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Ilako D, Barasa E, Gichangi M, Mwatha S, Watitu T, Bore J, Rajamani A, Butcher R, Flueckiger RM, Bakhtiari A, Willis R, Solomon AW, Harding-Esch EM, Matendechero SH. Prevalence of Trachomatous Trichiasis in Ten Evaluation Units of Embu and Kitui Counties, Kenya. Ophthalmic Epidemiol 2023; 30:591-598. [PMID: 35037814 PMCID: PMC10581664 DOI: 10.1080/09286586.2021.1986549] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [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: 12/18/2020] [Revised: 08/24/2021] [Accepted: 09/22/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND Late-stage blinding sequalae of trachoma such as trachomatous trichiasis (TT) typically take decades to develop and often do so in the absence of ongoing ocular Chlamydia trachomatis infection. This suggests that most TT risk accumulates in early life; as a result, population-level TT incidence and prevalence can remain high years after C. trachomatis transmission among children has decreased. In Embu and Kitui counties, Kenya, the prevalence of trachomatous inflammation - follicular is low in children. In this survey, we set out to determine the prevalence of TT in ten evaluation units (EUs) in these counties. METHODS We undertook ten cross-sectional prevalence surveys for TT. In each EU, people aged ≥15 years were selected by a two-stage cluster sampling method and examined for TT. Those with TT were asked questions on whether they had been offered management for it. Prevalence was adjusted to the underlying age and gender structure of the population. RESULTS A total of 18,987 people aged ≥15 years were examined. Per EU, the median number of examined participants was 1,656 (range: 1,451 - 3,016) and median response rate was 86% (range: 81 - 95%). The prevalence of TT unknown to the health system in people aged ≥15 years was above the threshold for elimination (≥0.2%) in all ten EUs studied (range: 0.2-0.7%). TT was significantly more common in older than younger individuals and in women than in men. DISCUSSION Provision of surgical services should be strengthened in Embu and Kitui counties of Kenya to achieve the World Health Organization threshold for eliminating TT as a public health problem.
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Affiliation(s)
- D Ilako
- Department of Ophthalmology, University of Nairobi, Nairobi, Kenya
| | - E Barasa
- Ophthalmic Services Unit, Ministry of Health, Nairobi, Kenya
| | - M Gichangi
- Ophthalmic Services Unit, Ministry of Health, Nairobi, Kenya
| | - S Mwatha
- Neglected Tropical Diseases Unit, Ministry of Health, Nairobi, Kenya
| | - T Watitu
- Neglected Tropical Diseases Unit, Ministry of Health, Nairobi, Kenya
| | - J Bore
- Kenya National Bureau of Statistics, Ministry of Planning, Nairobi, Kenya
| | - A Rajamani
- Clinical Research Department, London School of Hygiene & Tropical Medicine, London, UK
| | - R Butcher
- Clinical Research Department, London School of Hygiene & Tropical Medicine, London, UK
| | | | - A Bakhtiari
- Task Force for Global Health, Atlanta, GA, USA
| | - R Willis
- Task Force for Global Health, Atlanta, GA, USA
| | - AW Solomon
- Department of Control of Neglected Tropical Diseases, World Health Organization, Geneva, Switzerland
| | - EM Harding-Esch
- Clinical Research Department, London School of Hygiene & Tropical Medicine, London, UK
| | - SH Matendechero
- Neglected Tropical Diseases Unit, Ministry of Health, Nairobi, Kenya
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Uthup TK, Rajamani A, Ravindran M, Saha T. Molecular evolution and functional characterisation of haplotypes of an important rubber biosynthesis gene in Hevea brasiliensis. Plant Biol (Stuttg) 2016; 18:720-728. [PMID: 26787454 DOI: 10.1111/plb.12433] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [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: 08/26/2015] [Accepted: 01/12/2016] [Indexed: 06/05/2023]
Abstract
Hydroxy-methylglutaryl coenzyme-A synthase (HMGS) is a rate-limiting enzyme in the cytoplasmic isoprenoid biosynthesis pathway leading to natural rubber production in Hevea brasiliensis (rubber). Analysis of the structural variants of this gene is imperative to understand their functional significance in rubber biosynthesis so that they can be properly utilised for ongoing crop improvement programmes in Hevea. We report here allele richness and diversity of the HMGS gene in selected popular rubber clones. Haplotypes consisting of single nucleotide polymorphisms (SNPs) from the coding and non-coding regions with a high degree of heterozygosity were identified. Segregation and linkage disequilibrium analysis confirmed that recombination is the major contributor to the generation of allelic diversity, rather than point mutations. The evolutionarily conserved nature of some SNPs was identified by comparative DNA sequence analysis of HMGS orthologues from diverse taxa, demonstrating the molecular evolution of rubber biosynthesis genes in general. In silico three-dimensional structural studies highlighting the structural positioning of non-synonymous SNPs from different HMGS haplotypes revealed that the ligand-binding site on the enzyme remains impervious to the reported sequence variations. In contrast, gene expression results indicated the possibility of association between specific haplotypes and HMGS expression in Hevea clones, which may have a downstream impact up to the level of rubber production. Moreover, haplotype diversity of the HMGS gene and its putative association with gene expression can be the basis for further genetic association studies in rubber. Furthermore, the data also show the role of SNPs in the evolution of candidate genes coding for functional traits in plants.
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Affiliation(s)
- T K Uthup
- Genome Analysis Laboratory, Rubber Research Institute of India, Kottayam, Kerala, India
| | - A Rajamani
- Genome Analysis Laboratory, Rubber Research Institute of India, Kottayam, Kerala, India
| | - M Ravindran
- Genome Analysis Laboratory, Rubber Research Institute of India, Kottayam, Kerala, India
| | - T Saha
- Genome Analysis Laboratory, Rubber Research Institute of India, Kottayam, Kerala, India
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Rajamani A, Sundararajan T, Prasad B, Parthasarathy U, Velusamy K. Post shut-down decay heat removal from nuclear reactor core by natural convection loops in sodium pool. Nuclear Engineering and Design 2016. [DOI: 10.1016/j.nucengdes.2016.02.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Rajamani A, Barrett E, Weisbrodt L, Bourne J, Palejs P, Gresham R, Huang S. Protocolised Approach to End-of-Life Care in the ICU—The ICU PALCare Pilot Project. Anaesth Intensive Care 2015; 43:335-40. [DOI: 10.1177/0310057x1504300309] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
International literature on end-of-life care in intensive care units (ICUs) supports the use of ‘protocol bundles’, which is not common practice in our 18-bed adult general ICU in Sydney, New South Wales. We conducted a prospective observational study to identify problems related to end-of-life care practices and to determine whether there was a need to develop protocol bundles. Any ICU patient who had ‘withdrawal’ of life-sustaining treatment to facilitate a comfortable death was eligible. Exclusion criteria included organ donors, unsuitable family dynamics and lack of availability of research staff to obtain family consent. Process-of-care measures were collected using a standardised form. Satisfaction ratings were obtained using de-identified questionnaire surveys given to the healthcare staff shortly after the withdrawal of therapy and to the families 30 days later. Twenty-three patients were enrolled between June 2011 and July 2012. Survey questionnaires were given to 25 family members and 30 healthcare staff, with a high completion rate (24 family members [96%] and 28 staff [93.3%]). Problems identified included poor documentation of family meetings (39%) and symptom management. Emotional/spiritual support was not offered to families (39.1%) or ICU staff (0%). The overall level of end-of-life care was good. The overwhelming majority of families and healthcare staff were highly satisfied with the care provided. Problems identified related to communication documentation and lack of spiritual/emotional support. To address these problems, targeted measures would be more useful than the adoption of protocol bundles. Alternate models of satisfaction surveys may be needed.
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Affiliation(s)
- A. Rajamani
- Intensive Care Unit, Nepean Hospital, Kingswood, New South Wales
| | - E. Barrett
- Intensive Care Unit, Nepean Hospital, Kingswood, New South Wales
| | - L. Weisbrodt
- Intensive Care Nursing and Clinical Research Management, Nepean Hospital, Kingswood, New South Wales
| | - J. Bourne
- Intensive Care Unit, Nepean Hospital, Kingswood, New South Wales
| | - P. Palejs
- Intensive Care Unit, Nepean Hospital, Kingswood, New South Wales
| | - R. Gresham
- Intensive Care Unit, Nepean Hospital, Kingswood, New South Wales
| | - S. Huang
- Nepean Hospital, Kingswood, New South Wales
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Iyer A, Gao L, Hicks M, Kumarasinghe G, Jansz P, Jabbour A, Al-Soufi S, Aneman A, Flynn G, Rajamani A, Cheng A, Raper R, Goh D, MacPartlin M, Saul P, Dhital K, Macdonald P. Case Report of Cardiac Allografts Retrieved From Human Donation After Circulatory Death (DCD) Donors - Assessment on Ex Vivo Beating Heart Perfusion Device. J Heart Lung Transplant 2014. [DOI: 10.1016/j.healun.2014.01.038] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Rajamani A. Air-raising ST-uff. Anaesth Intensive Care 2014; 42:263-265. [PMID: 24580396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
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Mclean AS, Huang SJ, Kot M, Rajamani A, Hoyling L. Comparison of Cardiac Output Measurements in Critically Ill Patients: Flotrac/Vigileo Vs Transthoracic Doppler Echocardiography. Anaesth Intensive Care 2011; 39:590-8. [DOI: 10.1177/0310057x1103900409] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Measurement of cardiac output is an integral part of patient management in the intensive care unit. FloTrac/Vigileo is a continuous cardiac output monitoring device that does not need re-calibration. However, its reliability has been questioned in some studies, especially involving surgical patients. In this study, we evaluated the comparability of FloTrac/Vigileo and transthoracic Doppler echocardiography in 53 critically ill patients requiring continuous cardiac output monitoring. Most of these patients had septic or cardiogenic shock. Cardiac output was measured by both FloTrac/Vigileo and transthoracic Doppler echocardiography. The bias and precision (mean and SD) between the two devices was 0.35±1.35 l/minute. The limits of agreement were -2.3 to 3.0 l/minute (%error=49.3%). When patients with irregular heart rhythms and aortic stenosis were excluded, the bias and precision was 0.02±0.80 l/minute (n=42). The limits of agreement were -1.55 to 1.59 l/minute (%error=29.5%). Patient demographics (body surface area, gender and age) did not affect the bias, but there was a mild tendency for FloTrac/Vigileo to register a higher cardiac output at high heart rates. Changes in cardiac output for two consecutive days correlated well between the two methods (r=0.86; P <0.001). In summary, with the exceptions of patients with irregular heart rhythms and significant aortic stenosis, FloTrac/Vigileo is clinically comparable to transthoracic Doppler echocardiography in cardiac output measurements in critically ill patients.
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Affiliation(s)
- A. S. Mclean
- Intensive Care Unit, Nepean Hospital, Sydney Medical School, Penrith, New South Wales, Australia
- Department Head
| | - S. J. Huang
- Intensive Care Unit, Nepean Hospital, Sydney Medical School, Penrith, New South Wales, Australia
| | - M. Kot
- Intensive Care Unit, Nepean Hospital, Sydney Medical School, Penrith, New South Wales, Australia
| | - A. Rajamani
- Intensive Care Unit, Nepean Hospital, Sydney Medical School, Penrith, New South Wales, Australia
| | - L. Hoyling
- Intensive Care Unit, Nepean Hospital, Sydney Medical School, Penrith, New South Wales, Australia
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