary supplement market will undergo a period of transition within the next few years due to the establishment of the South African Health Products Regulatory Authority (SAHPRA), which has superseded the former Medicines Control Council (MCC). While regulatory steps are yet to be fully outlined, products such as whey protein, regarded as food, will be governed by the Department of Health R429 draft Regulations Relating to the Labelling and Advertising of Foods. The guideline provides for the minimum value of essential amino acids (plus cysteine and tyrosine) per gram of protein that products claiming to contain protein will be required to comply with. Determining the compliance levels of whey protein products currently available will assist in establishing the readiness of the dietary supplement industry for regulation, and provide an indication of the overall state of the industry.OBJECTIVES: To determine the amino acid profile of whey protein powder and compare analysed content to manufacturer stated content.To compare analysed amino acid content to the Department of Health R429 draft Regulations Relating to the Labelling and Advertising of Food template amino acid profile.METHOD: 15 of the best-selling whey protein products available in South Africa were selected for amino acid analysis. Tested amino acid content were compared to the label stated claim and the amino acid reference pattern, as stated in the Department of Health R429 draft Regulations Relating to the Labelling and Advertising of Foods.RESULTS: Sixty percent (60%) of products tested were non-compliant with the Department of Health R429 draft Regulations Relating to the Labelling and Advertising of Foods. Of the 15 products tested, 11 were manufactured in South Africa, with 8 being non-compliant to the guideline amino acid profile. Considerable variance was noted in the manufacturer stated and the tested amino acid content (ranging from 16–48% variance).CONCLUSION: Many of the whey protein products available in South Africa are not compliant to proposed industry guidelines. The considerable variance noted highlights the need for greater oversight of the industry with clearly defined regulatory procedures.
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26
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Naidoo K, Pinder S. The importance of histological assessment after neoadjuvant therapy and the need for standardisation. Clin Radiol 2018; 73:693-699. [DOI: 10.1016/j.crad.2018.01.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2017] [Accepted: 01/10/2018] [Indexed: 01/23/2023]
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27
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Thomas L, Naidoo K, Woolfall P, Carmichael AJ. A unique presentation of 'petrified ears' with pain due to fracture. J Eur Acad Dermatol Venereol 2018; 33:e51-e52. [PMID: 29972872 DOI: 10.1111/jdv.15169] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- L Thomas
- Department of Dermatology, The James Cook University Hospital, Middlesbrough, UK
| | - K Naidoo
- Department of Dermatology, The James Cook University Hospital, Middlesbrough, UK
| | - P Woolfall
- Department of Radiology, University Hospital of North Tees, Stockton-on-Tees, UK
| | - A J Carmichael
- Department of Dermatology, The James Cook University Hospital, Middlesbrough, UK
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28
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Khalique S, Naidoo K, Attygalle A, Kriplani D, Daley F, Jones T, Fenwick K, Lord C, Banerjee S, Natrajan R. PO-457 Optimised ARID1A immunohistochemistry is an accurate predictor of ARID1A mutational status in gynaecological cancers. ESMO Open 2018. [DOI: 10.1136/esmoopen-2018-eacr25.964] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
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29
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Reddy S, Ntoyanto S, Sakadavan Y, Reddy T, Mahomed S, Dlamini M, Spooner B, Ramjee G, Coutsoudis A, Ngomane N, Naidoo K, Mlisana K, Kiepiela P. Detecting Mycobacterium tuberculosis using the loop-mediated isothermal amplification test in South Africa. Int J Tuberc Lung Dis 2018; 21:1154-1160. [PMID: 28911361 DOI: 10.5588/ijtld.16.0863] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
SETTING In South Africa, KwaZulu-Natal is the epicentre of the human immunodeficiency virus (HIV) epidemic, where approximately 70% of people with tuberculosis (TB) are co-infected with HIV. Undiagnosed TB contributes to high mortality in HIV-infected patients. Delays in diagnosing TB and treatment initiation result in prolonged transmission and increased infectiousness. OBJECTIVE To evaluate the LoopampTM MTBC Detection kit (TB-LAMP; based on the loop-mediated isothermal amplification assay), smear microscopy and Xpert test with the gold standard of mycobacterial culture. METHODS Sputum samples were collected from 705 patients with symptoms of pulmonary TB attending a primary health care clinic. RESULTS The TB-LAMP assay had significantly higher sensitivity than smear microscopy (72.6% vs. 45.4%, P < 0.001), whereas specificity was slightly lower (99% vs. 96.8%, P = 0.05), but significantly higher than Xpert (92.9%, P = 0.004). There was no significant difference in sensitivity of smear-positive, culture-positive and smear-negative, culture-positive sputum samples using TB-LAMP vs. Xpert (respectively 95.9%/55.9% vs. 97.6%/66.1%; P =0.65, P = 0.27). The positive predictive value of TB-LAMP was significantly higher than that of Xpert (87.5% vs. 77.0%; P = 0.02), but similar to that of smear microscopy (94.2%; P = 0.18). The negative predictive value was respectively 91.9%, 92.5% (P = 0.73) and 83.1% (P = 0.0001). CONCLUSION Given its ease of operability, the TB-LAMP assay could be implemented as a point-of-care test in primary health care settings, and contribute to reducing treatment waiting times and TB prevalence.
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Affiliation(s)
- S Reddy
- HIV Prevention Research Unit
| | | | | | - T Reddy
- Biostatistics Unit, South African Medical Research Council, Durban
| | - S Mahomed
- School of Laboratory Medicine and Medical Sciences, University of KwaZulu-Natal, Durban, Medical Microbiology Department, National Health Laboratory Services, Durban, Centre for the AIDS Programme of Research in South Africa, Durban
| | - M Dlamini
- Medical Microbiology Department, National Health Laboratory Services, Durban
| | - B Spooner
- HIV Prevention Research Unit, Department of Paediatrics and Child Health, University of KwaZulu-Natal, Durban
| | | | - A Coutsoudis
- Department of Paediatrics and Child Health, University of KwaZulu-Natal, Durban
| | - N Ngomane
- eThekwini Health Unit, eThekwini Municipality, Durban, South Africa
| | - K Naidoo
- Centre for the AIDS Programme of Research in South Africa, Durban
| | - K Mlisana
- School of Laboratory Medicine and Medical Sciences, University of KwaZulu-Natal, Durban, Medical Microbiology Department, National Health Laboratory Services, Durban
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Zelnick JR, Seepamore B, Daftary A, Amico KR, Bhengu X, Friedland G, Padayatchi N, Naidoo K, O'Donnell MR. Training social workers to enhance patient-centered care for drug-resistant TB-HIV in South Africa. Public Health Action 2018; 8:25-27. [PMID: 29581940 DOI: 10.5588/pha.17.0114] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2017] [Accepted: 01/22/2018] [Indexed: 11/10/2022] Open
Abstract
KwaZulu-Natal, South Africa, is the epicenter of an epidemic of drug-resistant tuberculosis (DR-TB) and human immunodeficiency virus (HIV) co-infection, characterized by low rates of medication adherence and retention in care. Social workers may have a unique role to play in improving DR-TB-HIV outcomes. We designed, implemented and evaluated a model-based pilot training course on patient-centered care, treatment literacy in DR-TB and HIV coinfection, patient support group facilitation, and self-care. Ten social workers participated in a 1-day training course. Post-training questionnaire scores showed significant overall gains (P = 0.003). A brief training intervention may be a useful and feasible way to engage social workers in patient-centered care for DR-TB and HIV coinfection.
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Affiliation(s)
- J R Zelnick
- Touro College Graduate School of Social Work, New York, New York, USA.,Centre for AIDS Programme of Research in South Africa, South African Medical Research Council HIV-TB Pathogenesis and Treatment Research Unit, Durban, South Africa
| | - B Seepamore
- Centre for AIDS Programme of Research in South Africa, South African Medical Research Council HIV-TB Pathogenesis and Treatment Research Unit, Durban, South Africa.,School of Applied Human Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - A Daftary
- Centre for AIDS Programme of Research in South Africa, South African Medical Research Council HIV-TB Pathogenesis and Treatment Research Unit, Durban, South Africa.,McGill International TB Centre, McGill University Health Centre, McGill University, Montreal, Quebec, Canada
| | - K R Amico
- Department of Health Behavior and Health Education, School of Public Health, University of Michigan, Ann Arbor, Michigan, USA
| | - X Bhengu
- King DinuZulu Hospital Complex, Sydenham, South Africa
| | - G Friedland
- Yale School of Medicine, New Haven, Connecticut, USA
| | - N Padayatchi
- Centre for AIDS Programme of Research in South Africa, South African Medical Research Council HIV-TB Pathogenesis and Treatment Research Unit, Durban, South Africa
| | - K Naidoo
- Centre for AIDS Programme of Research in South Africa, South African Medical Research Council HIV-TB Pathogenesis and Treatment Research Unit, Durban, South Africa
| | - M R O'Donnell
- Centre for AIDS Programme of Research in South Africa, South African Medical Research Council HIV-TB Pathogenesis and Treatment Research Unit, Durban, South Africa.,Division of Pulmonary, Allergy, and Critical Care Medicine, Columbia University Medical Center, New York, New York, USA.,Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York, USA
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31
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Maharaj B, Gengiah TN, Yende-Zuma N, Gengiah S, Naidoo A, Naidoo K. Implementing isoniazid preventive therapy in a tuberculosis treatment-experienced cohort on ART. Int J Tuberc Lung Dis 2018; 21:537-543. [PMID: 28399969 DOI: 10.5588/ijtld.16.0775] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
SETTING Urban clinical research site in Durban, South Africa. OBJECTIVE To describe outcomes associated with the implementation of isoniazid preventive therapy (IPT) in a cohort of tuberculosis (TB) treatment-experienced human immunodeficiency virus (HIV) infected patients on antiretroviral therapy (ART). DESIGN We conducted a secondary analysis of data collected between October 2009 and October 2013 from patients enrolled in a prospective cohort study conducted in Durban, South Africa. RESULTS Of the 402 patients enrolled in the parent study, 344 (85.6%) were eligible for IPT, 212 of whom (61.6%) initiated IPT. Of those who initiated IPT, 184 (86.8%) completed the 6-month course, while 24 (11.3%) permanently discontinued IPT, 3.8% of whom due to side effects. More women than men initiated IPT (n = 130, 61.3% vs. n = 82, 38.7%, P = 0.001). Overall median adherence to IPT was 97.6% (interquartile range 94.2-99.4). There were 22 cases of incident TB in this cohort: 13 occurred before IPT and 9 after (incidence rate ratio 0.67, 95%CI 0.29-1.58, P = 0.362). CONCLUSIONS IPT implementation among ART and TB treatment-experienced patients was well tolerated, with good completion rates and fewer TB cases diagnosed after IPT.
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Affiliation(s)
- B Maharaj
- Centre for the AIDS Programme of Research in South Africa (CAPRISA), Durban
| | - T N Gengiah
- Centre for the AIDS Programme of Research in South Africa (CAPRISA), Durban
| | - N Yende-Zuma
- Centre for the AIDS Programme of Research in South Africa (CAPRISA), Durban
| | - S Gengiah
- Centre for the AIDS Programme of Research in South Africa (CAPRISA), Durban
| | - A Naidoo
- Centre for the AIDS Programme of Research in South Africa (CAPRISA), Durban
| | - K Naidoo
- Centre for the AIDS Programme of Research in South Africa (CAPRISA), Durban, Medical Research Council-CAPRISA HIV-TB Pathogenesis and Treatment Research Unit, Doris Duke Medical Research Institute, University of KwaZulu-Natal, Durban, South Africa
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32
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Naidoo K, Bates P. Natural History of Flail Chest Injuries. Int J Surg 2017. [DOI: 10.1016/j.ijsu.2017.08.425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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33
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Soogun S, Naidoo M, Naidoo K. An evaluation of the use of the South African Triage Scale in an urban district hospital in Durban, South Africa. S Afr Fam Pract (2004) 2017. [DOI: 10.1080/20786190.2017.1307908] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Affiliation(s)
| | - M Naidoo
- Discipline of Family Medicine, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa
| | - K Naidoo
- Discipline of Family Medicine, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa
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Irshad S, Cheang M, Gazinka P, Naidoo K, Buus R, Pinder S, Dowsett M, Tutt A. Abstract P2-04-07: Immune profiling of post neoadjuvant high metastatic risk (RCB-II/III) residual disease in patients with early triple negative breast cancers. Cancer Res 2017. [DOI: 10.1158/1538-7445.sabcs16-p2-04-07] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: Poor prognosis in TNBC can be predicted in the significant fraction of patients with large volume residual cancer burden (RCB-II/III) after neoadjuvant chemotherapy (NACT). Whilst residual disease has been characterised to identify “driver” mutations and copy number variations, the contribution of the immune response within its tumour microenvironment remains unclear. Here we aimed to: 1) assess the potential spatial heterogeneity of immune transcript related gene expression between areas of tumour approximately 1cm apart as might still occur with a radiologically guided biopsy through the residual disease; and 2) assess the immune stroma composition of the TNBC high metastatic risk RCB II/III disease.
Method: 12 TNBC post NACT RCB II/III residual cases were identified from the KHP biobank. H&E sections were reviewed and areas of tumor 1cm apart within a residual resection specimen marked as area A and area B. HistoQuest analysis software was used to quantify the proportion of tumor infiltrating lymphocytes (per total cell count) within both areas. RNA was extracted from both areas and immune gene expression profiling performed using a Nanostring nCounter® on all 24 samples. The immune PanCancer panel consisted of 770 genes combining markers for different immune cell populations. Differential genes between paired samples were compared and unsupervised hierarchical clustering using 770 genes and immune cell types performed.
Results:Quantitative comparison of the tumour infiltrating lymphocytes (TILS) between area A and B revealed that 73% (8/11) of the cases had a <2-fold difference in the percentage of TILS within a residual specimen; and 27% (3/11) displayed a >2-fold (range 2.03-3.16) difference in the TILS. When comparing the 770 gene expression profiles between sampling areas in the same tumour, we found little spatial heterogeneity with areas A/B clustering together in 10 out of 12 cases. Interestingly, the two cases that revealed spatial heterogeneity within the paired samples displayed little immune cell heterogeneity histologically (i.e. <1-fold change in the TILS percentage score between area A and B). Comparing patient samples by immune gene expression profiling divided the patients into two groups: i) those with immunologically enriched tumors in whom gene signatures for majority of the immune cell types (DC, Macrophages, CD8+T-cells, T-helper cells (Th17, Th2, Th1), Tregs, NK, B-cells, Neutrophils, Mast cells) were highly expressed and ii) those with immunologically inert tumors in whom the immune cell signatures were not highly expressed. Within our patient cohort, patients with immunologically enriched gene expression profiles were also seen to display higher TILS score (ranging between 28.17% to 40.66%) as compared to patients with immunologically inert gene expression with scores ranging from 11.82% to 16.80%.
Conclusion: The findings that high metastatic risk residual disease can be further characterized as either “immunologically inert” or “immunologically enriched” at the level of extensive immunological transcript gene expression and by histological assessment of TILS requires further investigation; and is being validated in a larger sample set.
Citation Format: Irshad S, Cheang M, Gazinka P, Naidoo K, Buus R, Pinder S, Dowsett M, Tutt A. Immune profiling of post neoadjuvant high metastatic risk (RCB-II/III) residual disease in patients with early triple negative breast cancers [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr P2-04-07.
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Affiliation(s)
- S Irshad
- Kings College London, London, United Kingdom; Institute of Cancer Research, London, United Kingdom
| | - M Cheang
- Kings College London, London, United Kingdom; Institute of Cancer Research, London, United Kingdom
| | - P Gazinka
- Kings College London, London, United Kingdom; Institute of Cancer Research, London, United Kingdom
| | - K Naidoo
- Kings College London, London, United Kingdom; Institute of Cancer Research, London, United Kingdom
| | - R Buus
- Kings College London, London, United Kingdom; Institute of Cancer Research, London, United Kingdom
| | - S Pinder
- Kings College London, London, United Kingdom; Institute of Cancer Research, London, United Kingdom
| | - M Dowsett
- Kings College London, London, United Kingdom; Institute of Cancer Research, London, United Kingdom
| | - A Tutt
- Kings College London, London, United Kingdom; Institute of Cancer Research, London, United Kingdom
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Abstract
OBJECTIVE To determine the optimal tuberculosis (TB) management strategy for children living in peri-urban, resource-limited settings. DESIGN We compared TB treatment outcomes among children aged 0-15 years receiving doorstep care (n = 82) with those of a historical group (n = 97) receiving clinic-based care. RESULTS The doorstep care and clinic-based groups had similar age and sex profiles; treatment default rates were 3.7% (3/82) vs. 38.1% (37/97, P < 0.0001), treatment completion rates were 65.9% (54/82) vs. 51.6% (50/97, P = 0.01), and cure rates were 13.4% (11/82) vs. 2.1% (2/97), respectively (P < 0.0001). CONCLUSION Children living in peri-urban communities had improved TB treatment outcomes with doorstep care.
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Affiliation(s)
- L Jeena
- Centre for the AIDS Programme of Research in South Africa (CAPRISA), South Africa
| | - K Naidoo
- Centre for the AIDS Programme of Research in South Africa (CAPRISA), South Africa; Medical Research Council CAPRISA HIV-TB Pathogenesis and Treatment Research Unit, Doris Duke Medical Research Institute, Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa
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36
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Gogate P, Parbhoo D, Ramson P, Budhoo R, Øverland L, Mkhize N, Naidoo K, Levine S, du Bryn A, Benjamin L. Surgery for sight: outcomes of congenital and developmental cataracts operated in Durban, South Africa. Eye (Lond) 2016; 30:1523-1524. [PMID: 27518542 PMCID: PMC5108017 DOI: 10.1038/eye.2016.158] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Affiliation(s)
- P Gogate
- Orbis Africa, Cape Town, Republic of South Africa
- African Vision Research Institute, University of KwaZulu Natal, Durban, Republic of South Africa
- Dr Gogate's Eye Clinic, Pune, India
| | - D Parbhoo
- Inkosi Albert Luthuli Central Hospital, Durban, Republic of South Africa
| | - P Ramson
- Orbis Africa, Cape Town, Republic of South Africa
| | - R Budhoo
- Inkosi Albert Luthuli Central Hospital, Durban, Republic of South Africa
| | - L Øverland
- Orbis Africa, Cape Town, Republic of South Africa
| | - N Mkhize
- Orbis Africa, Cape Town, Republic of South Africa
| | - K Naidoo
- African Vision Research Institute, University of KwaZulu Natal, Durban, Republic of South Africa
- Brien Holden Vision Research Institute, Durban, Republic of South Africa
| | - S Levine
- School of African and Gender studies, Anthropology and Linguistics, University of Cape Town, Cape Town, Republic of South Africa
| | - A du Bryn
- Inkosi Albert Luthuli Central Hospital, Durban, Republic of South Africa
| | - L Benjamin
- Consultant Ophthalmic Surgeon, Stoke Mandeville Hospital, Aylesbury, UK
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Hosseinipour MC, Bisson GP, Miyahara S, Sun X, Moses A, Riviere C, Kirui F, Badal-Faesen S, Lagat D, Nyirenda M, Naidoo K, Hakim J, Mugyenyi P, Henostroza G, Leger P, Lama J, Mohapi L, Alave J, Mave V, Veloso V, Pillay S, Kumarasamy N, Bao J, Hogg E, Jones L, Zolopa A, Kumwenda J, Gupta A. Empirical tuberculosis therapy versus isoniazid in adult outpatients with advanced HIV initiating antiretroviral therapy (REMEMBER): a multicountry open-label randomised controlled trial. Lancet 2016; 387:1198-209. [PMID: 27025337 PMCID: PMC4931281 DOI: 10.1016/s0140-6736(16)00546-8] [Citation(s) in RCA: 60] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND Mortality within the first 6 months after initiating antiretroviral therapy is common in resource-limited settings and is often due to tuberculosis in patients with advanced HIV disease. Isoniazid preventive therapy is recommended in HIV-positive adults, but subclinical tuberculosis can be difficult to diagnose. We aimed to assess whether empirical tuberculosis treatment would reduce early mortality compared with isoniazid preventive therapy in high-burden settings. METHODS We did a multicountry open-label randomised clinical trial comparing empirical tuberculosis therapy with isoniazid preventive therapy in HIV-positive outpatients initiating antiretroviral therapy with CD4 cell counts of less than 50 cells per μL. Participants were recruited from 18 outpatient research clinics in ten countries (Malawi, South Africa, Haiti, Kenya, Zambia, India, Brazil, Zimbabwe, Peru, and Uganda). Individuals were screened for tuberculosis using a symptom screen, locally available diagnostics, and the GeneXpert MTB/RIF assay when available before inclusion. Study candidates with confirmed or suspected tuberculosis were excluded. Inclusion criteria were liver function tests 2·5 times the upper limit of normal or less, a creatinine clearance of at least 30 mL/min, and a Karnofsky score of at least 30. Participants were randomly assigned (1:1) to either the empirical group (antiretroviral therapy and empirical tuberculosis therapy) or the isoniazid preventive therapy group (antiretroviral therapy and isoniazid preventive therapy). The primary endpoint was survival (death or unknown status) at 24 weeks after randomisation assessed in the intention-to-treat population. Kaplan-Meier estimates of the primary endpoint across groups were compared by the z-test. All participants were included in the safety analysis of antiretroviral therapy and tuberculosis treatment. This trial is registered with ClinicalTrials.gov, number NCT01380080. FINDINGS Between Oct 31, 2011, and June 9, 2014, we enrolled 850 participants. Of these, we randomly assigned 424 to receive empirical tuberculosis therapy and 426 to the isoniazid preventive therapy group. The median CD4 cell count at baseline was 18 cells per μL (IQR 9-32). At week 24, 22 (5%) participants from each group died or were of unknown status (95% CI 3·5-7·8) for empirical group and for isoniazid preventive therapy (95% CI 3·4-7·8); absolute risk difference of -0·06% (95% CI -3·05 to 2·94). Grade 3 or 4 signs or symptoms occurred in 50 (12%) participants in the empirical group and 46 (11%) participants in the isoniazid preventive therapy group. Grade 3 or 4 laboratory abnormalities occurred in 99 (23%) participants in the empirical group and 97 (23%) participants in the isoniazid preventive therapy group. INTERPRETATION Empirical tuberculosis therapy did not reduce mortality at 24 weeks compared with isoniazid preventive therapy in outpatient adults with advanced HIV disease initiating antiretroviral therapy. The low mortality rate of the trial supports implementation of systematic tuberculosis screening and isoniazid preventive therapy in outpatients with advanced HIV disease. FUNDING National Institutes of Allergy and Infectious Diseases through the AIDS Clinical Trials Group.
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Affiliation(s)
- Mina C. Hosseinipour
- UNC Project, Lilongwe, Malawi
- University of North Carolina School of Medicine, Chapel Hill, United States
| | - Gregory P. Bisson
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, United States
| | | | - Xin Sun
- Harvard University, Boston, United States
| | | | | | - F.K. Kirui
- Kenya Medical Research Institute (KEMRI), Kisumu, Kenya
| | - Sharla Badal-Faesen
- Clinical HIV Research Unit, Department of Medicine, University of Witwatersrand, Johannesburg, South Africa
| | - David Lagat
- Moi University School of Medicine, Eldoret, Kenya
| | | | - K Naidoo
- Centre for the AIDS Programme of Research in South Africa, Durban, South Africa
| | | | | | | | | | - Javier.R Lama
- Asociacion Civil Impacta Salud y Educacion, Lima, Peru
| | - Lerato Mohapi
- Perinatal HIV Research Unit (PHRU), University of the Witwatersrand, Johannesburg, South Africa
| | - Jorge Alave
- Asociacion Civil Impacta Salud y Educacion, Lima, Peru
| | - V Mave
- B.J. Medical College-Johns Hopkins Clinical Trials Unit, Pune, India
| | - Valdilea.G Veloso
- Evandro Chagas National Institute of Infectious Diseases/Fiocruz, Rio de Janeiro, Brazil
| | - Sandy Pillay
- Durban International CRS, Durban University of Technology, Durban, South Africa
| | | | - Jing Bao
- HJF-DAIDS, a Division of The Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Contractor to National Institute of Allergy and Infectious Diseases, Bethesda, United States
| | - Evelyn Hogg
- Social & Scientific Systems, Silver Spring, United States
| | | | | | | | - Amita Gupta
- Johns Hopkins University School of Medicine, Baltimore, United States
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Van der Nest MA, Steenkamp ET, McTaggart AR, Trollip C, Godlonton T, Sauerman E, Roodt D, Naidoo K, Coetzee MPA, Wilken PM, Wingfield MJ, Wingfield BD. Saprophytic and pathogenic fungi in the Ceratocystidaceae differ in their ability to metabolize plant-derived sucrose. BMC Evol Biol 2015; 15:273. [PMID: 26643441 PMCID: PMC4672557 DOI: 10.1186/s12862-015-0550-7] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2015] [Accepted: 11/25/2015] [Indexed: 11/25/2022] Open
Abstract
Background Proteins in the Glycoside Hydrolase family 32 (GH32) are carbohydrate-active enzymes known as invertases that hydrolyse the glycosidic bonds of complex saccharides. Fungi rely on these enzymes to gain access to and utilize plant-derived sucrose. In fungi, GH32 invertase genes are found in higher copy numbers in the genomes of pathogens when compared to closely related saprophytes, suggesting an association between invertases and ecological strategy. The aim of this study was to investigate the distribution and evolution of GH32 invertases in the Ceratocystidaceae using a comparative genomics approach. This fungal family provides an interesting model to study the evolution of these genes, because it includes economically important pathogenic species such as Ceratocystis fimbriata, C. manginecans and C. albifundus, as well as saprophytic species such as Huntiella moniliformis, H. omanensis and H. savannae. Results The publicly available Ceratocystidaceae genome sequences, as well as the H. savannae genome sequenced here, allowed for the identification of novel GH32-like sequences. The de novo assembly of the H. savannae draft genome consisted of 28.54 megabases that coded for 7 687 putative genes of which one represented a GH32 family member. The number of GH32 gene family members appeared to be related to the ecological adaptations of these fungi. The pathogenic Ceratocystis species all contained two GH32 family genes (a putative cell wall and a putative vacuolar invertase), while the saprophytic Huntiella species had only one of these genes (a putative cell wall invertase). Further analysis showed that the evolution of the GH32 gene family in the Ceratocystidaceae involved transposable element-based retro-transposition and translocation. As an example, the activity of a Fot5-like element likely facilitated the assembly of the genomic regions harbouring the GH32 family genes in Ceratocystis. Conclusions This study provides insight into the evolutionary history of the GH32 gene family in Ceratocystidaceae. Our findings suggest that transposable elements shaped the evolution of the GH32 gene family, which in turn determines the sucrolytic activities and related ecological strategies of the Ceratocystidaceae species that harbour them. The study also provides insights into the role of carbohydrate-active enzymes in plant-fungal interactions and adds to our understanding of the evolution of these enzymes and their role in the life style of these fungi. Electronic supplementary material The online version of this article (doi:10.1186/s12862-015-0550-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- M A Van der Nest
- Department of Genetics, Forestry and Agricultural Biotechnology Institute (FABI), University of Pretoria, Private Bag X20, Pretoria, 0028, South Africa.
| | - E T Steenkamp
- Department of Microbiology and Plant Pathology, Forestry and Agricultural Biotechnology Institute (FABI), University of Pretoria, Private Bag X20, Pretoria, 0028, South Africa.
| | - A R McTaggart
- Department of Microbiology and Plant Pathology, Forestry and Agricultural Biotechnology Institute (FABI), University of Pretoria, Private Bag X20, Pretoria, 0028, South Africa.
| | - C Trollip
- Department of Genetics, Forestry and Agricultural Biotechnology Institute (FABI), University of Pretoria, Private Bag X20, Pretoria, 0028, South Africa.
| | - T Godlonton
- Department of Genetics, Forestry and Agricultural Biotechnology Institute (FABI), University of Pretoria, Private Bag X20, Pretoria, 0028, South Africa.
| | - E Sauerman
- Department of Genetics, Forestry and Agricultural Biotechnology Institute (FABI), University of Pretoria, Private Bag X20, Pretoria, 0028, South Africa.
| | - D Roodt
- Department of Genetics, Forestry and Agricultural Biotechnology Institute (FABI), University of Pretoria, Private Bag X20, Pretoria, 0028, South Africa.
| | - K Naidoo
- Department of Genetics, Forestry and Agricultural Biotechnology Institute (FABI), University of Pretoria, Private Bag X20, Pretoria, 0028, South Africa.
| | - M P A Coetzee
- Department of Genetics, Forestry and Agricultural Biotechnology Institute (FABI), University of Pretoria, Private Bag X20, Pretoria, 0028, South Africa.
| | - P M Wilken
- Department of Genetics, Forestry and Agricultural Biotechnology Institute (FABI), University of Pretoria, Private Bag X20, Pretoria, 0028, South Africa.
| | - M J Wingfield
- Department of Microbiology and Plant Pathology, Forestry and Agricultural Biotechnology Institute (FABI), University of Pretoria, Private Bag X20, Pretoria, 0028, South Africa.
| | - B D Wingfield
- Department of Genetics, Forestry and Agricultural Biotechnology Institute (FABI), University of Pretoria, Private Bag X20, Pretoria, 0028, South Africa.
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Naidoo K, Amonsou E, Oyeyinka S. In vitro digestibility and some physicochemical properties of starch from wild and cultivated amadumbe corms. Carbohydr Polym 2015; 125:9-15. [DOI: 10.1016/j.carbpol.2015.02.066] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2014] [Revised: 02/25/2015] [Accepted: 02/27/2015] [Indexed: 10/23/2022]
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Padayatchi N, Abdool Karim SS, Naidoo K, Grobler A, Friedland G. Improved survival in multidrug-resistant tuberculosis patients receiving integrated tuberculosis and antiretroviral treatment in the SAPiT Trial. Int J Tuberc Lung Dis 2014; 18:147-54. [PMID: 24429305 DOI: 10.5588/ijtld.13.0627] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The therapeutic effects of antiretroviral treatment (ART) in patients with multidrug-resistant tuberculosis (MDR-TB) and human immunodeficiency virus (HIV) infection have not been established. OBJECTIVE To assess therapeutic outcomes of integrating ART with treatment for MDR-TB. DESIGN A subgroup of MDR-TB patients from a randomised controlled trial, the SAPiT (Starting Antiretroviral Therapy at Three Points in Tuberculosis) study, conducted in an out-patient clinic in Durban, South Africa, from 2008 to 2012. METHODS Clinical outcomes at 18 months were compared in patients randomised to receive ART within 12 weeks of initiating standard first-line anti-tuberculosis treatment with those who commenced ART after completing anti-tuberculosis treatment. RESULTS Mycobacterium tuberculosis drug susceptibility results were available in 489 (76%) of 642 SAPiT patients: 23 had MDR-TB, 14 in the integrated treatment arm and 9 in the sequential treatment arm. At 18 months, the mortality rate was 11.9/100 person-years (py; 95%CI 1.4-42.8) in the combined integrated treatment arm and 56.0/100 py (95%CI 18.2-130.8) in the sequential treatment arm (hazard ratio adjusted for baseline CD4 count and whether MDR-TB treatment was initiated: 0.14; 95%CI 0.02-0.94, P = 0.04). CONCLUSION Despite the small sample size, the 86% reduction in mortality due to early initiation of ART in MDR-TB patients was statistically significant.
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Affiliation(s)
- N Padayatchi
- Centre for the AIDS Programme of Research in South Africa (CAPRISA), University of KwaZulu-Natal, Durban, South Africa
| | - S S Abdool Karim
- Centre for the AIDS Programme of Research in South Africa (CAPRISA), University of KwaZulu-Natal, Durban, South Africa
| | - K Naidoo
- Centre for the AIDS Programme of Research in South Africa (CAPRISA), University of KwaZulu-Natal, Durban, South Africa
| | - A Grobler
- Centre for the AIDS Programme of Research in South Africa (CAPRISA), University of KwaZulu-Natal, Durban, South Africa
| | - G Friedland
- Departments of Internal Medicine and Epidemiology, Yale University School of Medicine, New Haven, Connecticut, USA
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Padayatchi N, Gopal M, Naidoo R, Werner L, Naidoo K, Master I, O'Donnell MR. Clofazimine in the treatment of extensively drug-resistant tuberculosis with HIV coinfection in South Africa: a retrospective cohort study. J Antimicrob Chemother 2014; 69:3103-7. [PMID: 24986495 DOI: 10.1093/jac/dku235] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Extensively drug-resistant (XDR) tuberculosis (TB) and HIV coinfection is associated with low cure rates and high mortality. Clofazimine has shown activity in vitro against Mycobacterium tuberculosis, but clinical experience with clofazimine in XDR-TB and HIV coinfection is limited. METHODS This was a retrospective cohort study of adult XDR-TB patients in KwaZulu-Natal, South Africa, treated with either a clofazimine- or non-clofazimine-containing XDR-TB treatment regimen. The primary outcome measure was TB culture conversion at 6 months. Survival analysis and multivariate logistic regression compared time to event in different strata and identified risk factors for TB culture conversion. RESULTS Between August 2009 and July 2011, eligible XDR-TB patients (n = 85) were initiated on treatment for XDR-TB. Most patients (86%) were HIV-infected and receiving antiretroviral therapy (90%). Patients receiving a clofazimine-containing regimen (n = 50) had a higher percentage of culture conversion (40%) compared with patients (n = 35) receiving a non-clofazimine regimen (28.6%). On multivariate analysis, there was a 2-fold increase in TB culture conversion at 6 months (hazard rate ratio 2.54, 95% CI 0.99-6.52, P = 0.05) in the group receiving a clofazimine-containing regimen. Adverse effects due to clofazimine were minor and rarely life-threatening. CONCLUSIONS Clofazimine was associated with improved culture conversion in the treatment of XDR-TB/HIV. Adverse effects were minor and non-life-threatening. Based on these preliminary data, further study of clofazimine in XDR-TB/HIV treatment is warranted. Given the present low rates of culture conversion in XDR-TB treatment, we recommend empirical inclusion of clofazimine in treatment regimens for XDR-TB.
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Affiliation(s)
- N Padayatchi
- Centre for the AIDS Programme of Research in South Africa (CAPRISA), Nelson R. Mandela School of Medicine, Doris Duke Medical Research Institute, University of KwaZulu-Natal, Private Bag X7, Congella, 4013, South Africa
| | - M Gopal
- Gulf Coast Pulmonary Medicine, Port Charlotte, FL 33952, USA
| | - R Naidoo
- Centre for the AIDS Programme of Research in South Africa (CAPRISA), Nelson R. Mandela School of Medicine, Doris Duke Medical Research Institute, University of KwaZulu-Natal, Private Bag X7, Congella, 4013, South Africa
| | - L Werner
- Centre for the AIDS Programme of Research in South Africa (CAPRISA), Nelson R. Mandela School of Medicine, Doris Duke Medical Research Institute, University of KwaZulu-Natal, Private Bag X7, Congella, 4013, South Africa
| | - K Naidoo
- Centre for the AIDS Programme of Research in South Africa (CAPRISA), Nelson R. Mandela School of Medicine, Doris Duke Medical Research Institute, University of KwaZulu-Natal, Private Bag X7, Congella, 4013, South Africa
| | - I Master
- King Dinuzulu Hospital, PO Box Dormerton 4015, South Africa
| | - M R O'Donnell
- Centre for the AIDS Programme of Research in South Africa (CAPRISA), Nelson R. Mandela School of Medicine, Doris Duke Medical Research Institute, University of KwaZulu-Natal, Private Bag X7, Congella, 4013, South Africa Division of Pulmonary Medicine, Department of Internal Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, 1300 Morris Park Avenue, Bronx, NY 10461, USA
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Keeffe J, Taylor HR, Fotis K, Pesudovs K, Flaxman SR, Jonas JB, Leasher J, Naidoo K, Price H, White RA, Wong TY, Resnikoff S, Bourne RRA. Prevalence and causes of vision loss in Southeast Asia and Oceania: 1990-2010. Br J Ophthalmol 2014; 98:586-91. [PMID: 24407561 DOI: 10.1136/bjophthalmol-2013-304050] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND To assess prevalence and causes of vision impairment in Southeast Asia and Oceania in 1990 and 2010. METHODS Based on a systematic review of medical literature, prevalence of moderate and severe vision impairment (MSVI; presenting visual acuity <6/18 but ≥3/60 in the better eye) and blindness (presenting visual acuity <3/60) was estimated for 1990 and 2010. RESULTS In Oceania, the age-standardised prevalence of blindness and MSVI did not decrease significantly (1.3% to 0.8% and 6.6% to 5.1%) respectively, but in Southeast Asia, blindness decreased significantly from 1.4% to 0.8%, a 43% decrease. There were significantly more women blind (2.18 million) compared with men (1.28 million) in the Southeast Asian population in 2010, but no significant gender differences in MSVI in either subregion. Cataract was the most frequent cause of blindness in Southeast Asia and Oceania in 1990 and 2010. Uncorrected refractive error, followed by cataract, macular degeneration, glaucoma and diabetic retinopathy were the most common causes for MSVI in 1990 and 2010. With the increasing size of the older population, there have been relatively small increases in the number of blind (2%), and with MSVI (14%) in Southeast Asia, whereas increases have been greater in Oceania of 14% for blindness and of 31% for MSVI. CONCLUSIONS The prevalence of blindness has reduced significantly from 1990 to 2010, with moderate but non-significant lowering of MSVI. Cataract and uncorrected refractive error are the main causes of vision impairment and blindness; cataract continues as the main cause of blindness, but at lower proportions.
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Affiliation(s)
- J Keeffe
- Department of Ophthalmology, University of Melbourne, , Melbourne, Victoria, Australia
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Langdon GS, Yuen SCK, Nurick GN, Naidoo K. Some Insights into the Response of "Shallow V Shape" Structures to Air Blast Loading. Proceedings of the Indian National Science Academy 2013. [DOI: 10.16943/ptinsa/2013/v79i4/48002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Naidoo K, Naidoo M, Gengiah S, Nkupiso N, Singh C, Leask K, Kharsany ABM. P3.233 Genital Tract Abnormalities in HIV-TB Co-Infected Women Initiating Antiretroviral Therapy (ART). Br J Vener Dis 2013. [DOI: 10.1136/sextrans-2013-051184.0690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Padayatchi N, Karim SA, Naidoo K, Grobler A, Gengiah T, Friedland G. Antiretroviral therapy improves survival in patients with HIV and multi-drug resistant tuberculosis. Int J Infect Dis 2012. [DOI: 10.1016/j.ijid.2012.05.963] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
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Naidoo K, Pupuma BSX, Moodley J. Immune evaluation of HIV-infected and noninfected pre-eclamptics. S Afr Fam Pract (2004) 2010. [DOI: 10.1080/20786204.2010.10873960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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Padayatchi N, Stiefvater E, Naidoo K, Naidoo K, Ndung'u T, Abdool Karim Q. Expanding HIV surveillance to include TB patients in resource-limited settings with a generalized epidemic. Int J Tuberc Lung Dis 2009; 13:1447-1449. [PMID: 19919760] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023] Open
Abstract
Screening of antenatal clinic attendees is central to monitoring the human immunodeficiency virus (HIV) epidemic. However, recent evidence suggests that declining fertility rates are affecting the reliability of antenatal clinic surveys as the epidemic matures. Population-based HIV surveys, while ideal, are resource-intensive, necessitating newer, cost-effective approaches. Unlinked anonymous testing for HIV in sputum of tuberculosis (TB) patients serves as reliable proxy for estimating the burden of symptomatic HIV disease and is a potential adjunct to current surveillance efforts. Unlinked anonymous testing for HIV surveillance in KwaZulu-Natal, South Africa, the epicentre of the global epidemic, is justified, as data from the largest urban TB referral clinic indicate that only 22% of TB patients uptake voluntary HIV testing.
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Affiliation(s)
- N Padayatchi
- Centre for the AIDS Programme of Research in South Africa, University of KwaZulu-Natal, Durban, South Africa.
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Lutge EE, Knight SE, Naidoo K, Jinabhai CC. Appropriateness of patient attendance at specialist clinics in public hospitals in eThekwini municipality. S Afr Med J 2006; 96:804-8. [PMID: 17068649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/12/2023] Open
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Naidoo K, Govender P. Acomparison of non - cyclopegic and cyclopegicautore fraction of African child renaged 5 - 1 5 years in Kwazulu-Natal. African Vision and Eye Health 2005. [DOI: 10.4102/aveh.v64i1.204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
Anecdotal evidence has revealed much debateabout the use of cycloplegia when screening children.The issue of precision versus practicalityremains an unresolved debate. In the developingworld, with huge disparities in eye care resourcesand services, there is a need to address this issueso as to ensure that access is not compromised inthe search for precision and vice versa. This studytherefore compared autorefraction measurementswith and without cycloplegia.Methods: One hundred and fifty childrenof 5 to 15 years of age were randomly selectedfrom a study population of 4890. Autorefractionwas conducted on the sample using the handheldNikon Retinomax autorefractor and thesereadings are referred to as the dry autorefractionreadings. Thereafter, readings were repeatedonce cycloplegia was reached following theinstillation of cyclopentolate and these arereferred to as the wet autorefraction readings.Of the 150 children, only 118 eyes met thefull cycloplegic criteria, that is, pupil diametergreater than 6 mm and absent light reflex.Results: Data analysis revealed a clinicallysignificant difference of 0.97 D between themean nearest equivalent sphere of the dry andwet readings with the majority of wet readingstending towards more positive values. This differencewas statistically significant to the 99%confidence interval (p = 0.00).Conclusions: Autorefraction with cycloplegiais the more reliable methodology of detectingrefractive error in screening or pre-examapplication. The difference is significant enoughto warrant the use of cycloplegics in children,given the minimal side-effects and despite theextra time and effort.
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