Trial-of-antibiotic algorithm for the diagnosis of tuberculosis in a district hospital in a developing country with high HIV prevalence

OBJECTIVE: To evaluate a diagnostic algorithm for pulmonary tuberculosis based on smear microscopy and objective response to trial of antibiotics. SETTING: Adult medical wards, Hlabisa Hospital, South Africa, 1996-1997. METHODS: Adults with chronic chest symptoms and abnormal chest X-ray had sputum examined for Ziehl-Neelsen stained acid-fast bacilli by light microscopy. Those with negative smears were treated with amoxycillin for 5 days and assessed. Those who had not improved were treated with erythromycin for 5 days and reassessed. Response was compared with mycobacterial culture. RESULTS: Of 280 suspects who completed the diagnostic pathway, 160 (57%) had a positive smear, 46 (17%) responded to amoxycillin, 34 (12%) responded to erythromycin and 40 (14%) were treated as smear-negative tuberculosis. The sensitivity (89%) and specificity (84%) of the full algorithm for culture-positive tuberculosis were high. However, 11 patients (positive predictive value [PPV] 95%) were incorrectly diagnosed with tuberculosis, and 24 cases of tuberculosis (negative predictive value [NPV] 70%) were not identified. NPV improved to 75% when anaemia was included as a predictor. Algorithm performance was independent of human immunodeficiency virus status. CONCLUSION: Sputum smear microscopy plus trial of antibiotic algorithm among a selected group of tuberculosis suspects may increase diagnostic accuracy in district hospitals in developing countries.

Trichomonas vaginalis is associated with pelvic inflammatory disease in women infected with human immunodeficiency virus

We assessed the association between the causative agents of vaginal discharge and pelvic inflammatory disease (PID) among women attending a rural sexually transmitted disease clinic in South Africa; the role played by coinfection with human immunodeficiency virus type 1 (HIV-1) was studied. Vaginal and cervical specimens were obtained to detect Neisseria gonorrhoeae, Chlamydia trachomatis, Trichomonas vaginalis, and bacterial vaginosis. HIV-1 infection was established by use of serum antibody tests. A total of 696 women with vaginal discharge were recruited, 119 of whom had clinical PID. Patients with trichomoniasis had a significantly higher risk of PID than did women without trichomoniasis (P = .03). PID was not associated with any of the other pathogens. When the patients were stratified according to HIV-1 status, the risk of PID in HIV-1-infected patients with T. vaginalis increased significantly (P = .002); no association was found in patients without HIV-1. T. vaginalis infection of the lower genital tract is associated with a clinical diagnosis of PID in HIV-1-infected women.

Association between HIV-1 infection, the etiology of genital ulcer disease, and response to syndromic management

Background: Reports on the effect of HIV-1 infection on healing rates of ulcers are conflicting. Goal: The goal was to determine the etiology and response to treatment of genital ulcer disease (GUD) in relation to HIV-1 infection. Study Design: This was a cohort study of patients with GUD treated with local syndromic management protocols. Results: Among the 587 recruited, the prevalences of infections due to HSV, Treponema pallidum, Chlamydia trachomatis (lymphogranuloma venereum [LGV]), Haemophilus ducreyi, Calymmatobacterium granulomatis, and HIV-1 were 48%, 14%, 11%, 10%, 1%, and 75%, respectively. The prevalence of T pallidum was higher among men (P = 0.03), and an association was seen among HIV-1-seronegatives on univariate and multivariate analyses (P < 0.001; P = 0.01). The prevalence of C trachomatis (LGV) was higher among females (P = 0.004), and an association was seen among HIV-1-seropositives on univariate analysis (P = 0.04). At follow-up, 40/407 (10%) showed a decreased healing tendency, not associated with ulcer etiology or HIV-1 seropositivity. Conclusion: Response to syndromic management of GUD was acceptable and not associated with HIV-1 coinfection.

The subfamily Aephnidiogeninae Yamaguti, 1934 (Digenea: Lepocreadiidae), its status and that of the genera Aephnidiogenes Nicoll, 1915, Holorchis Stossich, 1901, Austroholorchis n g, Pseudaephnidiogenes Yamaguti, 1971, Pseudoholorchis Yamaguti, 1958 and N

The status of all of the putative member genera of the subfamily Aephnidiogeninae is reconsidered, based mainly on the morphology of the terminal genitalia, Aephnidiogenes Nicoll, 1915 is the only genus retained in the Aaephnidiogeninae. Aephnidiogenes major Yamaguti, 1934 from Diagramma labiosum from the southern Great Barrier Reef is redescribed with particular reference to the terminal genitalia, and is shown to lack a true cirrussac, a condition considered to be diagnostic of the Aephnidiogeninae. Holorchis Stossich, 1901 is placed in the subfamily Lepidapedinae. Holorchis pycnoporus Stossich, 1901 from Pagellus acarne from off Spanish Sahara and from Diplodus vulgaris from off Italy and H. legendrei Dollfus, 1946 from Sparodon durbanensis and D. sargus from off eastern Cape Province, South Africa and from Pagellus erythrinus from the Adriatic Sea and Italy are studied and illustrated. The terminal genitalia of H. pycnoporus are found to be enigmatic, but those of H. legendrei are found to fit clearly into the 'Lepidapedon-like' pattern. A new genus Austroholorchis is erected in the Lepidapedinae, with A. sprenti (Gibson, 1987) n. comb. as the type-species. Its diagnostic features are its ani, infundibuliform oral sucker and the position of the ovary at about mid-level of the uterus. A. sprenti is illustrated, its hosts in Queensland waters being Sillago maculata, S, analis and S. ciliata. A, levis n. sp. is described from Sillago bassensis from south-western Western Australia. The genus Pseudaephnidiogenes Yamaguti, 1971 is placed in the Lepidapedinae. P. rhabdosargi (Prudhoe, 1956) from Rhabdosargus sarba from off Natal, South Africa is illustrated and the terminal genitalia of P. rhabdosargi from R. sarba and from R. holubi from off eastern Cape Province and Pseudaephnidiogenes vossi Bray, 1985 from Caffrogobius nudiceps from off eastern Cape Province, South Africa are illustrated. The genus Pseudoholorchis Yamaguti, 1958 is placed in the subfamily Lepocreadiinae. The terminal genitalia of P. pulcher (Manter, 1954) from Latridopsis ciliaris from New Zealand are illustrated, The genus Neolepocreadium Thomas, 1960 is placed in the Lepocreadiidae.

A report on socioeconomic attributes and gender inequality in Kondh-dominated villages: A comparative analysis of tribals and non-tribals in the Phulbani district, Orissa, India

Reports on results of a survey, completed in 2000, of wives in three villages in the Phulbani district, Orissa, India. These villages are dominated by the Kondh scheduled tribe but some also contain members of the scheduled caste, called Dombs in Orissa. The article reports on the total responses and comparative responses of these groups to a structured questionnaire. The article provides background information for the villages surveyed, and reports information in relation to wives and their families about property rights, assets and incomes, economic conditions and survival strategies, aspects of credit, production and marketing, social dynamics and eduction. In addition, children’s affairs, including the treatment and entitlements of female and male children, are considered as well as additional aspects of the socioeconomic status of wives.

Prejudice against female children: Economics and cultural explanations, and India evidence

Shows how economic theories based on parental self-interest may explain parental discrimination against daughters relative to sons. However, such theories often need to be adjusted (or even discarded) to allow for altruism of parents towards their children, and to take account of cultural influences on parental desires to have children of particular gender, and care equally for their children of different gender. The latter point is illustrated by a study of two different communities. In one situated in the Santal tribal belt I West Bengal, discrimination against daughters is found to be marked and accords (given the structure of society) with predictions of economic theories based on the pursuit of parental self-interest. By contrast, it is found that although the Knondh-dominated community in Orissa experiences similar economic conditions and social structures to the West Bengal communities, parental discrimination against daughters is almost absent. The differences seem to arise from a difference between the cultural values shared by the Kondhs in Orissa and those shared by the West Bengal community consisting of Santals and Bengali Hindus. This suggests that the applicability of economic theories of the family depends significantly on the social contexts in which they are to be applied. In this respect, both social structures and cultural values are important.

The geochemistry of late Archaean microbial carbonate: Implications for ocean chemistry and continental erosion history

Trace element concentrations and combined Sr- and Nd-isotope compositions were determined on stromatolitic carbonates (microbialites) from the 2.52 Ga Campbellrand carbonate platform (South Africa). Shale-normalised rare earth element and yttrium patterns of the ancient samples are similar to those of modern seawater in having positive La and Y anomalies and in being depleted in light rare earth elements. In contrast to modem seawater (and microbialite proxies), the 2.52 Ga samples lack a negative Ce anomaly but possess a positive Eu anomaly. These latter trace element characteristics are interpreted to reflect anoxic deep ocean waters where, unlike today, hydrothermal Fe input was not oxidised, and scavenged and rare earth elements were not coprecipitated with Fe-oxyhydroxides. The persistence of a positive Eu anomaly in relatively shallow Campbellrand platform waters indicates a dramatic reversal from hydrothermally dominated (Archaean) to continental erosion-dominated (Phanerozoic) rare earth element flux ratio. The dominant hydrothermal input is also expressed in the initial Sr- and Nd-isotope ratios. There is collinear variation in Sr-Nd systematics, which range from primitive values (Sr-87/Sr-86 of 0.702386 and epsilon (Nd) of +2.1) to more evolved crustal ratios. Mixing calculations show that the range in trace element ratios (e.g., Y/Ho) and initial isotope ratios is not a result of contamination by trapped sediment, but that the chemical band isotopic variation reflects carbonate deposition in an environment where different water masses mixed. Calculated Nd flux ratios yield a hydrothermal input into the 2.52 Ga oceans one order of magnitude larger than continental input. Such a change in flux ratio most likely required substantially reduced continental inputs, which could, in turn, reflect a plate tectonic causation (e.g., reduced topography or expansion of epicontinental seas). Copyright (C) 2001 Elsevier Science Ltd.

Trade relationships between the Gulf Cooperation Council and the European Union

This paper examines the trade relationship between the Gulf Cooperation Council (GCC) and the European Union (EU). A simultaneous equation regression model is developed and estimated to assist with the analysis. The regression results, using both the two stage least squares (2SLS) and ordinary least squares (OLS) estimation methods, reveal the existence of feedback effects between the two economic integrations. The results also show that during times of slack in oil prices, the GCC income from its investments overseas helped to finance its imports from the EU.

Sexual recombination in Phytophthora cinnamomi in vitro and aggressiveness of single-oospore progeny to Eucalyptus

Fifty single oospore progeny were established from an in vitro mating of A1 and A2 mating type isolates of Phytophthora cinnamomi from South Africa. Forty-nine progeny were identified as F-1 hybrids using seven random amplified polymorphic DNA (RAPD) primers, and one was a selfed isolate of the A1 mating type parent. Among the hybrid progeny, 24 and 25 were A1 and A2 mating type, respectively. Aggressiveness of progeny and parental isolates was assessed on 1-year-old seedlings of Eucalyptus smithii. The mean aggressiveness of hybrid oosporic isolates, expressed as lesion length, was significantly (P = 0.0001) lower than that of the parental isolates. No significant difference in aggressiveness of A1 and A2 mating type F-1 hybrid isolates was observed. This is the first report demonstrating sexual recombination in vitro in P. cinnamomi.

An aggregate sales model for consumer durables incorporating a time-varying mean replacement age

Forecasting category or industry sales is a vital component of a company's planning and control activities. Sales for most mature durable product categories are dominated by replacement purchases. Previous sales models which explicitly incorporate a component of sales due to replacement assume there is an age distribution for replacements of existing units which remains constant over time. However, there is evidence that changes in factors such as product reliability/durability, price, repair costs, scrapping values, styling and economic conditions will result in changes in the mean replacement age of units. This paper develops a model for such time-varying replacement behaviour and empirically tests it in the Australian automotive industry. Both longitudinal census data and the empirical analysis of the replacement sales model confirm that there has been a substantial increase in the average aggregate replacement age for motor vehicles over the past 20 years. Further, much of this variation could be explained by real price increases and a linear temporal trend. Consequently, the time-varying model significantly outperformed previous models both in terms of fitting and forecasting the sales data. Copyright (C) 2001 John Wiley & Sons, Ltd.

Argyrodes: phylogeny, sociality and interspecific interactions - a report on the Argyrodes symposium, Badplaas 2001

Argyrodes Simon 1864 is a large, cosmopolitan theridiid genus whose members exhibit a wide range of foraging techniques which usually involve exploiting other spiders, either by using their webs, stealing their food, or preying on them directly. We held a symposium on this genus at the 15th International Congress of Arachnology, Badplaas, South Africa in order to obtain a clearer perspective on the relationship between the phylogeny of the genus and the different foraging techniques. We concluded that Argyrodes forms a monophyletic group within the Theridiidae, and that there are clear monophyletic clades within the genus (already identified as species groups) that appear to share behavioral characteristics. We found no clear indication that foraging behaviors such as kleptoparasitism (stealing food) evolved from araneophagy (eating spiders) or vice versa. However, it appears that species that specialize in either kleptoparasitism or araneophagy use additional techniques in comparison to species that readily use both foraging modes. During our examination of Argyrodes/host interactions we noted the importance of Nephila species as hosts of Argyrodes species around the world and the impact of Argyrodes on Nephila. We also noted the fluid nature of the relationship between Argyrodes and the spiders with which they interact. For example, an Argyrodes/host relationship can change to an Argyrodes/prey relationship, and the type of kleptoparasitic behavior employed by an Argyrodes can change when it changes host species. The importance of eating silk was also noted and identified as an area for further research. We concluded that more work involving international collaboration is needed to fully understand the phylogeny of the genus and the relationships between the different types of foraging behaviors.

Magic happens: Revisiting the spirituality and social work debate

The social work profession is currently undergoing a resurgence of interest regarding the issue of spirituality in social work. This article attempts to summarise and explore the debate so far and to discuss the implications of this in a practice context. Current issues including definitions of spirituality and the key concerns in the areas of both practice and education are addressed. The article concludes with an overview of a model of spiritually sensitive social work practice, and poses options for further professional reflection on the place of spirituality in social work practice.

The trematodes of groupers (Serranidae : Epinephelinae) knowledge, nature and evolution

Groupers (Epinephelinae) are prominent marine fishes distributed in the warmer waters of the world. Review of the literature suggests that trematodes are known from only 62 of the 159 species and only 9 of 15 genera; nearly 90% of host-parasite combinations have been reported only once or twice. All 20 families and all but 7 of 76 genera of trematodes found in epinephelines also occur in non-epihephelines. Only 12 genera of trematodes are reported from both the Atlantic-Eastern Pacific and the Indo-West Pacific. Few (perhaps no) species are credibly cosmopolitan but some have wide distributions across the Indo-West Pacific. The hierarchical 'relatedness' of epinephelines as suggested by how they share trematode taxa (families, genera, species) shows little congruence with what is known of their phylogeny. The major determinant of relatedness appears to be geographical proximity. Together these attributes suggest that host-parasite coevolution has contributed little to the evolution of trematode communities of epinephelines. Instead, they appear to have arisen through localized episodes of host-switching, presumably both into and out of the epinephelines. The Epinephelinae may well be typical of most groups of marine fishes both in the extent to which their trematode parasites are known and in that, apparently, co-evolution has contributed little to the evolution of their communities of trematodes.

Effect of Metalaxyl Resistance and Cultivar Resistance on Control of Phytophthora nicotianae in Tobacco

Phytophthora nicotianae is a devastating root and stem pathogen of tobacco (Nicotiana tabacum) in South Africa. Growers strive to control the resulting disease, known as black shank, with metalaxyl treatments and resistant cultivars. The aim of this study was to consider whether development of metalaxyl resistance in P. nicotianae has contributed to poor disease control and if recently developed cultivars with high levels of resistance require metalaxyl for effective control. One hundred and thirty-two isolates of P. nicotianae were screened for sensitivity to metalaxyl. P. nicotianae isolates from most tobacco farms were metalaxyl sensitive. Growth of most isolates was inhibited completely at 1.0 μg a.i./ml. However, isolates from the MKTV tobacco producing area showed EC50 values ranging from 1.02 μg a.i./ml to 3.57 μg a.i./ml. Twenty-one tobacco cultivars were planted and treated with and without metalaxyl in two different growing seasons to evaluate their resistance to P. nicotianae and the value of using metalaxyl. Hicks was the most susceptible cultivar. Vuma/3/46, LK30/40/60-1, and LK33/60 exhibited the greatest resistance to P. nicotianae. Use of metalaxyl in combination with moderately resistant cultivars such as NC60 × TL33 and LK10/80/60 effectively reduced black shank in the field. Resistant cultivars were healthy and no significant difference between metalaxyl treated and untreated plants was observed.