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Biomedical subjects

E Sanders

Publications and source records attributed to E Sanders.

At least 19 recordsLinked to original sources
PubMed2004

Performance of routine syphilis serology in the Ethiopian cohort on HIV/AIDS.

OBJECTIVES: To assess the performance of routine syphilis screening during 5 year follow up of Ethiopian factory workers, participating in a cohort study on HIV/AIDS. METHODS: Syphilis serology test results of factory workers, who each donated at least six blood samples were evaluated. Screening in 1997-8 had been performed by the Treponema pallidum particle agglutination (TPPA) assay and in 1999-2001 by the rapid plasma reagin (RPR) test. TPPA had been followed by RPR or RPR by TPPA, in case of a positive screening result. Samples of study subjects showing inconsistent sequential TPPA and/or RPR results were retested independently by three laboratory technicians. RESULTS: A total of 540 cohort participants (8.3% HIV positive at enrollment) donated 4,376 blood samples (mean 8.3 per subject). From 93 of the 176 participants with at least one positive TPPA result during follow up, 152 samples were retested by RPR and/or TPPA. Based on the revised syphilis test results, the 540 cohort participants were classified as having no (70.5%), past (20.6%), prevalent (6.9%), or incident (2.0%) syphilis. The RPR screening test was difficult to interpret and yielded 8.2% biological false positive (BFP) RPR results, or 3.2% if weak positive results were excluded. There was no correlation between HIV infection and BFP RPR reactions. Sample mix-ups were detected in 1.2%. CONCLUSION: Evaluation of routine syphilis screening as performed in a long term cohort study on HIV/AIDS in Ethiopia showed difficulties encountered in syphilis screening programmes such as a high percentage of BFP RPR, inconsistencies in interpretation of the RPR test, and sample mix ups. The findings stress the need to develop a syphilis screening assay that is easy to perform and interpret and to implement quality assurance programmes.

AIDS-Related Opportunistic Infections↗
PubMed2004

Drug susceptibility of Mycobacterium tuberculosis in HIV-infected and -uninfected Ethiopians and its impact on outcome after 24 months of follow-up.

From a prospective cohort study on tuberculosis/human immunodeficiency virus (TB/HIV) interaction in Addis Ababa, Ethiopia, drug susceptibility results were available for 94 TB patients (46% HIV-infected). Resistance to one or more drug(s) was detected in 21 (22.3%) and multidrug resistance in five (5.3%) patients. Occurrence of resistance was not related to HIV status or outcome after 24 months of follow-up. However, among HIV-infected TB patients who died during follow-up, survival time in those with a resistant Mycobacterium tuberculosis strain was significantly shorter compared to those with a sensitive strain (6 vs. 13 months). Early detection of drug resistance and timely treatment change can therefore have a positive impact on survival in HIV-infected TB patients.

Adult↗
PubMed2003

Low CD4+ T-cell count and high HIV viral load precede the development of tuberculosis disease in a cohort of HIV-positive ethiopians.

SETTING: Prospective cohort study, Ethiopia. OBJECTIVE: To study changes in biological markers of HIV infection progression before and after development of TB disease. DESIGN: A longitudinal study of 804 adult factory workers (95 HIV-positive, 709 HIV-negative), who were followed every 6 months for a median of 3.8 years. RESULTS: Overall, the incidence rate of TB was 10/ 222 = 45.1 (95%CI 24.3-83.9) per 1000 person-years of observation (PYO) among HIV-1-positive participants, compared to 14/2,054 = 6.8 (95%CI 4.0-11.5) per 1,000 PYO among HIV-1-negative participants (incidence rate ratio 6.62, 95%CI 2.94-14.9). Among the 10 HIV-positive participants who subsequently developed TB disease, the CD4 count was low (median 201/microl, range 45-419), and viral load high (median 4.97 log copies/ml, range 3.70-5.58), at the routine follow-up visit prior to TB diagnosis. Following TB treatment, plasma viral load remained persistently elevated despite clinical resolution of TB disease, and seven of the 10 patients died within a median time of 8 months. CONCLUSION: In this cohort, HIV-infected Ethiopians who developed TB disease already had low CD4 counts and high viral load prior to the diagnosis of TB. Viral load did not decrease following TB treatment, leading to a poor overall prognosis in these patients.

Adult↗
PubMed2003

Low CD4+ T-cell count and high HIV viral load precede the development of tuberculosis disease in a cohort of HIV-positive Ethiopians.

SETTING: Prospective cohort study, Ethiopia. OBJECTIVE: To study changes in biological markers of HIV infection progression before and after development of TB disease. DESIGN: A longitudinal study of 804 adult factory workers (95 HIV-positive, 709 HIV-negative), who were followed every 6 months for a median of 3.8 years. RESULTS: Overall, the incidence rate of TB was 10/222 = 45.1 (95%CI 24.3-83.9) per 1000 person-years of observation (PYO) among HIV-1-positive participants, compared to 14/2054 = 6.8 (95%CI 4.0-11.5) per 1000 PYO among HIV-1-negative participants (incidence rate ratio 6.62, 95%CI 2.94-14.9). Among the 10 HIV-positive participants who subsequently developed TB disease, the CD4 count was low (median 201/microliter, range 45-419), and viral load high (median 4.97 log copies/ml, range 3.70-5.58), at the routine follow-up visit prior to TB diagnosis. Following TB treatment, plasma viral load remained persistently elevated despite clinical resolution of TB disease, and seven of the 10 patients died within a median time of 8 months. CONCLUSION: In this cohort, HIV-infected Ethiopians who developed TB disease already had low CD4 counts and high viral load prior to the diagnosis of TB. Viral load did not decrease following TB treatment, leading to a poor overall prognosis in these patients.

AIDS-Related Opportunistic Infections↗
PubMed2002

Quantitative and functional differences in CD8+ lymphocyte responses in resolved acute and chronic hepatitis C virus infection.

CD8+ T lymphocyte responses are important in the clearance of viral infections. In chronic infections they may contribute to pathogenesis. To investigate the role of CD8+ T lymphocyte responses in viral clearance and chronic hepatitis C we have compared hepatitis C virus (HCV) specific cytotoxicity and interferon-gamma (IFN-gamma) production in patients with resolved-acute, and chronic HCV infection. CD8+ T cell responses to a panel of 13 HCV T cell peptide epitopes were studied using Elispot assays of IFN-gamma production and chromium release cytotoxicity assays. Responses of seven patients with resolved acute HCV infection were compared with those of 14 chronically infected patients. HCV-specific cytotoxicity differentiated the two populations of patients. The majority (71%) of patients with resolved acute infection tested positive to 42% of relevant peptides compared with the minority (28%) of patients with chronic hepatitis C (P=0.03) who responded to only 8% of relevant peptides (P=0.0009). In contrast, HCV-specific IFN-gamma production was detected in 86% of patients with either resolved or chronic infection in response to 42% and 35%, respectively, of relevant peptides tested (not significant). In patients with chronic infection the magnitude of the HCV-specific IFN-gamma production was inversely correlated to viral load (R2=0.52; P=0.042). Failure to clear HCV infection may be attributable to the presence of noncytolytic IFN-gamma producing CD8+ T lymphocytes in chronically infected patients. However these CD8+ T cells may play a beneficial role in contributing to the control of viral load in chronic hepatitis C.

Acute Disease↗
PubMed2002

Right aortic arch symptomatic in adulthood.

We present a patient with progressive dysphagia and shortness of breath due to a right aortic arch with aberrant left subclavian artery that became symptomatic in adulthood. Diagnosis was made after a delay because the possibility of a congenital anomaly was not considered when the patient presented with dysphagia. A review is given of the incidence, embryology, aetiology, diagnostic evaluation and management, as well as a discussion of other congenital aortic arch anomalies.

Aged↗
PubMed2001

Effects of pubovaginal sling procedure on patients with urethral hypermobility and intrinsic sphincteric deficiency: would they do it again?

OBJECTIVE: This study was undertaken to assess the cure rate of stress urinary incontinence, long-term effects on other lower urinary tract symptoms, and quality of life in a cohort of patients who underwent pubovaginal sling procedures for treatment of incontinence related to intrinsic sphincteric deficiency and urethral hypermobility. STUDY DESIGN: This was a retrospective analysis of 57 patients with 90% follow-up who underwent pubovaginal autologous fascial sling procedures for stress urinary incontinence related to urethral hypermobility and intrinsic sphincteric deficiency. Objective postoperative urodynamic evaluation was performed in 34 (60%) of the cases. Telephone interviews to assess quality-of-life parameters were performed in all cases. RESULTS: The mean follow-up period was 42 months and the median follow-up period was 34 months, with a range of 0.5 to 134 months. The age at the time of the sling procedure ranged from 18 to 84 years, with a median parity of 3.0 (range, 0-6). Preoperative body mass index ranged from 19.5 to 39.1 kg/m(2). Five percent of patients had detrusor instability before the operation. Forty-one percent (41%) of the patients who underwent postoperative urodynamic evaluation had voiding dysfunction. The postoperative objective cure rate for stress urinary incontinence was 97%. Of all patients 88% indicated that the sling had improved the quality of life, 84% indicated that the sling relieved the incontinence in the long-term, and 82% would choose to undergo the procedure again. CONCLUSION: Construction of a pubovaginal sling is an effective technique for relief of severe stress urinary incontinence. Voiding dysfunction is a common side effect. Despite this problem, a significant number of patients would elect to undergo the procedure again.

Adolescent↗
PubMed2000

The HIV epidemic and the state of its surveillance in Ethiopia.

A review of the information on the HIV epidemic in Ethiopia is important to guide policy and action. Published and unpublished reports and surveillance data from records of governmental and non-governmental institutions were examined to assess the extent of the epidemic. It appears that the HIV/AIDS epidemic has affected a large segment of the urban population. Surveillance data from pregnant women attending antenatal clinics indicate a decreasing trend in the prevalence of HIV in Addis Ababa. Similarly, data from blood donors from the majority of transfusion centres in the country indicate a decrease in prevalence. However, further studies will be required to establish the validity of these findings. Currently available data are not adequate to accurately measure the level of infection in rural areas where 85% of the population live. Outside of Addis Ababa, in places where ANC-based sentinel surveillance are operational, the systems are not fully supported by quality control. Thus, there are concerns regarding the validity of reported results. The impact of HIV/AIDS epidemic in Ethiopia needs to be further quantified both in its burden of diseases and its impact on the urban and rural economy and society. It is, therefore, important that effort and adequate resources are put into strengthening surveillance systems.

Cost of Illness↗
PubMed1999

Development of capillary electrophoresis as an alternative to high resolution agarose electrophoresis for the diagnosis of multiple sclerosis.

The presence of oligoclonal bands in cerebrospinal fluid (CSF) is used as a diagnostic indicator of multiple sclerosis (MS). These bands, gamma-globulins thought to result from a restricted antibody response directed against autoantigens or viral antigens, are consistent with CSF-specific immunoglobulin synthesis when observed in the spinal fluid and not in the serum. Current methodology commonly involves electrophoresing concentrated CSF with high-resolution agarose gel electrophoresis (HRAGE) followed by protein staining in order to visualize the oligoclonal bands. Capillary zone electrophoresis (CZE) was evaluated as an alternative method. Separation of CSF and serum proteins from 54 patients in a bare silica capillary containing a high pH borate buffer allowed for resolution of the five major zones including the gamma-region and showed a 90% concordance with the results from HRAGE banding studies. Since a simple borate buffer did not provide adequate resolution of the oligoclonal bands in the gamma-region, the separation buffer was augmented with polyethylene glycol (PEG) which provided a significant enhancement in resolution of proteins in this region (24 patient study). In addition to obtaining banding information from electropherograms obtained with these separation conditions, it was feasible to calculate a CSF Index which compared favorably with the results from nephelometry. Finally, we show that zwitterionic additives such as O-phosphorylethanolamine may further enhance resolution and that capallary electrophoresis (CE) may allow oligoclonal banding information to be obtained directly from CSF without concentration.

Buffers↗
PubMed1998

Prospective study of serum protein capillary zone electrophoresis and immunotyping of monoclonal proteins by immunosubtraction.

Capillary zone electrophoresis and immune adsorption were evaluated for identification of serum protein abnormalities and immunotyping of monoclonal proteins. A 7-capillary, electrophoresis instrument and solid phase immunosubtraction reagents were used in a prospective study of 1,518 patients. Serum protein electrophoresis was performed by agarose gel electrophoresis and capillary electrophoresis and interpreted with regard to identification of abnormalities consistent with monoclonal gammopathies. The agarose gel electrophoresis had a sensitivity and specificity of 91% and 99%, respectively, whereas capillary electrophoresis gave results of 95% and 99%. Immunotyping of the monoclonal proteins was performed by immunofixation and immunosubtraction. Capillary electrophoresis was more sensitive than agarose gel electrophoresis for the identification of monoclonal proteins in serum. In addition, the immunosubtraction method seems technically simpler and more automated than immunofixation and represents a useful additional approach for immunotyping monoclonal proteins.

Antibodies, Monoclonal↗
PubMed1997

Identification of monoclonal proteins in serum: a quantitative comparison of acetate, agarose gel, and capillary electrophoresis.

A selected group of 308 sera were analyzed by capillary electrophoresis (CE), agarose gel electrophoresis (AGE), and cellulose acetate electrophoresis (CAE) and evaluated for abnormalities that would suggest the presence of a monoclonal protein. The sensitivity (an electrophoretic abnormality in sera that contained a monoclonal protein) and specificity (a normal electrophoretic pattern in sera that did not contain a monoclonal protein) was determined for each electrophoretic procedure. CAE was the most specific procedure and CE was the most sensitive. The increase in sensitivity of CE was primarily due to increased detection of cryoglobulins and free light chains. The quantitation of the gamma region and/or monoclonal antibody peaks by CE was similar to results obtained by AGE. Quantitation of very large monoclonal protein peaks (> 3.0 g/dL) by on-line absorption detection (CE) yielded higher results than quantitation by dye-binding (AGE).

Acetic Acid↗
PubMed1993

Determinants of participation in state-of-the-art cancer prevention, early detection/screening, and treatment trials among African-Americans.

It has been suggested that the greatest potential for reducing cancer mortality in high-risk populations may be realized through aggressive implementation of prevention, diagnostic, and state-of-the-art treatment programs and increasing participation in cancer trials. However, the national data suggest that African-Americans are most often underrepresented in such programs and/or trials. Multiple factors are assumed to contribute to this situation, but currently few studies have been conducted to validate their influence. A study focused on identifying factors that contribute to participation of African-Americans in investigational cancer programs and/or trials was therefore conducted. Two hundred twenty African-American men and women were recruited to participate in a regional survey. There was evidence to support the impact that perceptions, attitudes, and beliefs have on willingness to participate in investigational programs and/or trials. The factor having the greatest influence on willingness to participate in investigational programs and/or trials was perceived efficacy of the investigational programs and/or trials. Among this sample there was an apparent hesitancy of many to participate in research programs and/or trials. The prevailing belief that such programs and/or trials were only for those with the disease or condition under study appeared to influence their response. However, when provided information on the opportunities for participation in prevention, diagnostic, and treatment programs and/or projects for those within the general community (especially for those at higher risk) and on the benefits of participation, a much greater willingness to participate was expressed by participants.

Adolescent↗