Removal of organic pollutants through hydroxyl radical-based advanced oxidation processes

The use of Advance Oxidation Process (AOPs) has been extensively examined in order to eradicate organic pollutants. This review assesses the efficacy of photolysis, O3 based (O3/UV, O3/H2O2, O3/H2O2/UV, H2O2/UV, Fenton, Fenton-like, hetero-system) and sonochemical and electro-oxidative AOPs in this regard. The main purpose of this review and some suggestions for the advancement of AOPs is to facilitate the elimination of toxic organic pollutants. Initially proposed for the purification of drinking water in 1980, AOPs have since been employed for various wastewater treatments. AOPs technologies are essentially a process intensification through the use of hybrid methods for wastewater treatment, which generate large amounts of hydroxyl (•OH) and sulfate (SO4·-) radicals, the ultimate oxidants for the remediation of organic pollutants. This review covers the use of AOPs and ozone or UV treatment in combination to create a powerful method of wastewater treatment. This novel approach has been demonstrated to be highly effective, with the acceleration of the oxidation process through Fenton reaction and photocatalytic oxidation technologies. It is clear that Advance Oxidation Process are a helpful for the degradation of organic toxic compounds. Additionally, other processes such as •OH and SO4·- radical-based oxidation may also arise during AOPs treatment and contribute to the reduction of target organic pollutants. This review summarizes the current development of AOPs treatment of wastewater organic pollutants.

Magnetic nanocomposite of maize offal biomass for effective sequestration of Congo red and methyl orange dyes from contaminated water: modeling, kinetics and reusability

The current study aims to use a facile and novel method to remove Congo red (CR) and Methyl Orange (MO) dyes from contaminated water with Maize offal biomass (MOB) and its nanocomposite with magnetic nanoparticles (MOB/MNPs). The MOB and MOB/MNPs were characterized with Fourier-transform infrared (FTIR), scanning electron microscopy (SEM), BET, XRD and point of zero charge (pHPZC). The influence of initial CR and MO levels (20-320 mg/L), adsorbent dosage (1-3 g/L), pH (3-9), co-exiting ions, temperature (25-45 °C) and time (15-180 min) was estimated. The findings demonstrated that MOB/MNPs exhibited excellent adsorption of 114.75 and 29.0 mg/g for CR and MO dyes, respectively while MOB exhibited 81.35 and 23.02 mg/g adsorption for CR and MO dyes, respectively at optimum pH-5, and dose 2 g/L. Initially, there was rapid dye removal which slowed down until equilibrium was reached. The interfering/competing ions in contaminated water and elevated temperature favored the dyes sequestration. The MOB/MNPs exhibited tremendous reusability and stability. The dyes adsorption was spontaneous, and exothermic with enhanced randomness. The adsorption effects were well explained with Freundlich model, pseudo second order and Elovich models. It is concluded that MOB/MNPs showed excellent, eco-friendly, and cost-effective potential to decontaminate the water.

Heavy metals in five commonly consumed fish species from River Swat, Pakistan, and their implications for human health using multiple risk assessment approaches

This study analyzed the levels of heavy metals bioaccumulation in commonly consumed riverine fish species, including G. cavia, T. macrolepis, G. gotyla, S. plagiostomus, and M. armatus from River Swat in Pakistan, and quantify their potential risk to children and adults in general and fisherfolk communities using multiple pollution and risk assessment approaches. The highest metal detected by inductive coupled plasma mass spectrometry (ICP-MS) was Zn, which ranged from 49.61 to 116.83 mg/kg, followed by Fe (19.25-101.33 mg/kg) > Mn (5.25-40.35 mg/kg) > Cr (3.05-14.59 mg/kg) > Ni (4.26-11.80 mg/kg) > Al (1.59-12.25 mg/kg) > Cu (1.24-8.59 mg/kg) > Pb (0.29-1.95 mg/kg) > Co (0.08-0.46 mg/kg) > Cd (0.01-0.29 mg/kg), demonstrating consistent fluctuation with the safe recommendations of global regulatory bodies. The average bioaccumulation factor (BAF) values in the examined fish species were high (BAF > 5000) for Pb, Zn, Mn, Cu, Cr, Ni, and Cd, bioaccumulate (1000 > BAF < 5000) for Co, and probable accumulative (BAF <1000) for Fe, and Al, while the overall ∑heavy metals pollution index (MPI) values were greater than one (MPI > 1) indicating sever heavy metals toxicity in G. cavia, followed by S. plagiostomus, M. armatus, G. gotyla, and T. macrolepis. The multivariate Pearson's correlation analysis identified the correlation coefficients between heavy metal pairs (NiCr, CuCr, PbCr, AlCo, CuNi, and PbNi), the hierarchical cluster analysis (CA) determined the origin by categorizing heavy metal accumulation into Cluster-A, Cluster-B, and Cluster-C, and the principal component analysis (PCA) discerned nearby weathering, mining, industrial, municipal, and agricultural activities as the potential sources of heavy metals bioaccumulation in riverine fish. As per human risk perspective, S.plagiostomus contributed significantly to the estimated daily intake (EDI) of heavy metals, followed by G.cavia > M.armatus > G.gotyla > T.macrolepis in dependent children and adults of the fisherfolk followed by the general population. The non-carcinogenic target hazard quotient (THQ) and hazard index (HI) values for heavy metal intake through fish exposure were < 1, while the carcinogenic risk (CR) for individual metal intake and the total carcinogenic risk (TCR) for cumulative Cr, Cd, and Pb intake were within the risk threshold of 10-6-10-4, suggesting an acceptable to high non-carcinogenic and carcinogenic risk for both children and adults in the fisherfolk, followed by the general population.

Brief review: Applications of nanocomposite in electrochemical sensor and drugs delivery

The recent advancement of nanoparticles (NPs) holds significant potential for treating various ailments. NPs are employed as drug carriers for diseases like cancer because of their small size and increased stability. In addition, they have several desirable properties that make them ideal for treating bone cancer, including high stability, specificity, higher sensitivity, and efficacy. Furthermore, they might be taken into account to permit the precise drug release from the matrix. Drug delivery systems for cancer treatment have progressed to include nanocomposites, metallic NPs, dendrimers, and liposomes. Materials’ mechanical strength, hardness, electrical and thermal conductivity, and electrochemical sensors are significantly improved using nanoparticles (NPs). New sensing devices, drug delivery systems, electrochemical sensors, and biosensors can all benefit considerably from the NPs’ exceptional physical and chemical capabilities. Nanotechnology is discussed in this article from a variety of angles, including its recent applications in the medical sciences for the effective treatment of bone cancers and its potential as a promising option for treating other complex health anomalies via the use of anti-tumour therapy, radiotherapy, the delivery of proteins, antibiotics, and vaccines, and other methods. This also brings to light the role that model simulations can play in diagnosing and treating bone cancer, an area where Nanomedicine has recently been formulated. There has been a recent uptick in using nanotechnology to treat conditions affecting the skeleton. Consequently, it will pave the door for more effective utilization of cutting-edge technology, including electrochemical sensors and biosensors, and improved therapeutic outcomes.

Potential of magnetic quinoa biosorbent composite and HNO3 treated biosorbent for effective sequestration of chromium (VI) from contaminated water

The present study aims to prepare novel quinoa biosorbent (QB), acid activated QB (QB/Acid) and its nanocomposite with magnetic nanoparticles (QB/MNPs) for batch scale Cr removal from contaminated water. The Cr adsorption was systematically studied at different pH (2-9), adsorbent dosage (1-3 g/L), initial concentration (25-200 mg/L), contact time (180 min) and competing ions in water. Maximum Cr adsorption was observed onto QB/MNPs (57.4 mg/L), followed by QB/Acid (46.35 mg/g) and QB (39.9 mg/g). The Cr removal by QB/MNPs was higher than QB/Acid and QB. Results revealed that the highest Cr removal was obtained at optimum pH 4, 25 mg/L, and 2 g/L dosage. The FTIR spectra displayed various functional groups on adsorbents surface serving as a potential scaffold to remove Cr from contaminated water. The equilibrium and kinetic Cr adsorption data best fitted with Freundlich and pseudo-second order models, respectively (R² ≥ 0.96). The QB/MNPs showed excellent reusability in five adsorption/desorption cycles (4.7% decline) with minor leaching of Fe (below threshold level). The coexisting ions in groundwater showed an inhibitory effect on Cr sequestration (5%) from water. The comparison of Cr adsorption by QB/MNPs and QB/Acid showed better potential for Cr sequestration than various previously explored adsorbents in the literature.

Cobalt and nitrogen co-doped monolithic carbon foam for ultrafast degradation of emerging organic pollutants via peroxymonosulfate activation

Cobalt-based catalysts are expected as one of the most promising peroxymonosulfate (PMS) activators for the removal of organic pollutants from industrial wastewater. However, the easy agglomeration, difficult separation, and secondary pollution of cobalt ions limit their practical application. In this study, a novel, highly efficient, reusable cobalt and nitrogen co-doped monolithic carbon foam (Co-N-CMF) was utilized to activate PMS for ultrafast pollutant degradation. Co-N-CMF (0.2 g/L) showed ultrafast catalytic kinetics and higher total organic carbon (TOC) removal efficiency. Bisphenol A, ciprofloxacin, 2,4-dichlorophenoxyacetic acid, and 2,4-dichlorophenol could be completely degraded after 2, 4, 5, and 5 min, and the TOC removal efficiencies were 77.4 %, 68.9 %, 72.8 %, and 79.8 %, respectively, corresponding to the above pollution. The sulfate radical (SO4•-) was the main reactive oxygen species in Co-N-CMF/PMS based on electron paramagnetic resonance. The ecological structure-activity relationship program analysis via the quantitative structure activity relationship analysis and phytotoxicity assessment revealed that the Co-N-CMF/PMS system demonstrates good ecological safety and ecological compatibility. The Co-N-CMF catalyst has good catalytic activity and facile recycling, which provides a fine method with excellent PMS activation capacity for 2,4-dichlorophenol elimination from simulated industrial wastewater. This study provides new insights into the development of monolithic catalysts for ultrafast wastewater treatment via PMS activation.

Photocatalytic response in water pollutants with addition of biomedical and anti-leishmanial study of iron oxide nanoparticles

Public health is a major concern globally, owing to the presence of industrial dyes in the effluent. Nanoparticles with green synthesis are an enthralling research field with various applications. This study deals with investigating the photocatalytic potential of Fe-oxide nanoparticles (FeO-NPs) for the degradation of methylene blue dye and their potential biomedical investigations. Biosynthesis using Anthemis tomentosa flower extract showed to be an effective method for the synthesis of FeO-NPs. The freshly prepared FeO-NPs were characterized through UV/Vis spectroscopy showing clear peak at 318 nm. The prepared FeO-NPs were of smaller size and spherical shape having large surface area and porosity with no aggregations. The FeO-NPs were characterized using XRD, FTIR, HRTEM, SEM and EDX. The HRTEM results showed that the particle size of FeO-NPs was 60-90 nm. The antimicrobial properties of FeO-NPs were investigated against two bacterial Staphylococcus aureus 13 (±0.8) and Klebsiella pneumoniae 6(±0.6) and three fungal species Aspergillus Niger, Aspergillus flavus, and Aspergillus fumigatus exhibiting a maximum reduction of 57% 47% and 50%, respectively. Moreover, FeO-NPs exhibited high antioxidant properties evaluated against ascorbic acid. Overall, this study showed high photocatalytic, antimicrobial, and antioxidant properties of FeO-NPs owing to their small size and large surface area. However, the ecotoxicity study of methylene blue degradation products showed potential toxicity to aquatic organisms.

Potential of nanocomposites of zero valent copper and magnetite with Eleocharis dulcis biochar for packed column and batch scale removal of Congo red dye

The current study is the first attempt to prepare nanocomposites of Eleocharis dulcis biochar (EDB) with nano zero-valent Copper (nZVCu/EDB) and magnetite nanoparticles (MNPs/EDB) for batch and column scale sequestration of Congo Red dye (CR) from synthetic and natural water. The adsorbents were characterized with advanced analytical techniques. The impact of EDB, MNPs/EDB and nZVCu/EDB dosage (1-4 g/L), pH (4-10), initial concentration of CR (20-500 mg/L), interaction time (180 min) and material type to remove CR from water was examined at ambient temperature. The CR removal followed sequence of nZVCu/EDB > MNPs/EDB > EDB (84.9-98% > 77-95% > 69.5-93%) at dosage 2 g/L when CR concentration was increased from 20 to 500 mg/L. The MNPs/EDB and nZVCu/EDB showed 10.9% and 20.1% higher CR removal than EDB. The adsorption capacity of nZVCu/EDB, MNPs/EDB and EDB was 212, 193 and 174 mg/g, respectively. Freundlich model proved more suitable for sorption experiments while pseudo 2nd order kinetic model well explained the adsorption kinetics. Fixed bed column scale results revealed excellent retention of CR (99%) even at 500 mg/L till 2 h when packed column was filled with 3.0 g nZVCu/EDB, MNPs/EDB and EDB. These results revealed that nanocomposites with biochar can be applied efficiently for the decontamination of CR contaminated water.

Trends in TB and HIV care and treatment cascade, Kenya, 2008-2018

BACKGROUND: HIV infection is associated with high mortality among people with TB. Antiretroviral therapy (ART) reduces TB incidence and mortality among people living with HIV (PLHIV). Since 2005, Kenya has scaled up TB and HIV prevention, diagnosis and treatment. We evaluated the impact of these services on trends and TB treatment outcomes.METHODS: Using Microsoft Excel (2016) and Epi-Info 7, we analysed Kenya Ministry of Health TB surveillance data from 2008 to 2018 to determine trends in TB notifications, TB classification, HIV and ART status, and TB treatment outcomes.RESULTS: Among the 1,047,406 people reported with TB, 93% knew their HIV status, and 37% of these were HIV-positive. Among persons with TB and HIV, 69% received ART. Between 2008 and 2018, annual TB notifications declined from 110,252 to 96,562, and HIV-coinfection declined from 45% to 27%. HIV testing and ART uptake increased from 83% to 98% and from 30% to 97%, respectively. TB case fatality rose from 3.5% to 3.9% (P <0.018) among HIV-negative people and from 5.1% to 11.2% (P <0.001) among PLHIV on ART.CONCLUSION: TB notifications decreased in settings with suboptimal case detection. Although HIV-TB services were scaled-up, HIV-TB case fatality rose significantly. Concerted efforts are needed to address case detection and gaps in quality of TB care.

Effect of statin on progression of degenerative aortic root dilatation

Background

Aortic root dilatation (ARD) is the most common thoracic aortic aneurysm (TAA). Causes of TAA include congenital and heritable disorders, degenerative disorders, inflammatory and infectious etiologies (1.) Hypertension management and smoking cessation are the two most important risk factor modification strategies to prevent rapid progression (&gt;2 mm/year) of TAAs. Beta blockers and angiotensin receptor blockers are the preferred agents to treat HTN (5,6). Statin use is associated with a lower rate of progression of ascending arch and thoracoabdominal aortic aneurysms (2,3,4). However, their role in the progression of degenerative ARD remains unclear.

Purpose

To evaluate the association between statin use and progression of ARD.

Methods

A retrospective chart analysis was performed on 340 patients with a known diagnosis of degenerative ARD. Aortic root measurements were followed by serial transthoracic echocardiograms from the time of first diagnosis for a total of 10 years. The study population was dichotomized based on statin use. The mean change in ARD was calculated for each patient in millimeters. Baseline characteristics were compared between the groups. Multivariate adjusted linear regression models were used to estimate unit change in mean ARD change based on statin use.

Results

Patients in the statin group were older, more obese, with a higher prevalence of comorbidities and medication use compared to patients not on statin. Over a 10-year follow up, the mean increase in ARD was comparable for statin vs. non-statin users (0.83 mm vs. 0.73 mm, p=0.53). On a multivariate regression model adjusted for baseline demographics, risk factors and medication use, the statin group showed a 0.16 mm reduction in ARD compared to non-statin group but this decrease was not statistically significant (Table 1, p=0.47)

Conclusion

In patients with degenerative ARD on a pre-existing regimen of statin, there was no statistically significant change in ARD.

Funding Acknowledgement

Type of funding sources: None. Table 1

Arsenic biogeochemical cycling in paddy soil-rice system: Interaction with various factors, amendments and mineral nutrients

Arsenic (As) contamination is a well-recognized environmental and health issue, threatening over 200 million people worldwide with the prime cases in South and Southeast Asian and Latin American countries. Rice is mostly cultivated under flooded paddy soil conditions, where As speciation and accumulation by rice plants is controlled by various geo-environmental (biotic and abiotic) factors. In contrast to other food crops, As uptake in rice has been found to be substantially higher due to the prevalence of highly mobile and toxic As species, arsenite (As(III)), under paddy soil conditions. In this review, we discussed the biogeochemical cycling of As in paddy soil-rice system, described the influence of critical factors such as pH, iron oxides, organic matter, microbial species, and pathways affecting As transformation and accumulation by rice. Moreover, we elucidated As interaction with organic and inorganic amendments and mineral nutrients. The review also elaborates on As (im)mobilization processes and As uptake by rice under the influence of different mineral nutrients and amendments in paddy soil conditions, as well as their role in mitigating As transfer to rice grain. This review article provides critical information on As contamination in paddy soil-rice system, which is important to develop suitable strategies and mitigation programs for limiting As exposure via rice crop, and meet the UN's key Sustainable Development Goals (SDGs: 2 (zero hunger), 3 (good health and well-being), 12 (responsible consumption and production), and 13 (climate action)).

Can isoniazid preventive therapy be scaled up rapidly? Lessons learned in Kenya, 2014-2018

BACKGROUND: TB is the leading cause of mortality among people living with HIV (PLHIV), for whom isoniazid preventive therapy (IPT) has a proven mortality benefit. Despite WHO recommendations, countries have been slow in scaling up IPT. This study describes processes, challenges, solutions, outcomes and lessons learned during IPT scale-up in Kenya.METHODS: We conducted a desk review and analyzed aggregated Ministry of Health (MOH) IPT enrollment data from 2014 to 2018 to determine trends and impact of program activities. We further analyzed IPT completion reports for patients initiated from 2015 to 2017 in 745 MOH sites in Nairobi, Central, Eastern and Western Kenya.RESULTS: IPT was scaled up 75-fold from 2014 to 2018: the number of PLHIV covered increased from 9,981 to 749,890. The highest percentage increases in the cumulative number of PLHIV on IPT were seen in the quarters following IPT pilot projects in 2014 (49%), national launch in 2015 (54%), and HIV treatment acceleration in 2016 (158%). Among 250,069 patients initiating IPT from 2015 to 2017, 97.5% completed treatment, 0.2% died, 0.8% were lost to follow-up, 1.0% were not evaluated, and 0.6% discontinued treatment.CONCLUSIONS: IPT can be scaled up rapidly and effectively among PLHIV. Deliberate MOH efforts, strong leadership, service delivery integration, continuous mentorship, stakeholder involvement, and accountability are critical to program success.

Distribution and health risk assessment of trace elements in ground/surface water of Kot Addu, Punjab, Pakistan: a multivariate analysis

Water is a key component for living beings to sustain life and for socio-economic development. Anthropogenic activities contribute significantly to ground/surface water contamination particularly with trace elements. The present study was designed to evaluate distribution and health risk assessment of trace elements in ground/surface water of the previously unexplored area, Tehsil Kot Addu, Southern-Punjab, Pakistan. Ground/surface water samples (n = 120) were collected from rural and urban areas of Kot Addu. The samples were analyzed for physicochemical characteristics: total dissolved solids (TDS), pH, and EC (electrical conductivity), cations, anions, and trace elements particularly arsenic (As), lead (Pb), cadmium (Cd), and zinc (Zn). All of the water characteristics were evaluated based on the water quality standards set by World Health Organization (WHO). Results revealed the suitability of water for drinking purpose with respect to physicochemical attributes. However, the alarming levels of trace elements especially As, Cd, and Pb make it unfit for drinking purpose. Noticeably, 23, 96, and 98% of water samples showed As, Cd, and Pb concentrations higher than the permissible limits. Overall, the estimated carcinogenic and non-carcinogenic risk to the exposed community was higher than the safety level of USEPA, suggesting the probability of cancer and other diseases through long-term exposure via ingestion routes. Therefore, this study demonstrated an urgent need for water filtration/purification techniques, and some quality control measures are warranted to protect the health of the exposed community in Tehsil Kot Addu.

The effect of TB treatment on health-related quality of life for people with advanced HIV

BACKGROUND: Study A5274 was an open-label trial of people with HIV (PLHIV) with CD4 cell count <50 cells/µL who were randomized to empirical TB treatment vs. isoniazid preventive therapy (IPT) in addition to antiretroviral therapy (ART). We evaluated health-related quality of life (HRQoL) by study arm, changes over time, and association with sociodemographic and clinical factors.METHODS: Participants aged >13 years were enrolled from outpatient clinics in 10 countries. HRQoL was assessed at Weeks 0, 8, 24 and 96 with questions about daily activity, hospital or emergency room visits, and general health status. We used logistic regression to examine HRQoL by arm and association with sociodemographic and clinical factors.RESULTS: Among 850 participants (424 empiric arm, 426 IPT arm), HRQoL improved over time with no difference between arms. At baseline and Week 24, participants with WHO Stage 3 or 4 events, or those who had Grade 3 or 4 signs/symptoms, were significantly more likely to report poor HRQoL using the composite of four HRQoL measures.CONCLUSION: HRQoL improved substantially in both arms during the study period. These findings show that ART, TB screening, and IPT can not only reduce mortality, but also improve HRQoL in PLHIV with advanced disease.

Arsenic speciation and biotransformation pathways in the aquatic ecosystem: The significance of algae

The contamination of aquatic systems with arsenic (As) is considered to be an internationally-important health and environmental issue, affecting over 115 countries globally. Arsenic contamination of aquatic ecosystems is a global threat as it can enter the food chain from As-rich water and cause harmful impacts on the humans and other living organisms. Although different factors (e.g., pH, redox potential, iron/manganese oxides, and microbes) control As biogeochemical cycling and speciation in water systems, the significance of algal species in biotransformation of As is poorly understood. The overarching attribute of this review is to briefly elaborate various As sources and its distribution in water bodies and factors affecting As biogeochemical behavior in aqueous ecosystems. This review elucidates the intriguing role of algae in biotransformation/volatilization of As in water bodies under environmentally-relevant conditions. Also, we critically delineate As sorption, uptake, oxidation and reduction pathways of As by algae and their possible role in bioremediation of As-contaminated water (e.g., drinking water, wastewater). The current review provides the updated and useful framework for government and water treatment agencies to implement algae in As remediation programs globally.

Synthesis, characterization and application of novel MnO and CuO impregnated biochar composites to sequester arsenic (As) from water: Modeling, thermodynamics and reusability

The present study aimed at enhancing the adsorption potential of novel nanocomposites of Sesbania bispinosa biochar (SBC) with copper oxide (SBC/CuO) and manganese oxide nanoparticles (SBC/MnO) for the efficient and inexpensive removal of environmentally concerned contaminant arsenic (As) from contaminated water at batch scale. The scanning electron microscopy (SEM), Fourier transform infrared (FTIR) spectroscopy, energy dispersive X-ray (EDX), X-ray diffraction (XRD) and point of zero charge (PZC) analyses proved successful impregnation of the metallic nanoparticles on SBC surface. The results revealed the maximum As removal (96 %) and adsorption (12.47 mg/g) by SBC/CuO composite at 10 mg As/L, optimum pH-4, dose 1.0 g/L and ambient temperature (25 ± 1.5 °C) as compared with SBC (7.33 mg/g) and SBC/MnO (7.34 mg/g). Among four types of adsorption isotherms, Freundlich isotherm demonstrated best fit with R² > 0.997. While pseudo second-order kinetic model revealed better agreement with kinetic experimental data as matched with other kinetic models. The thermodynamic results depicted that As adsorption on the as-synthesized adsorbents was endothermic and spontaneous in nature with increased randomness. The SBC/CuO displayed excellent reusability and stability over four adsorption/desorption cycles and proved that the as-synthesized SBC/CuO composite may be the efficient adsorbent for practical removal of As from contaminated water.

Performance of Xpert® MTB/RIF and Determine™ TB-LAM Ag in HIV-infected adults in peri-urban sites in Zambia

Setting

Peri-urban health facilities providing HIV and TB care in Zambia.

Objective

To evaluate 1) the impact of Xpert^® MTB/RIF on time-to-diagnosis, treatment initiation, and outcomes among adult people living with HIV (PLHIV) on antiretroviral therapy (ART); and 2) the diagnostic performance of Xpert and Determine™ TB-LAM Ag assays.

Design

Quasi-experimental study design with the first cohort evaluated per standard-of-care (SOC; first sputum tested using smear microscopy) and the second cohort per an algorithm using Xpert as initial test (intervention phase; IP). Xpert testing was provided onsite in Chongwe District, while samples were transported 5-10 km in Kafue District. TB was confirmed using mycobacterial culture.

Results

Among 1350 PLHIV enrolled, 156 (15.4%) had confirmed TB. Time from TB evaluation to diagnosis (P = 0.018), and from evaluation to treatment initiation (P = 0.03) was significantly shorter for IP than for SOC. There was no difference in all-cause mortality (7.0% vs. 8.6%). TB-LAM Ag showed higher sensitivity with lower CD4 cell count: 81.8% at CD4 < 50 cells/mm³ vs. 31.7% overall.

Conclusion

Xpert improved time to diagnosis and treatment initiation, but there was no difference in all-cause mortality. High sensitivity of Determine TB-LAM Ag at lower CD4 count supports increased use in settings providing care to PLHIV, particularly with advanced HIV disease.

Withdrawal Notice: Electro-Catalytic process for the Synthesis of Organic Compounds and their Biological Applications

The article for the journal Current Organic Synthesis has been removed by the Publisher due to acute language inconsistencies and grammatical errors. Bentham Science apologizes to the readers of the journal for any inconvenience this may cause. The Bentham Editorial Policy on Article Withdrawal can be found at https://benthamscience.com/editorial-policies-main.php

Bentham Science Disclaimer

It is a condition of publication that manuscripts submitted to this journal have not been published and will not be simultaneously submitted or published elsewhere. Furthermore, any data, illustration, structure or table that has been published elsewhere must be reported, and copyright permission for reproduction must be obtained. Plagiarism is strictly forbidden, and by submitting the article for publication the authors agree that the publishers have the legal right to take appropriate action against the authors, if plagiarism or fabricated information is discovered. By submitting a manuscript, the authors agree that the copyright of their article is transferred to the publishers if and when the article is accepted for publication.

A new biochar from cotton stalks for As (V) removal from aqueous solutions: its improvement with H3PO4 and KOH

The present study is the first attempt to evaluate the potential of acid and base activated biochar derived from cotton stalks (CSB) for the removal of As from contaminated water. The CSB was treated with 0.5 M KOH (BCSB) and H₃PO₄ (ACSB) separately to change its surface properties. The CSB, ACSB and BSCB were characterized using BET, FTIR, and SEM analysis to check the effectiveness and insight of the main mechanisms involved in the removal of As. A series of batch experiments was performed using As-contaminated synthetic water and groundwater samples. The effects of initial concentration of As, contact time, dose of the biochars, solution pH, type of the biochar and coexisting ions on the removal of As were investigated. Results revealed that BCSB efficiently removed As (90-99.5%) from contaminated water as compared with ACSB (84-98%) and CSB (81-98%) due to improved surface properties when As concentration was varied from 0.1 to 4.0 mg/L. The experimental data were best fitted with Freundlich adsorption isotherm as compared with Langmuir, Temkin and Dubinin-Radushkevich models. However, kinetic data were well explained with pseudo-second-order kinetic model rather than pseudo-first-order, intra-particle diffusion and Elovich models. The sorption energy indicated that physical adsorption was involved in the removal of As. The comparison of adsorption results with other biochars and their modified forms suggests that activation of CSB with base can be used effectively (4.48 mg/g) as a low-cost adsorbent for maximum removal of As from contaminated aqueous systems.

Compositional and health risk assessment of drinking water from health facilities of District Vehari, Pakistan

Arsenic (As) is a potentially toxic and carcinogenic metalloid. It has gained considerable attention owing to its high ecotoxic nature. High As contamination of groundwater in scattered areas is the current status of Pakistan. A number of assessments exist for the As contamination of the drinking water in District Vehari, Pakistan. However, there is scarcity of data about As contents in drinking water of health facilities and healthcare centers in District Vehari. The current study, therefore, was carried out to assess As concentration and associated health risk in the drinking water of three health facilities (district head quarter, rural health center and basic health unit) of District Vehari. In total, 75 drinking water samples were collected and examined for As contents in addition to physicochemical characteristics such as electrical conductivity, pH, total soluble salts, chloride, carbonates, bicarbonates, fluoride, nitrate, nitrite, calcium, magnesium and iron. Results indicated that the groundwater samples are not fully fit for drinking purposes with respect to several parameters, especially the alarming levels of As. It was found that 52% of drinking water samples of Vehari have As concentration greater than WHO permissible limit (10 µg/L) and 17% have As concentration greater than Pak-EPA permissible limit (50 µg/L). The risk assessment parameters (average daily dose, hazard quotient and carcinogenic risk) showed possible carcinogenic and non-carcinogenic risks associated with ingestion of As-contaminated drinking water in the healthcare facilities. Based on the results of the present study, it is anticipated that hospitals and health centers in Vehari are in need of safe drinking water. The implementation of national/international standards for drinking water in healthcare facilities is a necessary measure to improve the services and increase local access to safe drinking water. The same may be applied to other public offices and organizations such as educational institutes and district government offices.

Effect of biochar modified with magnetite nanoparticles and HNO3 for efficient removal of Cr(VI) from contaminated water: A batch and column scale study

Chromium (Cr) poses serious consequences on human and animal health due to its potential carcinogenicity. The present study aims at preparing a novel biochar derived from Chenopodium quinoa crop residues (QBC), its activation with magnetite nanoparticles (QBC/MNPs) and strong acid HNO₃ (QBC/Acid) to evaluate their batch and column scale potential to remove Cr (VI) from polluted water. The QBC, QBC/MNPs and QBC/Acid were characterized with SEM, FTIR, EDX, XRD as well as point of zero charge (PZC) to get an insight into their adsorption mechanism. The impact of different process parameters including dose of the adsorbent (1-4 g/L), contact time (0-180 min), initial concentration of Cr (25-200 mg/L) as well as solution pH (2-8) was evaluated on the Cr (VI) removal from contaminated water. The results revealed that QBC/MNPs proved more effective (73.35-93.62-%) for the Cr (VI) removal with 77.35 mg/g adsorption capacity as compared with QBC/Acid (55.85-79.8%) and QBC (48.85-75.28-%) when Cr concentration was changed from 200 to 25 mg/L. The isothermal experimental results follow the Freundlich adsorption model rather than Langmuir, Temkin and Dubinin-Radushkevich adsorption isotherm models. While kinetic adsorption results were well demonstrated by pseudo second order kinetic model. Column scale experiments conducted at steady state exhibited excellent retention of Cr (VI) by QBC, QBC/MNPs and QBC/Acid at 50 and 100 mg Cr/L. The results showed that this novel biochar (QBC) and its modified forms (QBC/Acid and QBC/MNPs) are applicable with excellent reusability and stability under acidic conditions for the practical treatment of Cr (VI) contaminated water.

Potential of siltstone and its composites with biochar and magnetite nanoparticles for the removal of cadmium from contaminated aqueous solutions: Batch and column scale studies

The present study is the first attempt to evaluate the pilot and batch scale adsorption potential of siltstone (SS) and its nanocomposites with biochar (EDB/SS), magnetite nanoparticles (MNPs/SS) and MNPs/EDB/SS for Cd removal from contaminated water. The SS, EDB/SS, MNPs/SS and MNPs/EDB/SS were characterized with FTIR, XRD, BET, SEM, TEM, TGA and point of zero charge (PZC). The effects of adsorbent dosage, contact time, initial Cd concentration, pH and presence of competing ions were evaluated on the Cd removal and its adsorption. The order for Cd removal was: MNPs/EDB/SS > MNPs/SS > EDB/SS > SS (95.86-99.72% > 93.10-98.5% > 89.66.98-98.40% > 74.90-90%). Column scale experiments yielded maximum retention (95%) of Cd even after 2 h of injection at 100 mg Cd/L. The exhausted SS, EDB/SS, MNPs/SS and MNPs/EDB/SS were reused without losing significant adsorption potential. Similarly, maximum Cd adsorption (117.38 mg/g) was obtained with MNPs/EDB/SS at dose 1.0 g/L. The results revealed that coexisting cations reduced the Cd removal due to competition with Cd ions. The experimental results were better explained with Freundlich isotherm model and pseudo 2nd order kinetic models. The results revealed that SS and its composites can be used efficiently for the removal of Cd from contaminated water.

Extensively drug-resistant tuberculosis 'hotspots' and sociodemographic associations in Durban, South Africa

<sec> <title>BACKGROUND</title> In KwaZulu-Natal, South Africa, the incidence of extensively drug-resistant tuberculosis (XDR-TB) is driven by the transmission of resistant strains. As data suggest that cases may be spatially clustered, we sought to identify 'hotspots' and describe these communities. </sec> <sec> <title>METHODS</title> We enrolled XDR-TB patients diagnosed from 2011 to 2014 in eThekwini. Global positioning system (GPS) coordinates for participant homes were collected and hotspots were identified based on population-adjusted XDR-TB incidence. The sociodemographic features of hotspots were characterised using census data. For a subset of participants, we mapped non-home XDR-TB congregate locations and compared these with results including only homes. </sec> <sec> <title>RESULTS</title> Among 132 participants, 75 (57%) were female and 87 (66%) lived in urban or suburban locations. Fifteen of 197 census tracts were identified as XDR-TB hotspots with ≥95% confidence. Four spatial mapping methods identified one large hotspot in northeastern eThekwini. Hotspot communities had higher proportions of low educational attainment (12% vs. 9%) and unemployment (29.3% vs. 20.4%), and lower proportion of homes with flush toilets (36.4% vs. 68.9%). The case density shifted towards downtown Durban when congregate locations (e.g., workplaces) for 43 (33%) participants were mapped. </sec> <sec> <title>CONCLUSIONS</title> In eThekwini, XDR-TB case homes were clustered into hotspots with more poverty indicators than non-hotspots. Prevention efforts targeting hotspot communities and congregate settings may be effective in reducing community transmission. </sec>.

P3138Age based outcomes after implantable cardioverter-defibrillator extraction

Background

There are growing numbers of defibrillator implantations for prevention of sudden cardiac death. As such, there has been a concomitant need for lead extraction. This procedure is often indicated in the setting of device or systemic infection, device upgrade, lead malfunction or elective extraction in cases of abandoned leads. Lead Extraction is associated with increased morbidity and mortality. The comparative safety and effectiveness of lead extraction in various age groups has not been well evaluated.

Purpose

The average age of patients undergoing lead extraction in our single center database is (65.5±15.9). There are lack of studies on age associated outcomes with lead extraction. We intend to evaluate differences in major in minor adverse outcomes in patients undergoing lead extraction stratified by age.

Methods

We identified 1,297 patients who underwent lead extraction between January 2003 and April 2016 at a major metropolitan center and evaluated procedural outcomes stratified by age. Age groups were stratified as <55, 55–64, 65–74, 75–84, and >85 years old. Baseline characteristics including history of coronary artery bypass graft (CABG), hypertension (HTN), congestive heart failure (CHF), hyperlipidemia (HLD), diabetes mellitus (DM) and coronary artery disease (CAD) were evaluated using chi-squared analysis. Adverse events were identified as major complications (death, cardiac arrest, cardiac perforation, coronary venous dissection, pericardial tamponade, or urgent cardiac surgery), and minor complications (coronary sinus dissection, pneumothorax, pocket bleeding requiring drainage, worsening tricuspid valve function, vegetation embolization, venous thrombosis, requirement of blood transfusion or lead migration). Subgroups for age were also analyzed using chi squared analysis to prevent type 1 error.

Results

There was no statistically significant difference in overall major and minor complications amongst different age groups (P>0.05). An overall statistically significant difference was noted in baseline characteristics of CABG, HTN, HLD, DM, and CAD (P<0.05). Within each age subgroup, no statistically significant difference was noted for major or minor complications post lead extraction (P>0.05).

Conclusion

This study shows lead extraction can be performed safely in patients of all age groups without significant overall risk of major or minor complications.

Acknowledgement/Funding

None

HIV testing uptake among the household contacts of multidrug-resistant tuberculosis index cases in eight countries

SETTING

The household contacts (HHCs) of multidrug-resistant tuberculosis (MDR-TB) index cases are at high risk of tuberculous infection and disease progression, particularly if infected with the human immunodeficiency virus (HIV). HIV testing is important for risk assessment and clinical management.

METHODS

This was a cross-sectional, multi-country study of adult MDR-TB index cases and HHCs. All adult and child HHCs were offered HIV testing if never tested or if HIV-negative >1 year previously when last tested. We measured HIV testing uptake and used logistic regression to evaluate predictors.

RESULTS

A total of 1007 HHCs of 284 index cases were enrolled in eight countries. HIV status was known at enrolment for 226 (22%) HHCs; 39 (4%) were HIV-positive. HIV testing was offered to 769 (98%) of the 781 remaining HHCs; 544 (71%) agreed to testing. Of 535 who were actually tested, 26 (5%) were HIV-infected. HIV testing uptake varied by site (median 86%, range 0-100%; P < 0.0001), and was lower in children aged <18 years than in adults (59% vs. 78%; adjusted for site P < 0.0001).

CONCLUSIONS

HIV testing of HHCs of MDR-TB index cases is feasible and high-yield, with 5% testing positive. Reasons for low test uptake among children and at specific sites-including sites with high HIV prevalence-require further study to ensure all persons at risk for HIV are aware of their status.

Primary Sjogren's syndrome presenting as hypokalemic paralysis: A case series

Primary Sjögren's syndrome (pSS) primarily involves exocrine glands, and renal tubular acidosis (RTA) is seen in one-third of the cases. RTA with hypokalemic paralysis as a presenting feature of pSS is described in few case reports in literature. We report 13 cases who presented as hypokalemic paralysis, and on evaluation were diagnosed to be pSS, as per the diagnostic criteria laid by the Sjögren's International Collaborative Clinical Alliance (2012). All patients were female, with a mean age at presentation being 33.1 ± 8.22 years (range, 25–48 years). Eleven patients had a complete distal RTA and two patients had incomplete distal RTA at the time of presentation. 62% (8/13) of patients had no signs and symptoms of exocrine gland involvement. All the cases were managed with oral alkali therapy, and six patients received additional immunomodulating agents. No improvement in renal tubular dysfunction (in the form of a reduction in the alkali dose) after immunomodulating therapy was observed over a mean follow-up of 2.8 years. Renal tubular dysfunction can be the presenting manifestation of pSS. It is important to consider the possible presence of this disorder in adults with otherwise unexplained distal RTA or hypokalemia.

Synthesis of magnetite-based nanocomposites for effective removal of brilliant green dye from wastewater

The present study aims at evaluating the batch scale potential of cotton shell powder (CSP), Moringa oleifera leaves (ML), and magnetite-assisted composites of Moringa oleifera leaves (MLMC) and cotton shell powder (CSPMC) for the removal of brilliant green dye (BG) from synthetic wastewater. This is the first attempt to combine biosorbents with nanoparticles (NPs) for the removal of BG. The surface properties of ML, CSP, and their composites were characterized with Fourier-transform infrared spectroscopy (FTIR), scanning electron microscopy (SEM), and energy-dispersive X-ray (EDX). The impact of dosage of the adsorbents (1-4 g/L), initial concentrations of BG (20-320 mg/L), pH (6-12), and contact time (15-180 min) on BG removal was evaluated. The BG removal was in order of CSPMC > MLMC > CSP > ML (98.8-86.6% > 98.2-82.0% > 92.3-70.7% > 89.0-57.4%) at optimum dosage (2 g/L) and pH (8). Moreover, maximum adsorption (252.17 mg/g) was obtained with CSPMC. The experimental results showed better fit with Freundlich adsorption isotherm model and kinetic data revealed that sorption followed pseudo-second-order kinetic model. The values of Gibbs free energy and mean free energy of sorption showed that physical adsorption was involved in the removal of BG. FTIR results confirmed that -O-H, -C-OH, =C-H, -C-H, =-CH₃, HC ≡ CH, C=C, -C=O, -C-N, and -C-O-C- groups were involved in the removal of BG. The results revealed that application of low-cost biosorbents combined with NPs is very effective and promising for the removal of textile dyes from wastewater.

Health risk assessment of drinking arsenic-containing groundwater in Hasilpur, Pakistan: effect of sampling area, depth, and source

Currently, several news channels and research publications have highlighted the dilemma of arsenic (As)-contaminated groundwater in Pakistan. However, there is lack of data regarding groundwater As content of various areas in Pakistan. The present study evaluated As contamination and associated health risks in previously unexplored groundwater of Hasilpur-Pakistan. Total of 61 groundwater samples were collected from different areas (rural and urban), sources (electric pump, hand pump, and tubewell) and depths (35-430 ft or 11-131 m). The water samples were analyzed for As level and other parameters such as pH, electrical conductivity, total dissolved solids, cations, and anions. It was found that 41% (25 out of 61) water samples contained As (≥ 5 μg/L). Out of 25 As-contaminated water samples, 13 water samples exceeded the permissible level of WHO (10 μg/L). High As contents have been found in tubewell samples and at high sampling depths (> 300 ft). The major As-contaminated groundwater in Hasilpur is found in urban areas. Furthermore, health risk and cancer risk due to As contamination were also assessed with respect to average daily dose (ADD), hazard quotient (HQ), and carcinogenic risk (CR). The values of HQ and CR of As in Hasilpur were up to 58 and 0.00231, respectively. Multivariate analysis revealed a positive correlation between groundwater As contents, pH, and depth in Hasilpur. The current study proposed the proper monitoring and management of well water in Hasilpur to minimize the As-associated health hazards.

Biosorption of lead by cotton shells powder: Characterization and equilibrium modeling study

Lead (Pb) is a toxic heavy metal causing serious health risks to humans and animals. In the present study, cotton (Gossypium hirsutum L.) shells powder was used as adsorbent for the treatment of synthetic Pb-contaminated water. The batch scale biosorption capacity of cotton shells powder was evaluated to study the effects of Pb concentrations, adsorbent doses and contact time at constant pH (6) and temperature (25 °C). Results revealed that sorption of Pb increased (q = 0.09-9.60 mg/g) with increasing Pb concentration (1-15 mg/L) and contact time (15-90 min) while decreasing adsorbent dose (1-0.1 g/100 mL). The maximum Pb removal (90%) was achieved at Pb concentration (1 mg/L), contact time (90 min) and adsorbent dose (1 g/100 mL). Freundlich isotherm model proved best fit for Pb sorption (R² = 0.99). The cotton shells powder has microporous structure confirmed by SEM, and has BET surface area (45 m²/g) and pore size (2.3 µm). These surface moieties along with various functional groups (C-H, C-O, C=O, O-H, S=O) confirmed by FTIR analysis might involve in Pb removal by complexation and ion exchange mechanisms. The cotton shells powder biomass could be considered as promising adsorbent for the removal of Pb from contaminated water.

Biosorption of Pb(II) from contaminated water onto Moringa oleifera biomass: kinetics and equilibrium studies

The present study aims at evaluating a batch scale biosorption potential of Moringa oleifera leaves (MOL) for the removal of Pb(II) from aqueous solutions. The MOL biomass was characterized by FTIR, SEM, EDX, and BET. The impact of initial concentrations of Pb (II), adsorbent dosage, pH, contact time, coexisting inorganic ions (Ca²⁺, Na⁺, K⁺, Mg²⁺, CO₃^2-, HCO₃^-, Cl^-), electrical conductivity (EC) and total dissolved salts (TDS) in water was investigated. The results revealed that maximum biosorption (45.83 mg/g) was achieved with adsorbent dosage 0.15 g/100 mL while highest removal (98.6%) was obtained at adsorbent biomass 1.0 g/100 mL and pH 6. The presence of coexisting inorganic ions in water showed a decline in Pb(II) removal (8.5% and 5%) depending on the concentrations of ions. The removal of Pb(II) by MOL decreased from 97% to 89% after five biosorption/desorption cycles with 0.3 M HCl solution. Freundlich model yielded a better fit for equilibrium data and the pseudo-second-order well described the kinetics of Pb(II) biosorption. FTIR spectra showed that -OH, C-H, -C-O, -C = O, and -O-C functional groups were involved in the biosorption of Pb(II). The change in Gibbs free energy (ΔG = -28.10 kJ/mol) revealed that the biosorption process was favorable and thermodynamically driven. The results suggest MOL as a low cost, environment-friendly alternative biosorbent for the remediation of Pb(II) contaminated water.

Resource utilization for multidrug-resistant tuberculosis household contact investigations (A5300/I2003)

BACKGROUND

Current guidelines recommend evaluation of the household contacts (HHCs) of individuals with multidrug-resistant tuberculosis (MDR-TB); however, implementation of this policy is challenging.

OBJECTIVE

To describe the resource utilization and operational challenges encountered when identifying and characterizing adult MDR-TB index cases and their HHCs.

DESIGN

Cross-sectional study of adult MDR-TB index cases and HHCs at 16 clinical research sites in eight countries. Site-level resource utilization was assessed with surveys.

RESULTS

Between October 2015 and April 2016, 308 index cases and 1018 HHCs were enrolled. Of 280 index cases with sputum collected, 94 were smear-positive (34%, 95%CI 28-39), and of 201 with chest X-rays, 87 had cavitary disease (43%, 95%CI 37-50) after a mean duration of treatment of 8 weeks. Staff required 512 attempts to evaluate the 308 households, with a median time per attempt of 4 h; 77% (95%CI 73-80) of HHCs were at increased risk for TB: 13% were aged <5 years, 8% were infected with the human immunodeficiency virus, and 79% were positive on the tuberculin skin test/interferon-gamma release assay. One hundred and twenty-one previously undiagnosed TB cases were identified. Issues identified by site staff included the complexity of personnel and participant transportation, infection control, personnel safety and management of stigma.

CONCLUSION

HHC investigations can be high yield, but are labor-intensive.

Lignin and Lignin Based Materials for the Removal of Heavy Metals from Waste Water-An Overview

Water Pollution through heavy metals is the concerned issue as many industries like tanning, steel production and electroplating are the major contributors. Various toxic Heavy metals are a matter of concern as they have severe environmental and health effects. Most commonly, conventional methods are using to remove these heavy metals like precipitation, ion exchange, which are not economical and have disposal issues. Adsorption of heavy metals by different low-cost adsorbents seems to be the best option in wastewater treatment. Many agricultural by-products proved to be suitable as low-cost adsorbents for removing heavy metals efficiently in a minimum time. Lignin residues that involves both agricultural and wood residues and sometimes separated out from black liquor through precipitation have adsorption capacity and affinity comparable to other natural adsorbents. However, lignin as bio adsorbents have the advantage of less cost and gives efficient adsorption results. This study is a review of the recent literature on the use of natural lignin residues for heavy metals adsorption under different experimental scenarios.

Latent tuberculous infection testing among HIV-infected persons in clinical care, United States, 2010-2012

SETTING

Current guidelines recommend latent tuberculous infection (LTBI) testing at the time of human immunodeficiency virus (HIV) diagnosis and annually thereafter for persons at high risk of LTBI.

OBJECTIVES

To estimate LTBI testing prevalence and describe the characteristics of HIV-infected persons who would benefit from annual LTBI testing.

DESIGN

We estimated the proportions of LTBI testing among a nationally representative sample of HIV-infected adults in care between 2010 and 2012, and compared the patient characteristics of those with a positive LTBI test result to those with a negative result using χ2 tests.

RESULTS

Among 2772 patients, 68.8% had been tested for LTBI at least once since HIV diagnosis, and 39.4% had been tested during the previous 12 months. Among patients tested at least once, 6.9% tested positive, 80.7% tested negative, and 12.4% had an indeterminate or undocumented result. Patients with a positive test were significantly more likely to be foreign-born, have lower educational attainment, and a household income at or below the federal poverty level.

CONCLUSIONS

More than 30% of HIV-infected patients had never been tested for LTBI. Providers should test all patients for LTBI at the time of HIV diagnosis. The patient characteristics associated with a positive LTBI test result may guide provider decisions about annual testing.

The California Multidrug-Resistant Tuberculosis Consult Service: a partnership of state and local programs

Background: The US Centers for Disease Control and Prevention recommend expert consultation for multi-drug-resistant tuberculosis (MDR-TB) cases. In 2002, the California MDR-TB Service was created to provide expert MDR-TB consultations. We describe the characteristics, treatment outcomes and management of patients referred to the Service. Methods: Surveillance data were used for descriptive analysis of cases, with consultation during July 2002-December 2012. Clinical consultation data and modified World Health Organization indicators were used to assess the care and management of cases, with consultation from January 2009 to December 2012. Results: Of 339 MDR-TB patients, 140 received a consultation. The proportion of patients receiving a consultation increased from 12% in 2002 to 63% in 2012. There were 24 pre-extensively drug-resistant TB and 5 patients with extensively drug-resistant TB. The majority (n = 123, 88%) completed treatment, 5 (4%) died, 7 (5%) moved before treatment completion, 4 (3%) stopped treatment due to an adverse event and 1 (1%) had an unknown outcome. Indicator data showed that 86% underwent rapid molecular drug susceptibility testing, 98% received at least four drugs to which they had known or presumed susceptibility, and 93% culture converted within 6 months. Conclusions: Consultations with the MDR-TB Service increased over time. Results highlight successful treatment and indicator outcomes.

Tuberculosis, human rights and ethics considerations along the route of a highly vulnerable migrant from sub-Saharan Africa to Europe

Migrant health is a critical public health issue, and in many countries attention to this topic has focused on the link between migration and communicable diseases, including tuberculosis (TB). When creating public health policies to address the complex challenges posed by TB and migration, countries should focus these policies on evidence, ethics, and human rights. This paper traces a commonly used migration route from sub-Saharan Africa to Europe, identifying situations at each stage in which human rights and ethical values might be affected in relation to TB care. This illustration provides the basis for discussing TB and migration from the perspective of human rights, with a focus on the right to health. We then highlight three strands of discussion in the ethics and justice literature in an effort to develop more comprehensive ethics of migrant health. These strands include theories of global justice and global health ethics, the creation of 'firewalls' to separate enforcement of immigration law from protection of human rights, and the importance of non-stigmatization to health justice. The paper closes by reflecting briefly on how TB programs can better incorporate human rights and ethical principles and values into public health practice.

Malnutrition associated with unfavorable outcome and death among South African MDR-TB and HIV co-infected children

SETTING

Pediatric multidrug-resistant tuberculosis (MDR-TB) is complicated by difficult diagnosis, complex treatment, and high mortality. In South Africa, these challenges are amplified by human immunodeficiency virus (HIV) co-infection; however, evidence on treatment outcomes among co-infected children is limited.

OBJECTIVE

Using conventional and new pediatric definitions, to describe treatment outcomes and identify risk factors for unfavorable outcome and mortality in children aged <15 years with MDR-TB or extensively drug-resistant TB (XDR-TB) in KwaZulu-Natal, South Africa.

DESIGN

Retrospective cohort study in a regional TB referral hospital.

RESULTS

From January 2009 to June 2010, 84 children (median age 8 years, IQR 4-12) with MDR-TB (n = 78) or XDR-TB (n = 6) initiated treatment. Sixty-four (77%) were HIV-positive and 62 (97%) received antiretroviral therapy. Sixty-six (79%) achieved favorable treatment outcomes. Overall mortality was 11% (n = 9) at 18 months after initiation of treatment. Malnutrition (aOR 27.4, 95%CI 2.7-278.7) and severe radiographic findings (aOR 4.68, 95%CI 1.01-21.9) were associated with unfavorable outcome. New pediatric outcome definitions increased the proportion classified as cured.

CONCLUSION

It is possible to successfully treat pediatric MDR-TB-HIV even in resource-poor settings. Malnutrition is a marker for severe TB-HIV disease, and is a potential target for future interventions in these patients.

Rifampicin-resistant Mycobacterium tuberculosis: susceptibility to isoniazid and other anti-tuberculosis drugs

Based on data from 14 Supranational Tuberculosis (TB) Reference Laboratories worldwide, the proportion of rifampicin (RMP) resistant isolates that were isoniazid (INH) susceptible by phenotypic drug susceptibility testing varied widely (0.5-11.6%). RMP-resistant isolates that were INH-susceptible had significantly lower rates of resistance to other first- and second-line anti-tuberculosis drugs (except rifabutin) compared to multidrug-resistant isolates. RMP resistance is not always a good proxy for a presumptive diagnosis of multidrug-resistant TB, which has implications for use of molecular assays that identify only RMP resistance-associated DNA mutations.

Integrated, home-based treatment for MDR-TB and HIV in rural South Africa: an alternate model of care

SETTING

Treatment outcomes for multidrug-resistant tuberculosis (MDR-TB) in South Africa have suffered as centralized, in-patient treatment programs struggle to cope with rising prevalence and human immunodeficiency virus (HIV) co-infection rates. A new treatment model is needed to expand treatment capacity and improve MDR-TB and HIV outcomes.

OBJECTIVE

To describe the design and preliminary results of an integrated, home-based MDR-TB-HIV treatment program created in rural KwaZulu-Natal.

METHOD

In 2008, a decentralized center was established to provide out-patient MDR-TB and HIV treatment. Nurses, community health workers and family supporters have been trained to administer injections, provide adherence support and monitor adverse reactions in patients' homes. Physicians assess clinical response, adherence and the severity of adverse reactions to MDR-TB and HIV treatment at monthly follow-up visits. Treatment outcomes are assessed by monthly cultures and CD4 and viral load every 6 months.

RESULTS

Of 80 patients initiating MDR-TB treatment from February 2008 to April 2010, 66 were HIV-co-infected. Retention has been high (only 5% defaults, 93% of visits attended), and preliminary outcomes have been favorable (77% cured/still on treatment, 82% undetectable viral load). Few patients have required escalation of care (9%), had severe adverse events (8%) or died (6%).

CONCLUSION

Integrated, home-based treatment for MDR-TB and HIV is a promising treatment model to expand capacity and achieve improved outcomes in rural, resource-poor and high HIV prevalent settings.

Clinical accuracy of a non-contact infrared skin thermometer in paediatric practice

BACKGROUND

Rectal thermometry is considered the most reliable method for measuring the temperature in the paediatric population. Recently, a new non-contact skin infrared thermometer for children was introduced in the market with excellent acceptance by parents.

METHODS

A prospective, analytical, cross-sectional study was designed in order to assess the effectiveness of the infrared non-contact thermometer (Thermofocus) in comparison with two other known methods used to measure body temperature. Children aged 1 to 48 months were included from the emergency room and inpatient unit. All patients selected were assessed with three different thermometers: (1) non-contact infrared thermometer (Thermofocus); (2) temporal artery thermometer (Exergen); and (3) rectal glass mercury thermometer.

RESULTS

Four hundred and thirty-four patients were eligible to complete the study. One hundred and sixty-seven were identified with fever. The mean age of the patients studied was 14.6 ± 10.7 months. Both devices were strongly correlated with the rectal temperature: r = 0.950 for Exergen and r = 0.952 for Thermofocus. The mean difference in temperature between the rectal temperature and the non-contact thermometer was 0.029 ± 0.01 °C (P < 0.001), while the mean difference between the temporal artery thermometer and the rectal temperature was -0.20 ± 0.27 °C (P < 0.001). The sensitivity and specificity for the non-contact thermometer is 97%. The negative predictive value is 99%, which is especially important to rule out fever and avoid unnecessary laboratory work-up.

CONCLUSIONS

The non-contact infrared thermometer is a reliable, comfortable and accurate option for measurement of temperature and is very useful for the screening of fever in the paediatric population. More studies are recommended to support the evidence found in this study and compare its accuracy with more complex devices.

Epidemiology of smear-negative pulmonary tuberculosis in the United States, 1993-2008

BACKGROUND

Smear-negative tuberculosis (TB) is difficult to diagnose and has been associated with poor treatment outcomes and excessive mortality, particularly in high human immunodeficiency virus (HIV) prevalent settings. However, few studies have used mycobacterial culture to rigorously confirm all smear-negative TB cases in a population-based cohort.

DESIGN

We included all culture-confirmed, pulmonary TB cases reported to the US National TB Surveillance System from 1993 to 2008. We analyzed smear-negative TB risk factors and survival, as compared to smear-positive TB. We calculated prevalence ratios (PRs) and adjusted for confounders (aPR).

RESULTS

From 1993 to 2008, 159,121 cases of culture-confirmed pulmonary TB were reported in the United States, of which 58,786 (37%) were sputum smear-negative. Smear-negative TB cases were more likely to be foreign-born (aPR 1.10, 95%CI 1.08-1.12), incarcerated (aPR 1.52, 95%CI 1.48-1.56) or HIV-infected (aPR 1.27, 95%CI 1.24-1.30). Hispanics and non-Hispanic Blacks were less likely to have smear-negative TB (respectively aPR 0.87, 95%CI 0.85-0.89 and aPR 0.90, 95%CI 0.89-0.92). Smear-negative TB cases had lower mortality (aRR 0.78, 95%CI 0.74-0.81), independent of HIV status.

CONCLUSION

Smear-negative TB represents a large proportion of TB cases in the United States, and occurs more often among persons in groups more likely to undergo TB screening. The lower mortality may indicate earlier TB detection, and underscores the need for continued vigilance in screening of high-risk persons.

Henoch-Schönlein purpura: a rare vasculitis in older adults

Henoch-Schönlein purpura (HSP) is a small vessel vasculitis with immunoglobulin A-dominant immune deposits found in vessel walls. It primarily affects children, is uncommon in adults and often under-recognised in the elderly population due to its rarity in this group. When a purpuric rash develops in an older person it is typically treated with antibiotics for presumed infection, rather than investigated as potentially HSP. It is important to recognise this condition, particulary in older adults, as diagnosis has implications for management and prognosis. We report a case of vasculitis with renal involvement in an older person.