Knowledge and attitudes towards TB among healthcare workers in Yogyakarta, Indonesia

SETTING:

Healthcare workers (HCWs) are at an increased risk of TB worldwide. Individual knowledge and attitudes may influence HCW behaviour, and subsequently, TB risk. Indonesia has the second highest case-load globally.

OBJECTIVE:

To measure TB knowledge and attitudes among a subsection of HCWs in Yogyakarta, Indonesia, and to explore factors associated with knowledge.

DESIGN:

A cross-sectional study using an online survey targeting all HCW staff was conducted among HCWs from four pre-selected healthcare facilities in Yogyakarta. Descriptive analysis and a multivariable linear regression were undertaken.

RESULTS:

Of 792 HCWs, 290 (37%) completed the survey; 64% (n = 185) were medical staff, 33% (n = 95) reported previously being tested for active TB and 8% (n = 24) for latent TB. The mean knowledge score was 7.2/11 (SD 1.5): this was higher among medical staff and those with university education (average score increase: 0.53, 95% CI 0.15 to 0.90; and 0.38, 95% CI 0.01 to 0.74, respectively). Participants agreed that free access to TB screening (93%) and treatment (93%) should be available, and 57% of medical and 77% of non-medical staff would take preventive therapy if eligible.

CONCLUSION:

Participants had practical understanding of TB; however, gaps were identified in knowledge about TB disease progression and prevention. Prevention programmes were viewed positively. We suggest further TB education and engagement programmes for HCWs.

Origins and spread of novel genetic variants of sulfadoxine-pyrimethamine resistance in Plasmodium falciparum isolates in Indonesia

Background

While malaria incidence in Indonesia has decreased threefold in the last decade, more than 200,000 cases were reported in 2016. Different endemicity of Plasmodium falciparum malaria among several islands in Indonesia has been recognized and two unique mutations of P. falciparum dihydropteroate synthase (pfdhps) affecting sulfadoxine–pyrimethamine (SP) resistance were detected from the research of SP efficiency and genotype analysis in South Kalimantan. In this study, geographical distribution and origin of these pfdhps K540T and I588F mutations were analysed.

Methods

Malaria parasites DNA from several endemic areas in Indonesia; Sumatera, Java, Kalimantan, Lombok, Sumbawa, Timor, Sulawesi, and Papua islands; in two periods, 2004–2006 and 2009–2012 were subjected for pfdhfr and pfdhps sequence analysis.

Results

Different genotype polymorphisms of pfdhfr and pfdhps were observed in the parasites from various regions in Indonesia and relatively more divergent genotypes were determined from Kalimantan isolates in both 2004–2006 and 2009–2012. The parasites containing K540T mutation were identified in 2004–2006 isolates from East Kalimantan, East Java and Sumbawa as an SGTGA haplotype. The other I588F mutation was also determined in 2004–2006 parasites, isolated from Lombok and Sumbawa islands as an SGEAA(588F) haplotype. The parasites with pfdhfr/pfdhps quintuple or sextuple mutation, a genotype marker of SP resistance, were determined mostly in Kalimantan in both 2004–2006 and 2009–2012.

Conclusion

Analysis of the prevalence and pfdhfr/pfdhps combined genotypes of K540T or I588F mutations suggested that K540T might be origin in Kalimantan Island and I588F in Sumbawa Island and then these were spread to other areas along with people movement. This research indicates regular monitoring of drug efficacy and parasite genotype analysis is important to keep efficiency and prevent the spread of resistance. It is also essential for the latest anti-malarial drug artemisinin-based combination therapy.

Release of hydrophilic drug from biodegradable polymer blends

This paper reports on the release behavior of the drug lidocaine-HCl from a immiscible polymeric blend. Biodegradable polymer blends of poly(L-lactic acid)/poly(lactic-co-glycolic acid) (PLLA/PLGA) were loaded with lidocaine-HCl, and the release of lidocaine-HCl from these blends was monitored. It was found that the release profiles were significantly affected by the affinity and subsequent partitioning of the drug into one of the two phases in the blends. It was hypothesized that the hydrophilic lidocaine-HCl seems to have a tendency to reside in the PLGA component of the PLLA/PLGA blend. This resulted in a release very much controlled by the degradation of PLGA, even when PLLA is the major phase of the blend. A mathematical model was further employed to quantify the partitioning, as well as model the lidocaine-HCl release profiles of different blend compositions.

Epicorneal aspergilloma after penetrating keratoplasty

PURPOSE

To report an epicorneal aspergilloma in a postkeratoplasty patient with a bandage soft contact lens.

METHODS

Case report of a 77-year-old postkeratoplasty patient who presented with an epicorneal mass under a bandage soft contact lens placed for a nonhealing epithelial defect. On removal of the contact lens, a 4 x 4-mm placoid mass fell free from the corneal surface and was sent for culture and histopathology.

RESULTS

Gram stain demonstrated septated branching hyphae, and cultures confirmed the diagnosis of Histopathologic sections of the epicorneal mass revealed a full-thickness aspergilloma.

CONCLUSION

Contact lens removal and aggressive antimycotic treatment resulted in epithelial healing and resolution of the keratomycosis. The patient remained stable for 6 months followed by a successful repeat penetrating keratoplasty.

Refractive-Index Changes of Standard Telecommunication Fiber through Exposure to Femtosecond Laser Pulses at 810 cm

We report on permanent refractive-index changes as great as 6 x 10(-3) in standard fibers on irradiation with tightly focused femtosecond (120-fs) near-IR (lambda = 800-nm) pulses. The refractive-index increase was measured through changes in the transmission spectrum of an UV photowritten Bragg-grating-based Fabry-Perot interferometer. We depict the dependence of the index variation on exposure time. The changes in refractive index can be optimized after a few seconds of irradiation. The measured induced excess loss increases during near-IR exposure.

Temperature-induced reversible changes in the spectral characteristics of fiber Bragg gratings

It is reported that reversible changes in the reflectivity of Bragg gratings can be induced by a change in the temperature of the grating (77 K < T < K). The changes have proved to be greater in highly doped Ge fibers than in standard fibers, whereas they could hardly be detected in hydrogenated fibers. The sign of the change for type I gratings was opposite that for type IIA gratings. The changes are likely due to a temperature-induced increase (or a decrease) in the amplitude of the refractive-index modulation. Possible mechanisms for these changes in modulation are discussed. Interestingly for the purpose of correcting data of isothermal accelerated aging experiments, a numerical relation that accounts for the temperature-induced changes in type I grating reflectivity is given.

Therapeutic effects of oral zinc in acute and persistent diarrhea in children in developing countries: pooled analysis of randomized controlled trials

BACKGROUND

Zinc deficiency is prevalent in children in developing countries. Supplemental zinc provides therapeutic benefits in diarrhea.

OBJECTIVE

We sought to measure the effect of supplemental zinc given with oral rehydration therapy during recovery from acute or persistent diarrhea.

DESIGN

We conducted pooled analyses including all available published and unpublished randomized controlled trials of the effects of supplementary oral zinc in children aged <5 y with acute or persistent diarrhea. We used Cox survival regression analysis to evaluate the overall effect of zinc on continuation of diarrhea and possible differential effects in subgroups divided by sex, age, weight-for-height, and initial plasma zinc concentration. Dichotomous outcomes were analyzed by logistic regression. To assess the effects of excluding studies without original data from the pooled analyses, effect-size was estimated for all studies by using random-effects models.

RESULTS

Zinc-supplemented children had a 15% lower probability of continuing diarrhea on a given day (95% CI: 5%, 24%) in the acute-diarrhea trials and a 24% lower probability of continuing diarrhea (95% CI: 9%, 37%) and a 42% lower rate of treatment failure or death (95% CI: 10%, 63%) in the persistent-diarrhea trials. In none of the subgroup analyses were the 2 subgroups of each pair significantly different from each other; however, in persistent diarrhea there tended to be a greater effect in subjects aged <12 mo, who were male, or who had wasting or lower baseline plasma zinc concentrations.

CONCLUSION

Zinc supplementation reduces the duration and severity of acute and persistent diarrhea.

A comparative clinicopathologic study of endogenous mycotic endophthalmitis: variations in clinical and histopathologic changes in candidiasis compared to aspergillosis

PURPOSE

Endophthalmitis caused by endogenous Candida and Aspergillus species has emerged as a visually threatening complication in patients with immune deficiency of various causes. Twenty-five patients who underwent enucleation, 13 with endogenous Aspergillus endophthalmitis and 12 with endogenous Candida intraocular infections, were evaluated. Both clinical features and intraocular spread of the fungi were studied to determine which clinical and/or histopathologic features could help distinguish aspergillosis from Candida infections.

METHODS

Clinical information was sought from each case to determine whether there was any underlying systemic condition and to delineate the characteristic clinical features seen at initial presentation. The results of vitreous and other tissue cultures for bacteria and fungi were evaluated. Patients with AIDS were excluded. The enucleated globes were processed for histopathologic analysis to detect location of the fungal elements, inflammatory response, and vascular invasion by the fungi.

RESULTS

With respect to the various predisposing systemic conditions, Candida species endophthalmitis was noted in patients with a history of gastrointestinal surgery, hyperalimentation, or diabetes mellitus, whereas aspergillosis was present in patients who had undergone organ transplantation or cardiac surgery. The vitreous was the primary focus of infection for Candida, whereas subretinal or sub-retinal pigment epithelium infection was noted in eyes with aspergillosis. Retinal and choroidal vessel wall invasion by fungal elements was noted in cases of aspergillosis but not in cases with candidiasis. The high rate of cerebral and cardiac infection in patients with Aspergillus endophthalmitis was not seen in those with Candida infection.

CONCLUSIONS

The present study indicates that unlike Candida endophthalmitis, aspergillosis is seen in organ transplant or cardiac surgery patients, and its initial clinical presentation includes extensive areas of deep retinitis/choroiditis. Contrary to the findings in Candida endophthalmitis, vitreous biopsy may not yield positive results in aspergillosis. Aspergillus endophthalmitis is usually associated with a high rate of mortality caused by cerebral and cardiac complications.

Prevention of diarrhea and pneumonia by zinc supplementation in children in developing countries: pooled analysis of randomized controlled trials. Zinc Investigators' Collaborative Group

OBJECTIVES

This study assessed the effects of zinc supplementation in the prevention of diarrhea and pneumonia with the use of a pooled analysis of randomized controlled trials in children in developing countries.

STUDY DESIGN

Trials included were those that provided oral supplements containing at least one half of the United States Recommended Daily Allowance (RDA) of zinc in children <5 years old and evaluated the prevention of serious infectious morbidity through household visits. Analysis included 7 "continuous" trials providing 1 to 2 RDA of elemental zinc 5 to 7 times per week throughout the period of morbidity surveillance and 3 "short-course" trials providing 2 to 4 RDA daily for 2 weeks followed by 2 to 3 months of morbidity surveillance. The effects on diarrhea and pneumonia were analyzed overall and in subgroups defined by age, baseline plasma zinc concentration, nutritional status, and sex. The analysis used random effects hierarchical models to calculate odds ratios (OR) and 95% CIs.

RESULTS

For the zinc-supplemented children compared with the control group in the continuous trials, the pooled ORs for diarrheal incidence and prevalence were 0.82 (95% CI 0.72 to 0.93) and 0.75 (95% CI 0.63 to 0.88), respectively. Zinc-supplemented children had an OR of 0.59 (95% CI 0.41 to 0.83) for pneumonia. No significant differences were seen in the effects of the zinc supplement between the subgroups examined for either diarrhea or pneumonia. In the short-course trials the OR for the effects of zinc on diarrheal incidence (OR 0.89, 95% CI 0.62 to 1.28) and prevalence (OR 0.66, 95% CI 0.52 to 0.83) and pneumonia incidence (OR 0.74, 95% CI 0.40 to 1.37) were similar to those in the continuous trials.

CONCLUSIONS

Zinc supplementation in children in developing countries is associated with substantial reductions in the rates of diarrhea and pneumonia, the 2 leading causes of death in these settings.

Amperometric detection of organic thiols at a tungsten wire electrode following their separation by liquid chromatography

The amperometric detection of thiols following their separation by reversed-phase chromatography and reaction into a post-column mercury carrier stream is shown to be a sensitive method when using a tungsten wire sensor as the working electrode in a three-electrode flow cell. Five organic thiols (cysteine, homocysteine, reduced glutathione, D,L-penicillamine and 2-mercaptopropionic acid) and thiourea could be separated within approx. 18 min. The analytical performance is comparable, and stability superior, to chemically modified electrodes previously reported.

The histopathology and the mechanism of entropion in patients with trachoma

BACKGROUND

Eyelids of patients with trachoma may be thickened. This thickening could be attributed to trachomatous changes in the conjunctiva and tarsus.

METHODS

Biopsies of tarsal plates and palpebral conjunctivae were obtained from 17 upper eyelids of 11 patients with inactive trachoma who underwent posterior tarsotomy procedures for entropion repair.

RESULTS

Light microscopy studies showed a thick and compact subepithelial fibrous membrane adherent to the tarsal plate. This membrane caused apparent thickening of the tarsus when measured intraoperatively (range, 1.25-2.00 mm). Other histopathologic findings include atrophy of the meibomian glands with thickening of the acinar basement membrane, loss of goblet cells, retention cysts, and hyaline degeneration of the tarsal plate with focal replacement by adipose tissue.

CONCLUSION

The contraction of the subepithelial fibrous membrane formed by vertically oriented parallel collagen fibers is one of the main factors contributing to the entropion formation.

Ciliary body melanoma with optic nerve invasion

A case of melanoma of the ciliary body is presented. Initially the patient was diagnosed and treated for uveitis, but following CT scanning and ultrasound a tumour was detected and the eye enucleated. Histopathologically it was found that the tumour had invaded the optic nerve head, apparently via Cloquet's canal.

Pleomorphic adenocarcinoma of ciliary epithelium simulating an epibulbar tumor

A 72-year-old woman had epibulbar nodules and a blind eye following trauma in childhood. Histologic examination disclosed a pleomorphic adenocarcinoma of ciliary epithelium with invasion of the epibulbar region, retina, retinal pigment epithelium, and optic nerve. The diagnosis was confirmed by histochemical stains and electron microscopy. The pigmented and nonpigmented neoplastic cells of the ciliary epithelium had a patchy basement membrane around the cell membrane and produced hyaluronic acid in the stroma.

Retinoblastoma: the Saudi Arabian experience

During the period March 1983-May 1987, 74 cases of retinoblastoma were evaluated at the King Khaled Eye Specialist Hospital in Riyadh, Saudi Arabia. 60% of the cases were unilateral with a female preponderance of 59.4% noted for this series. Additionally, the mean age at diagnosis was 22 months, and delay of retinoblastoma diagnosis since the first symptoms were observed ranged from two days to 36 months. Fifty-seven eyes were enucleated, and in 21 of these patients, this was the sole form of therapy. The remainder of patients were treated with radiotherapy alone or combined with chemotherapy, cryotherapy/photocoagulation. Overall, two-year survival statistics of this group of Saudi patients is 80% which compares favorably to other reports in the West. Emphasis is placed on management of the retinoblastoma patients by a multi-disciplinary group, and public educational efforts are imperative.

Conjunctival myxoma: a case report

A rare case of conjunctival myxoma in an 18-year-old female is reported. Clinically it presented as a painless mass located in the nasal bulbar conjunctiva. It was composed of spindle and stellate shaped cells in a loose mucoid stroma. Some of the cells had intracytoplasmic vacuoles consistent with dilated rough endoplasmic reticulum and/or intranuclear vacuoles of nuclear membrane invaginations. Mast cells were also seen in the stroma. No recurrence has been reported eight months postoperatively.

Conjunctival synthetic fiber granuloma. A lesion that resembles conjunctivitis nodosa

Histopathologic examination of forniceal conjunctival lesions excised from five young patients revealed granulomatous inflammation surrounding filamentous foreign material. Polarization microscopy, special histochemical stains, scanning electron microscopy and energy dispersive x-ray elemental analysis identified the inciting material as predominantly synthetic fabric fiber. Three of these cases initially were diagnosed as conjunctivitis nodosa, an inflammatory reaction to caterpillar setae. Many synthetic fibers contained numerous granules of titanium, barium, or zinc delustering agent, which served to differentiate them from natural fibers or caterpillar hairs. Synthetic fabric fiber is a previously unrecognized cause of conjunctival inflammatory mass lesions.

Retinocytoma. A benign variant of retinoblastoma

Six examples of a distinctive benign retinal tumor, occurring in five children and treated only by enucleation, were studied by light and electron microscopy and tested for S-100 protein, a glial-cell tissue marker. The small placoid, noninvasive lesions were composed entirely of benign-appearing cells with numerous fleurettes. These tumors showed no necrosis or mitotic activity. Ultrastructurally, they were composed predominantly of neuronal cells exhibiting photoreceptor differentiation. Some tumor cells had cytologic features of Müller's fibers and other glial cells that in one lesion stained positively for S-100 protein. In two patients there was a family history of retinoblastoma. All children were alive and well at follow-up examinations conducted three to 14 years after enucleation. To expand our concept of retinoblastoma to include this benign variant, we propose the term "retinocytoma." Although clinically and morphologically distinct from retinoblastoma, retinocytoma should carry the same genetic implication as its malignant counterpart.

Diffuse iris nevus manifested by unilateral open angle glaucoma

Uncontrolled unilateral glaucoma developed in the right eye of a 24-year-old woman. It was caused by the diffuse growth of a nonpigmented nevus of the iris into the anterior chamber angle. Histologically, the nonpigmented nevus cells in the angle were distinguishable from a proliferation of corneal endothelium. Clinically, there was no heterochromia, and a tumor was not suspected as the cause of the glaucoma.

Adenocarcinoma of the small bowel in association with regional enteritis. Four new cases

Four cases of carcinoma of the small bowel following chronic regional enteritis are presented. Search of the medical literature revealed 31 other cases reported up to the present. We must entertain the possibility that chronic regional enteritis may predispose to the development of cancer of the small bowel.