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Oral Antimicrobial Rinse to Reduce Mycobacterial Culture Contamination among Tuberculosis Suspects in Uganda: A Prospective Study
Nelson Kalema, Saskia Den Boon, Adithya Cattamanchi, J. Lucian Davis, Alfred Andama, Winceslaus Katagira, Charles Everett, Nicholas Walter, Patrick Byanyima, Sylvia Kaswabuli, William Worodria, Laurence Huang
PLOS ONE , 2012, DOI: 10.1371/journal.pone.0038888
Abstract: Rationale Contamination by bacterial or fungal organisms reduces the effectiveness of mycobacterial culture for diagnosis of pulmonary tuberculosis (TB). We evaluated the effect of an anti-microbial and an anti-fungal oral rinse prior to expectoration on culture-contamination rates. Methods We enrolled a consecutive random sample of adults with cough for ≥2 weeks and suspected TB admitted to Mulago Hospital (Kampala, Uganda) between October 2008 and June 2009. We randomly assigned patients to oral rinse (60 seconds with chlorhexidine followed by 60 seconds with nystatin) vs. no oral rinse prior to initial sputum collection. Uganda National Tuberculosis Reference Laboratory technicians blinded to the method of sputum collection (with or without oral rinse) processed all sputum specimens for smear microscopy (direct Ziehl-Neelsen) and mycobacterial culture (Lowenstein-Jensen media). Results Of 220 patients enrolled, 177 (80%) were HIV-seropositive (median CD4-count 37 cells/uL, IQR 13–171 cells/uL). Baseline characteristics were similar between patients in the oral-rinse (N = 110) and no oral-rinse (N = 110) groups. The proportion of contaminated cultures was significantly lower in the oral-rinse group compared to the no oral-rinse group (4% vs. 15%, risk difference ?11%, 95% CI ?18 to ?3%, p = 0.005). Oral rinse significantly reduced the proportion of contaminated cultures among HIV-infected patients (3% vs. 18%, risk difference ?14%, 95% CI ?23 to ?6%, p = 0.002) but not HIV-uninfected (6% vs. 4%, risk difference 2%, 95% CI ?12 to +15%, p = 0.81) patients. However, the proportion of smear-positive specimens (25% vs. 35%, p = 0.10) and culture-positive specimens (48% vs. 56%, p = 0.24) were lower in the oral-rinse compared to the no oral-rinse group, although the differences were not statistically significant. Conclusions Oral rinse prior to sputum expectoration is a promising strategy to reduce mycobacterial culture contamination in areas with high HIV prevalence, if strategies can be devised to reduce the adverse impact of oral rinse on smear- and culture-positivity.
The Lung Microbiome of Ugandan HIV-Infected Pneumonia Patients Is Compositionally and Functionally Distinct from That of San Franciscan Patients
Shoko Iwai, Delphine Huang, Serena Fong, Leah G. Jarlsberg, William Worodria, Samuel Yoo, Adithya Cattamanchi, J. Lucian Davis, Sylvia Kaswabuli, Mark Segal, Laurence Huang, Susan V. Lynch
PLOS ONE , 2014, DOI: 10.1371/journal.pone.0095726
Abstract: Sub-Saharan Africa represents 69% of the total number of individuals living with HIV infection worldwide and 72% of AIDS deaths globally. Pulmonary infection is a common and frequently fatal complication, though little is known regarding the lower airway microbiome composition of this population. Our objectives were to characterize the lower airway microbiome of Ugandan HIV-infected patients with pneumonia, to determine relationships with demographic, clinical, immunological, and microbiological variables and to compare the composition and predicted metagenome of these communities to a comparable cohort of patients in the US (San Francisco). Bronchoalveolar lavage samples from a cohort of 60 Ugandan HIV-infected patients with acute pneumonia were collected. Amplified 16S ribosomal RNA was profiled and aforementioned relationships examined. Ugandan airway microbiome composition and predicted metagenomic function were compared to US HIV-infected pneumonia patients. Among the most common bacterial pulmonary pathogens, Pseudomonas aeruginosa was most prevalent in the Ugandan cohort. Patients with a richer and more diverse airway microbiome exhibited lower bacterial burden, enrichment of members of the Lachnospiraceae and sulfur-reducing bacteria and reduced expression of TNF-alpha and matrix metalloproteinase-9. Compared to San Franciscan patients, Ugandan airway microbiome was significantly richer, and compositionally distinct with predicted metagenomes that encoded a multitude of distinct pathogenic pathways e.g secretion systems. Ugandan pneumonia-associated airway microbiome is compositionally and functionally distinct from those detected in comparable patients in developed countries, a feature which may contribute to adverse outcomes in this population.
Impact of Xpert MTB/RIF Testing on Tuberculosis Management and Outcomes in Hospitalized Patients in Uganda
Christina Yoon, Adithya Cattamanchi, J. Lucian Davis, William Worodria, Saskia den Boon, Nelson Kalema, Winceslaus Katagira, Sylvia Kaswabuli, Cecily Miller, Alfred Andama, Heidi Albert, Pamela Nabeta, Christen Gray, Irene Ayakaka, Laurence Huang
PLOS ONE , 2012, DOI: 10.1371/journal.pone.0048599
Abstract: Rationale The clinical impact of Xpert MTB/RIF for tuberculosis (TB) diagnosis in high HIV-prevalence settings is unknown. Objective To determine the diagnostic accuracy and impact of Xpert MTB/RIF among high-risk TB suspects. Methods We prospectively enrolled consecutive, hospitalized, Ugandan TB suspects in two phases: baseline phase in which Xpert MTB/RIF results were not reported to clinicians and an implementation phase in which results were reported. We determined the diagnostic accuracy of Xpert MTB/RIF in reference to culture (solid and liquid) and compared patient outcomes by study phase. Results 477 patients were included (baseline phase 287, implementation phase 190). Xpert MTB/RIF had high sensitivity (187/237, 79%, 95% CI: 73–84%) and specificity (190/199, 96%, 95% CI: 92–98%) for culture-positive TB overall, but sensitivity was lower (34/81, 42%, 95% CI: 31–54%) among smear-negative TB cases. Xpert MTB/RIF reduced median days-to-TB detection for all TB cases (1 [IQR 0–26] vs. 0 [IQR 0–1], p<0.001), and for smear-negative TB (35 [IQR 22–55] vs. 22 [IQR 0–33], p = 0.001). However, median days-to-TB treatment was similar for all TB cases (1 [IQR 0–5] vs. 0 [IQR 0–2], p = 0.06) and for smear-negative TB (7 [IQR 3–53] vs. 6 [IQR 1–61], p = 0.78). Two-month mortality was also similar between study phases among 252 TB cases (17% vs. 14%, difference +3%, 95% CI: ?21% to +27%, p = 0.80), and among 87 smear-negative TB cases (28% vs. 22%, difference +6%, 95% CI: ?34 to +46%, p = 0.77). Conclusions Xpert MTB/RIF facilitated more accurate and earlier TB diagnosis, leading to a higher proportion of TB suspects with a confirmed TB diagnosis prior to hospital discharge in a high HIV/low MDR TB prevalence setting. However, our study did not detect a decrease in two-month mortality following implementation of Xpert MTB/RIF possibly because of insufficient powering, differences in empiric TB treatment rates, and disease severity between study phases.
Low Prevalence of Pneumocystis pneumonia (PCP) but High Prevalence of Pneumocystis dihydropteroate synthase (dhps) Gene Mutations in HIV-Infected Persons in Uganda
Steve M. Taylor, Steven R. Meshnick, William Worodria, Alfred Andama, Adithya Cattamanchi, J. Lucian Davis, Samuel D. Yoo, Patrick Byanyima, Sylvia Kaswabuli, Carol D. Goodman, Laurence Huang, International HIV-associated Opportunistic Pneumonias (IHOP) Study
PLOS ONE , 2012, DOI: 10.1371/journal.pone.0049991
Abstract: Pneumocystis jirovecii pneumonia (PCP) is an important opportunistic infection in patients infected with HIV, but its burden is incompletely characterized in those areas of sub-Saharan Africa where HIV is prevalent. We explored the prevalence of both PCP in HIV-infected adults admitted with pneumonia to a tertiary-care hospital in Uganda and of putative P. jirovecii drug resistance by mutations in fungal dihydropteroate synthase (dhps) and dihydrofolate reductase (dhfr). In 129 consecutive patients with sputum smears negative for mycobacteria, 5 (3.9%) were diagnosed with PCP by microscopic examination of Giemsa-stained bronchoalveolar lavage fluid. Concordance was 100% between Giemsa stain and PCR (dhps and dhfr). PCP was more prevalent in patients newly-diagnosed with HIV (11.4%) than in patients with known HIV (1.1%; p = 0.007). Mortality at 2 months after discharge was 29% overall: 28% among PCP-negative patients, and 60% (3 of 5) among PCP-positive patients. In these 5 fungal isolates and an additional 8 from consecutive cases of PCP, all strains harbored mutant dhps haplotypes; all 13 isolates harbored the P57S mutation in dhps, and 3 (23%) also harbored the T55A mutation. No non-synonymous dhfr mutations were detected. PCP is an important cause of pneumonia in patients newly-diagnosed with HIV in Uganda, is associated with high mortality, and putative molecular evidence of drug resistance is prevalent. Given the reliability of field diagnosis in our cohort, future studies in sub-Saharan Africa can investigate the clinical impact of these genotypes.
The Role of Interactive Visual Art Learning in Development of Young Children’s Creativity  [PDF]
Sylvia Stavridi
Creative Education (CE) , 2015, DOI: 10.4236/ce.2015.621235
Abstract: Learning by interactive arts methods is a non-traditional approach to new creative teaching methods, in which young children are simultaneously engaged to feel and understand the original concept of core content areas in education, such as science, technology and math from a broad perspective. This article is an attempt to investigate the question of “how to keep young children’s creativity alive”. It focuses on the visual art and its interrelation between interactivity and creativity, and how the exploration of arts shapes new ways for our children to improve their practice and interaction in an increasingly intelligent setting. The article explores different digital platforms, tools, art-tech/software, and web-based applications that support the benefits of innovative active learning, and which differentiate teaching methods in traditional classes. The author confers that recently, integrated digital aesthetic learning has shifted the focus from not only fulfilling the existing education system, but also developing new interactive environmentally-friendly education, where educators are encouraged to design and build a creative digital curriculum to engage their students in a constructive way, both formally and informally. Furthermore, it discusses how arts and humanities-based initiatives are taking a prominent place in our integrated learning systems in private elementary schools in Alexandria. The paper then concludes with an emphasis on the crucial and efficient use of digital technologies through primary education as a tool to create and conduct art activities in order to help improve children learning in a creative process.
Steps to the Reopening of an Interdisciplinary Journal Club—Austrian Experiences  [PDF]
Margit Eidenberger, Sylvia ?hlinger
Creative Education (CE) , 2016, DOI: 10.4236/ce.2016.717246
Abstract: Journal Clubs are one of the methods for continuing professional development in defined working units and have proved to be an effective teaching tool. A Journal Club introduced in 2011 for the University of Applied Sciences for Health Professions Upper Austria had limited success and was discontinued after 18 months. Searching for improvements, an online survey addressing the needs and expectations of the university staff was conducted. Results showed that the majority of the respondents (98%) are interested in attending a JC in the future. The new JC should take place between 3 and 5 pm. The main reasons for not participating in the former JC were other professional obligations and no time for preparation. Critical evaluation of studies should be the main target for further capacity building realised in the future. It is planned to reopen the JC with the knowledge gained.
La Syrie au quotidien : cultures et pratiques du changement Présentation
Sylvia Chiffoleau,Sylvia Chiffoleau,Sylvia Chiffoleau
Revue des Mondes Musulmans et de la Méditerranée , 2012, DOI: 10.4000/remmm.3008
Abstract: La Syrie subit depuis plus de 40 ans le poids d’un régime autoritaire. Géographiquement voisine de l’Europe, historiquement liée à la France, traditionnellement traversée de flux commerciaux, ayant produit une diaspora établie dans bien des pays du monde, attirant un tourisme, certes encore modeste, grace à ses sites archéologiques et historiques, la Syrie est loin d’être coupée du monde. Elle reste cependant méconnue et suscite la méfiance. En effet, ses multiples atouts favorables à une int...
Integration of Spirituality and Religion in the Care of Patients with Severe Mental Disorders
Sylvia Mohr
Religions , 2011, DOI: 10.3390/rel2040549
Abstract: Spirituality and religiousness (S/R) are resources for finding meaning and hope in suffering and have been identified as key components in the process of psychological recovery. However, religion may also be associated with psycho-pathology, suffering and non-adherence with psychiatric treatment. Based on a literature review, this paper examines how S/R can be integrated in the treatment of patients with serious mental illness. We implemented a pilot “Spirituality and Recovery Group” designed to (1) help patients to resort to S/R as a means of recovery; (2) work on resolving conflicts between S/R and life issues and treatment; and (3) provide information on S/R in the context of psychosis. Preliminary results are presented.
O Laboratório de Artrópodes do Instituto Butantan e os aracnídeos pe?onhentos
Lucas, Sylvia;
História, Ciências, Saúde-Manguinhos , 2003, DOI: 10.1590/S0104-59702003000300011
Abstract: the text follows the history of the butantan institute's arthropod laboratory from its foundation to the mid-1967 retirement of wolfgang bücherl, one of brazil's greatest arachnologists. information is drawn from several sources: annual reports by vital brazil, director of the institute, from the periods 1900-1919 and 1924-1927; works published as part of memórias do instituto butantan; and my personal experience with the institute's researchers, technical staff, and contributors, as bücherl's assistant starting in 1961.
A porta e suas múltiplas significa??es
Cavalcante, Sylvia;
Estudos de Psicologia (Natal) , 2003, DOI: 10.1590/S1413-294X2003000200010
Abstract: the door is one of the oldest and most fundamental elements of the space structure. it takes over functions of a mechanical, thermal, visual, and acoustic barrier. it also assures topological functions of junctions or disjunctions between spaces to differentiate or to unite them. in order to understand the door in all its richness of meanings we searched for uncovering its subjective dimensions, recognizing the valuable role that it plays in social relationships and tried to indicate the psychological states that can arise from them. this article also makes evident the possibility of getting to know fundamental aspects of human ways of life through the analysis of the inter-relationship between individuals and a spatial element. from a methodological point of view this paper can be defined as a descriptive study supported by a phenomenological reflection.
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