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Search Results: 1 - 10 of 32723 matches for " Daniel Faurholt-Jepsen "
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The role of diabetes co-morbidity for tuberculosis treatment outcomes: a prospective cohort study from Mwanza, Tanzania
Faurholt-Jepsen Daniel,Range Nyagosya,Praygod George,Kidola Jeremiah
BMC Infectious Diseases , 2012, DOI: 10.1186/1471-2334-12-165
Abstract: Background Due to the association between diabetes and pulmonary tuberculosis (TB), diabetes may threaten the control of TB. In a prospective cohort study nested in a nutrition trial, we investigated the role of diabetes on changes in anthropometry, grip strength, and clinical parameters over a five months follow-up period. Methods Among pulmonary TB patients with known diabetes status, we assessed anthropometry and clinical parameters (e.g. haemoglobin) at baseline and after two and five months of TB treatment. A linear mixed-effects model (repeated measurements) was used to investigate the role of diabetes during recovery. Results Of 1205 TB patients, the mean (standard deviation) age was 36.6 (13.0) years, 40.9% were females, 48.9% were HIV co-infected, and 16.3% had diabetes. TB patients with diabetes co-morbidity experienced a lower weight gain at two (1.3 kg, CI95% 0.5; 2.0, p = 0.001) and five months (1.0 kg, CI95% 0.3; 1.7, p = 0.007). Similarly, the increase in the level of haemoglobin was lower among TB patients with diabetes co-morbidity after two (Δ 0.6 g/dL, CI95% 0.3; 0.9 p < 0.001) and five months (Δ 0.5 g/dL, CI95% 0.2; 0.9 p = 0.004) of TB treatment, respectively. Conclusion TB patients initiating TB treatment with diabetes co-morbidity experience delayed recovery of body mass and haemoglobin, which are important for the functional recovery from disease.
Diabetes Is a Risk Factor for Pulmonary Tuberculosis: A Case-Control Study from Mwanza, Tanzania
Daniel Faurholt-Jepsen, Nyagosya Range, George PrayGod, Kidola Jeremiah, Maria Faurholt-Jepsen, Martine Grosos Aabye, John Changalucha, Dirk Lund Christensen, Christian Bressen Pipper, Henrik Krarup, Daniel Rinse Witte, Aase Bengaard Andersen, Henrik Friis
PLOS ONE , 2011, DOI: 10.1371/journal.pone.0024215
Abstract: Background Diabetes and TB are associated, and diabetes is increasingly common in low-income countries where tuberculosis (TB) is highly endemic. However, the role of diabetes for TB has not been assessed in populations where HIV is prevalent. Methods A case-control study was conducted in an urban population in Tanzania among culture-confirmed pulmonary TB patients and non-TB neighbourhood controls. Participants were tested for diabetes according to WHO guidelines and serum concentrations of acute phase reactants were measured. The association between diabetes and TB, and the role of HIV as an effect modifier, were examined using logistic regression. Since blood glucose levels increase during the acute phase response, we adjusted for elevated serum acute phase reactants. Results Among 803 cases and 350 controls the mean (SD) age was 34.8 (11.9) and 33.8 (12.0) years, and the prevalence of diabetes was 16.7% (95% CI: 14.2; 19.4) and 9.4% (6.6; 13.0), respectively. Diabetes was associated with TB (OR 2.2, 95% CI: 1.5; 3.4, p<0.001). However, the association depended on HIV status (interaction, p = 0.01) due to a stronger association among HIV uninfected (OR 4.2, 95% CI: 1.5; 11.6, p = 0.01) compared to HIV infected (OR 0.1, 95% CI: 0.01; 1.8, p = 0.13) after adjusting for age, sex, demographic factors and elevated serum acute phase reactants. Conclusion Diabetes is a risk factor for TB in HIV uninfected, whereas the association in HIV infected patients needs further study. The increasing diabetes prevalence may be a threat to TB control.
The Prevalence of Latent Mycobacterium tuberculosis Infection Based on an Interferon-γ Release Assay: A Cross-Sectional Survey among Urban Adults in Mwanza, Tanzania
Andreas V. Jensen, Lotte Jensen, Daniel Faurholt-Jepsen, Martine G. Aabye, George Praygod, Jeremiah Kidola, Maria Faurholt-Jepsen, John Changalucha, Nyagosya Range, Henrik Krarup, Henrik Friis, Aase B. Andersen
PLOS ONE , 2013, DOI: 10.1371/journal.pone.0064008
Abstract: Introduction One third of the world’s population is estimated to be latently infected with Mycobacterium tuberculosis (LTBI). Surveys of LTBI are rarely performed in resource poor TB high endemic countries like Tanzania although low-income countries harbor the largest burden of the worlds LTBI. The primary objective was to estimate the prevalence of LTBI in household contacts of pulmonary TB cases and a group of apparently healthy neighborhood controls in an urban setting of such a country. Secondly we assessed potential impact of LTBI on inflammation by quantitating circulating levels of an acute phase reactant: alpha-1-acid glycoprotein (AGP) in neighborhood controls. Methods The study was nested within the framework of two nutrition studies among TB patients in Mwanza, Tanzania. Household contacts- and neighborhood controls were invited to participate. The study involved a questionnaire, BMI determination and blood samples to measure AGP, HIV testing and a Quantiferon Gold In tube (QFN-IT) test to detect signs of LTBI. Results 245 household contacts and 192 neighborhood controls had available QFN-IT data. Among household contacts, the proportion of QFT-IT positive was 59% compared to 41% in the neighborhood controls (p = 0.001). In a linear regression model adjusted for sex, age, CD4 and HIV, a QFT-IT positive test was associated with a 10% higher level of alpha-1-acid glycoprotein(AGP) (10B 1.10, 95% CI 1.01; 1.20, p = 0.03), compared to individuals with a QFT-IT negative test. Conclusion LTBI is highly prevalent among apparently healthy urban Tanzanians even without known exposure to TB in the household. LTBI was found to be associated with elevated levels of AGP. The implications of this observation merit further studies.
Level and intensity of objectively assessed physical activity among pregnant women from urban Ethiopia
Mads F Hjorth, Stine Kloster, Tsinuel Girma, Daniel Faurholt-Jepsen, Gregers Andersen, Pernille K?stel, S?ren Brage, Henrik Friis
BMC Pregnancy and Childbirth , 2012, DOI: 10.1186/1471-2393-12-154
Abstract: Physical activity was measured for seven consecutive days in 304 women using a combined uniaxial accelerometer and heart rate sensor. Activity energy expenditure was determined using a group calibration in a branched equation model framework. Type and duration of activities were reported using a 24-hour physical activity recall and grip strength was assessed using a dynamometer.Median (interquartile-range, IQR) activity energy expenditure was 31.1 (23.7-42.0) kJ/kg/day corresponding to a median (IQR) physical activity level of 1.46 (1.39-1.58). Median (IQR) time in sedentary, light, and moderate-to-vigorous intensity was 1100 (999–1175), 303 (223–374) and 40 (22–69) min/day, respectively. Mean (standard deviation) sleeping heart rate was 73.6 (8.0) beats/min and grip strength was 21.6 (4.5) kg. Activity energy expenditure was 14% higher for every 10 cm2 difference in arm muscle area and 10% lower for every 10 cm2 difference in arm fat area and 10-week difference in gestational age.The level and intensity of physical activity among pregnant women from urban Ethiopia is low compared to non-pregnant women from other low income countries as well as pregnant European women from high-income countries.Women in low-income countries are generally considered to have a high physical workload [1-4], which is sustained during pregnancy [2,5], and may contribute to the high incidence of low birth weight [5-7]. However, there are only few published studies on physical activity among pregnant women in low-income countries, and most have been based on questionnaires. In a recent meta-analysis it was suggested that women from developing countries perform similar amounts of physical activity as women from developed countries when assessed by doubled labeled water [8] raising questions about the actual physical workload. However, these data provide no insight into the patterns of physical activity. Thus, there is a need for more studies with objective methods for assessing physical act
CD4 lymphocyte dynamics in Tanzanian pulmonary tuberculosis patients with and without hiv co-infection
Aase B Andersen, Nyagosya S Range, John Changalucha, George PrayGod, Jeremiah Kidola, Daniel Faurholt-Jepsen, Henrik Krarup, Harleen MS Grewal, Henrik Friis
BMC Infectious Diseases , 2012, DOI: 10.1186/1471-2334-12-66
Abstract: CD4 counts were assessed from time of diagnosis till the end of TB treatment in a cohort of pulmonary TB patients with and without HIV co-infection and compared with cross-sectional data on age- and sex-matched non-TB controls from the same area.Of 1,605 study participants, 1,250 were PTB patients and 355 were non-TB controls. At baseline, HIV was associated with 246 (95% CI: 203; 279) cells per μL lower CD4 counts. All PTB patients had 100 cells per μL lower CD4 counts than the healthy controls. The CD4 levels were largely unchanged during a five-month of TB treatment. HIV infected patients not receiving ART at any time and those already on ART at baseline had no increase in CD4 counts after 5 months of TB treatment, whereas those prescribed ART between baseline and 2 months, and between 2 and 5 months increased by 69 (22;117) and 110 (52; 168) CD4 cells per μL after 5 months.The increase in circulating CD4 levels observed in PTB in patients is acquired after 2 months of treatment irrespective of HIV status. Initiation of ART is the strongest factor correlated with CD4 increase during TB treatment.Clinical trials.gov: NCT00311298The total number of circulating CD4 cells in HIV infected patients have in large patient series been acknowledged as the strongest, single predictive factor of clinical deterioration [1-3]. In individuals with latent Mycobacterium tuberculosis infection, CD4 depletion accelerates the progression from latent infection to active tuberculosis (TB), which, in turn, is believed to further fuel HIV replication rates due to elevated levels of pro-inflammatory cytokines [4]. TB by itself has also been associated with transitory lymphopenia including the CD4 positive cell lines [5,6]. A recent, retrospective study from Italy showed an impaired immune recovery in TB/AIDS cases compared to AIDS caused by other co morbidities which seemed not the be retrieved even after 3 years and despite access to efficient antiretroviral therapy (ART) [7]. However,
Vitamin D Status among Pulmonary TB Patients and Non-TB Controls: A Cross-Sectional Study from Mwanza, Tanzania
Henrik Friis, Nyagosya Range, John Changalucha, George PrayGod, Kidola Jeremiah, Daniel Faurholt-Jepsen, Henrik Krarup, Christian M?lgaard, ?se Bengaard Andersen
PLOS ONE , 2013, DOI: 10.1371/journal.pone.0081142
Abstract: Background Little is known about vitamin D status in low-income populations burdened with infectious diseases. Hence, there is a need for data on correlates of serum 25-hydroxy vitamin D (S-25(OH)D) and its validity during infections. Objective To assess the role of pulmonary TB (PTB) and HIV as correlates of S-25(OH)D. Design Age-sex-matched cross-sectional study among PTB patients and non-TB controls. Methods PTB patients were categorized as sputum negative (PTB?) and positive (PTB+) by culture. Non-TB controls were randomly selected among age-sex-matched neighbours to PTB+ patients. Height, weight, arm circumference and triceps skinfold were measured, and body mass index (BMI), arm fat (AFA) and muscle area (AMA) computed. HIV status, and S-25(OH)D, C-reactive protein (S-CRP) and α1-acid glycoprotein (S-AGP) were determined. Linear regression analysis with controls and PTB patients combined was used to identify correlates of S-25(OH)D. Results S-25(OH)D data were available on 97.8% (1570) of 1605 participants. Mean (SD) S-25(OH)D was 84.4 (25.6) nmol/L with 39.6% <75 nmol/L among 347 non-TB controls. Time of recruitment, sex, PTB and HIV, and elevated S-AGP were correlates of S-25(OH)D. S-25(OH)D was 24.8 (95% CI 18.6;30.9) nmol/L higher in PTB compared to controls among females, but only 9.8 (95% CI:4.5;15.2) nmol/L among males (interaction p<0.0001). Females had 13.8 (95% CI:8.2;21.9) nmol/L lower S-25(OH)D than males, and HIV infected individuals had 8.5 (95% CI:4.9;12.1) higher S-25(OH)D compared to uninfected. Elevated S-AGP was a positive correlate of S-25(OH)D. Low BMI was associated with S-25(OH)D, but not with infections or S-AGP in the model. Conclusion While S-25(OH)D may decline transiently during a mild acute phase response, it may increase if the acute phase response leads to loss of fat. The validity of S-25(OH)D as a marker of vitamin D status may be affected by infections.
Infrequent detection of Pneumocystis jirovecii by PCR in oral wash specimens from TB patients with or without HIV and healthy contacts in Tanzania
Lotte Jensen, Andreas V Jensen, George Praygod, Jeremiah Kidola, Daniel Faurholt-Jepsen, John Changalucha, Nyagosya Range, Henrik Friis, Jannik Helweg-Larsen, Jorgen S Jensen, Aase B Andersen
BMC Infectious Diseases , 2010, DOI: 10.1186/1471-2334-10-140
Abstract: A prospective study of 384 patients initiating treatment for sputum smear-positive and smear-negative TB and 100 healthy household contacts and neighbourhood controls.DNA from oral wash specimens was examined by PCR for P. jirovecii. All patients delivered sputum for TB microscopy and culture. Healthy contacts and community controls were clinically assessed and all study subjects were HIV tested and had CD4 cell counts determined. Clinical status and mortality was assessed after a follow-up period of 5 months.384 patients and 100 controls were included, 53% and 8% HIV positive respectively. A total number of 65 patients and controls (13.6%) were at definitive risk for PCP based on CD4 counts <200 cells per mm3 and no specific PCP prophylaxis. Only a single patient (0.3% of the patients) was PCR positive for P. jirovecii. None of the healthy household contacts or neighbourhood controls had PCR-detectable P. jirovecii DNA in their oral wash specimens regardless of HIV-status.The prevalence of P. jirovecii as detected by PCR on oral wash specimens was very low among TB patients with or without HIV and healthy individuals in Tanzania. Colonisation by P. jirovecii was not detected among healthy controls. The present findings may encourage diagnostic use of this non-invasive method.Pneumocystis jirovecii pneumonia (PCP) remains a relatively common and serious opportunistic infection among HIV infected in Western countries, even in the era of antiretroviral therapy (ART) [1,2]. In Africa, PCP is common and often fatal in HIV infected infants less than 1 year of age [3]. Data regarding adult patients from Uganda [4], Malawi [5] and Ethiopia [6] have shown P. jirovecii prevalence varying from 9% to 38% among smear-negative, mainly HIV-positive TB patients.The present study was inspired by results of a study performed in Mwanza, Tanzania, in which we observed a HIV prevalence of 63% among patients with smear-negative TB, according to WHO classification [7]. Among the smear-po
The Impact of HIV Infection and CD4 Cell Count on the Performance of an Interferon Gamma Release Assay in Patients with Pulmonary Tuberculosis
Martine G. Aabye, Pernille Ravn, George PrayGod, Kidola Jeremiah, Apolinary Mugomela, Maria Jepsen, Daniel Faurholt, Nyagosya Range, Henrik Friis, John Changalucha, Aase B. Andersen
PLOS ONE , 2009, DOI: 10.1371/journal.pone.0004220
Abstract: Background The performance of the tuberculosis specific Interferon Gamma Release Assays (IGRAs) has not been sufficiently documented in tuberculosis- and HIV-endemic settings. This study evaluated the sensitivity of the QuantiFERON TB-Gold In-Tube (QFT-IT) in patients with culture confirmed pulmonary tuberculosis (PTB) in a TB- and HIV-endemic population and the effect of HIV-infection and CD4 cell count on test performance. Methodology/Principal Findings 161 patients with sputum culture confirmed PTB were subjected to HIV- and QFT-IT testing and measurement of CD4 cell count. The QFT-IT was positive in 74% (119/161; 95% CI: 67–81%). Sensitivity was higher in HIV-negative (75/93) than in HIV-positive (44/68) patients (81% vs. 65%, p = 0.02) and increased with CD4 cell count in HIV-positive patients (test for trend p = 0.03). 23 patients (14%) had an indeterminate result and this proportion decreased with increasing CD4 cell count in HIV-positive patients (test for trend p = 0.03). Low CD4 cell count (<300 cells/μl) did not account for all QFT-IT indeterminate nor all negative results. Sensitivity when excluding indeterminate results was 86% (95% CI: 81–92%) and did not differ between HIV-negative and HIV–positive patients (88 vs. 83%, p = 0.39). Conclusions/Significance Sensitivity of the QFT-IT for diagnosing active PTB infection was reasonable when excluding indeterminate results and in HIV-negative patients. However, since the test missed more than 10% of patients, its potential as a rule-out test for active TB disease is limited. Furthermore, test performance is impaired by low CD4 cell count in HIV-positive patients and possibly by other factors as well in both HIV-positive and HIV-negative patients. This might limit the potential of the test in populations where HIV-infection is prevalent.
The Australian National Seismograph Network
D. Jepsen
Annals of Geophysics , 1994, DOI: 10.4401/ag-4192
Abstract: The Australian Seismological Centre of the Australian Geological Survey Organisation, operates and co-operates a national seismograph network consisting of 24 analogue and 8 digitally telemetred (3 broadband) stations (see fig. 1 and table 1). The network covers the Australian continent and the Australian Antarctic Territory.
Upper limb neuropathy in computer operators? A clinical case study of 21 patients
J?rgen Jepsen
BMC Musculoskeletal Disorders , 2004, DOI: 10.1186/1471-2474-5-26
Abstract: I have studied a consecutive series of 21 heavily exposed and severely handicapped computer-aided designers. Their history was recorded and questionnaire information was collected, encompassing their status 1/2 – 1 1/2 years after the initial clinical contact. The physical examination included an assessment of the following items: Isometric strength in ten upper limb muscles; sensibility in five homonymously innervated territories; and the presence of abnormal tenderness along nerve trunks at 14 locations.Rather uniform physical findings in all patients suggested a brachial plexus neuropathy combined with median and posterior interosseous neuropathy at elbow level. In spite of reduced symptoms at follow-up, the prognosis was serious in terms of work-status and persisting pain.This small-scale study of a clinical case series suggests the association of symptoms to focal neuropathy with specific locations. The inclusion of a detailed neurological examination would appear to be advantageous with upper limb symptoms in computer operators.Upper limb pain and dysfunction are frequent complaints associated with computer work. However, the responsible pathology and the pathophysiological mechanisms are insufficiently understood. In addition, there is no consensus with regard to physical findings that may reflect symptoms.The involvement of the nerves in "non-specific" upper limb disorder, e.g. in computer operators, is suggested by various observations: The demonstration of an elevated threshold to vibratory stimulation [1-3]; abnormal upper limb tension tests [4,5]; reduced nerve mobility [6,7]; abnormal nerve tenderness (mechanical allodynia) [8]; changed axonal flare reaction [9]; allodynic response to supra-threshold vibration [2]; reduced muscle strength [10,11] and sympathetic reflexes [12]; and thermographic changes [13]. Still, clinical practice and epidemiological studies tend to attribute upper limb symptoms in computer operators to a disorder in muscle, tendon, o
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