Tuberculous Peritonitis, Poor Ultra Filtration, And Hypotension In A Patient On Continuous Ambulatory Peritoneal Dialysis
Indian Journal of Peritoneal Dialysis, Aug 2010
Cranial Consumption: A Case Study Examining of Calvarial Tuberculosis in a Middle Mississippian Ossuary Burial
I wrote this for an undergraduate research class. So comments are welcome.
A diagnosis of tuberculosis in prehistoric skeletal remains is not uncommon and can most often be identified by the... more
A diagnosis of tuberculosis in prehistoric skeletal remains is not uncommon and can most often be identified by the manifestation of rib lesions and destruction of vertebral bodies, resulting in kyphosis, as well as other elements with large amounts of cancellous bone, such as joint areas. However cranial lesions associated with TB are much less common. The cranial vault is usually affected only after the disease has travelled via the bloodstream from a primary site, such as the lungs, and then it causes lesions in the diploe.
This paper discusses a case of calvarial tuberculosis that was discovered in a Middle Mississippian (ca AD 1100-1300) ossuary burial from the Shady Grove site (22QU525) in Quitman County, Mississippi. Burial 43-5A, a young adult male, shows classic signs of tuberculosis in the vertebrae and ribs as well as on the sternum. However, he also had two severe circular lesions perforating the cranial table, along with several other smaller progressive lesions on the interior cranial surface. This pattern has been seen in several cases of tuberculosis identified in more clinical literature. Additionally, severe osteomyelitis is seen on the left clavicle, but this may be related to causes in addition to the tuberculosis. This individual was one of the few bundled burials in the ossuary. Had associated postcranial remains not been present, the diagnosis of tubercular lesions in the cranium likely not would have been made.
TB diagnostics in India: creating an ecosystem for innovation
by Nora Engel
Co-authored with John Kenneth & Madukar Pai. Published in Expert Reviews of Molecular Diagnostics, 2012, 12(1): 21-24.
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Seen by:Patient and doctor perspectives on incorporating smoking cessation into tuberculosis care in Beijing, China.
Published in the International Journal of TB and Lung Disease 2012;16(1):126-131.
SETTING: Tuberculosis (TB) hospital in Beijing, China.
OBJECTIVE: To describe perspectives of patients and... more
SETTING: Tuberculosis (TB) hospital in Beijing, China.
OBJECTIVE: To describe perspectives of patients and physicians regarding the incorporation of smoking cessation interventions as part of TB treatment.
DESIGN: Seven focus groups were conducted with 39 patients and 17 physicians.
RESULTS: Patients were more receptive to physicians' advice to quit smoking due to increased concerns about their health after becoming ill with TB. However, patients indicated that they might start smoking again after they recovered from TB. Patients' attempts to quit smoking may have been inhibited by exposure to smoking at the TB facility. Physicians had low levels of knowledge regarding the effect of smoking on TB. Many doctors, particularly those who smoked, did not view smoking cessation as an integral part of TB treatment.
CONCLUSION: Despite the presence of a `teachable moment', TB patients experience significant barriers to quitting smoking. Patient education in TB treatment programs should address the specific effects of smoking on TB and the general health benefits of cessation. Smoke-free policies should be strictly enforced in TB facilities. Successful integration of smoking cessation interventions within TB treatment regimens may require that providers adopt smoking cessation as an essential part of TB treatment.
Gender-specific association of smoking and latent tuberculosis infection among marginalized populations in Tijuana, Mexico
Shin SS1,2, Laniado-Laborin R3, Lozada R4, Cuevas-Mota J2, Burgos JL2, Rodwell TC2, Novotny TE1, Garfein RS2
1San Diego State University, San Diego, CA, USA
2University of California San Diego, San Diego, California, USA
3Universidad Autonoma de Baja California, Tijuana, Baja California, Mexico
4Patronato Pro-COMUSIDA, Tijuana, Baja California, Mexico
BACKGROUND: We investigated the association between smoking and latent tuberculosis infection (LTBI) among groups at risk for HIV in Tijuana, Mexico.
DESIGN/METHODS: We conducted a cross-sectional survey among injection drug users (IDUs), drug users who never injected (DUs), homeless persons, and female sex workers (FSWs) aged >18 years. Interferon-gamma release assays and clinical measures were used to determine LTBI.
RESULTS: Of 503 participants, 300 (60.0%) were men; and 232 (46.1%), 207 (41.2%), 280 (55.7%), and 115 (22.9%) reported being IDU, DU, homeless and FSW, respectively. Overall, 148 (72.9%) women and 248 (82.7%) men reported smoking daily during the past six months, and smoked a mean of 13.1 and 12.2 cigarettes per day, respectively. LTBI prevalence was 49.3% among women and 62.0% among men. Smokers had higher LTBI prevalence compared to non-smokers among women (Prevalence Ratio [PR]=1.81; 95% CI=1.19, 2.76) but not among men (PR=0.87; 95% CI=0.71, 1.07). LTBI prevalence increased with the number of cigarettes smoked per day among women (p=0.002) but not among men (p=0.245). Using multivariate regression to control for age and incarceration history, LTBI prevalence remained higher for smokers compared with non-smokers among women (PR=1.65; 95% CI=1.09, 2.52) but not among men (PR=0.93; 95% CI=0.77, 1.13).
CONCLUSION: Smoking and LTBI were common among marginalized populations in Tijuana. Tuberculosis control efforts in these populations should include LTBI treatment and smoking cessation. Additional research is needed to understand gender differences in smoking and LTBI.
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Seen by:Mining Genomic Patterns in Mycobacterium tuberculosis H37Rv Using a Web Server Tuber-Gene
Authors: L Rishishwar, B Pant, K Pant, KR Pardasani.
DOI: 10.1016/S1672-0229(11)60020-X.
Mycobacterium tuberculosis (MTB), causative agent of tuberculosis, is one of the most dreaded diseases of the century.... more Mycobacterium tuberculosis (MTB), causative agent of tuberculosis, is one of the most dreaded diseases of the century. It has long been studied by researchers throughout the world using various wet-lab and dry-lab techniques. In this study, we focus on mining useful patterns at genomic level that can be applied for in silico functional characterization of genes from the MTB complex. The model developed on the basis of the patterns found in this study can correctly identify 99.77% of the input genes from the genome of MTB strain H37Rv. The model was tested against four other MTB strains and the homologue M. bovis to further evaluate its generalization capability. The mean prediction accuracy was 85.76%. It was also observed that the GC content remained fairly constant throughout the genome, implicating the absence of any pathogenicity island transferred from other organisms. This study reveals that dinucleotide composition is an efficient functional class discriminator for MTB complex. To facilitate the application of this model, a web server Tuber-Gene has been developed, which can be freely accessed at http://www.bifmanit.org/tb2/.
Nutrition, hygiene, and mortality. Setting parameters for Roman health and life expectancy consistent with our comparative evidence
In E. Lo Cascio (a cura di), L’impatto della “peste antonina,” (Collana di Pragmateiai) (Bari: Edipuglia) (in press)
Any hypotheses regarding the likely long-term demographic impact of the Antonine plague will have to take into... more
Any hypotheses regarding the likely long-term demographic impact of the Antonine plague will have to take into account, not only the cause of the epidemic, but also the underlying mortality and fertility regime of the Roman empire. Health, nutritional status and hygiene have a significant effect upon the virulence of some epidemics, while for others, like the bubonic plague, for example, they are largely irrelevant. But whatever the effect on the morbidity of the epidemic, the underlying mortality regime of the population will have a significant impact on determining both the extent to which the population will be able to absorb this excess mortality, and the extent to which it will or will not recover.
At least since the influential work of Keith Hopkins in the 1960’s, a broad consensus has emerged among ancient historians setting the life expectancy at birth in the Roman Principate and Empire at between 20 and 30 years of age, with most estimates falling on the lower end of this range, often below 25 years. As the trenchant critiques of Tim Parkin and Walter Scheidel have emphasized, however, solid evidence for the calculation of ancient life expectancy simply does not exist. Recent estimates must therefore remain largely educated guesses based on comparative evidence from early-industrial Europe or the contemporary Third World. I intend to argue that at least three strong considerations suggest that the present scholarly consensus is unrealistically low. .
First, a more careful reading of the modern demographic evidence will show that the life expectancies as low as those conjectured for Roman Italy are rarely documented for Western European societies, generally only in brief periods of extreme poverty and stress, or for limited segments of society.
Second, researchers of ancient demography have generally neglected the critical role of nutrition in the modern rise in life expectancy, as argued in a classic, if controversial, work by Thomas MacKeown, and confirmed by the correlation between the secular increase in heights and decline in mortality in modern Europe and North America drawn by Robert Fogel. In fact, anthropometric evidence of ancient heights suggests that Greco-Roman societies enjoyed a significantly higher biological standard of living than the working classes of 18th and 19th century Western Europe. Early industrial life expectancies are therefore likely to represent a floor, rather than a ceiling, for plausible Greco-Roman estimates.
Finally, there is evidence that, in addition to enjoying superior nutritional standards, Greco-Roman populations likely faced fewer health stresses from contaminated drinking water, over-crowding, poor hygiene and sanitation, lack of exercise, and social inequality generally than the poor of the European ancien régime.
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Seen by:Blind Spots and Adverse Conditions of Care: screenig migrants for tuberculosis in France and Germany
by Janina Kehr
Blind spots and adverse conditions of care: screening migrants for tuberculosis in France and Germany In Sociology of Health and Illness, 34, 2, february 2012
Tuberculosis (TB) is an infectious disease that declined significantly throughout the 20th century. Large-scale TB... more Tuberculosis (TB) is an infectious disease that declined significantly throughout the 20th century. Large-scale TB screening of entire populations in France and Germany has thus been replaced by active screening of risk-groups, particularly migrants. The article engages with its problems and practices on three levels: by looking at the way information on migrants as an at-risk group is produced through disease surveillance data; by analysing how such at-risk group data influence local screening practices; and by showing which political and medical problems arise in the field. I overturn the discussion about screening and surveillance of migrants as a risk-group by showing that it is not the stigmatisation of migrants through disease risk that is most at stake, but the invisibility of the most vulnerable among them in disease surveillance data and the way restrictive national immigration policies interfere with and subvert local screening and treatment practices targeting them. The aim of my article is to promote a pragmatic sociology of screening, while paying attention to the practical complexities, political conditions and medical ambivalences of screening and follow-up care, especially when the migrant groups concerned are socially, politically and medically vulnerable.
Deleuze’s bodies, philosophical diseases and the thought of illness
by Laura Cull
Like those who inspired him – Spinoza, Nietzsche & Artaud – Deleuze experienced a poor state of health during much... more
Like those who inspired him – Spinoza, Nietzsche & Artaud – Deleuze experienced a poor state of health during much of his working life: beginning in 1968 with the first major episode of the pulmonary illness that would dog the philosopher’s body until his fatal defenestration in 1995. But what was the relationship, for Deleuze, between philosophy and illness, between thought and the body in poor health? In his late interview with Claire Parnet, Deleuze proposes that ‘illness sharpens a kind of vision of life or a sense of life’. Rather than merely thinking about one’s illness, one might use a fragile state of health to develop a mode of thought that is more tuned-in to life, Deleuze suggests. Alternatively, in Pure Immanence, Deleuze argues that, for Nietzsche, ‘Illness is not a motive for a thinking subject, nor is it an object for thought: it constitutes, rather, a secret intersubjectivity at the heart of a single individual’. In these ways, and indeed in Nietzsche and Philosophy, Deleuze suggests that illness need not just separate us from our power to act; ‘the same physiological state may weaken some powers but open up new possibilities of feeling or bring about new capacities for acting and being acted upon’. However, in The Logic of Sense, Deleuze also speaks of ‘philosophical diseases’; arguing that idealism, for instance ‘is the illness congenital to the Platonic philosophy’.
This paper will explore the value Deleuze attributes to illness in relation to thought as evidence of his embodied approach to philosophy. Contra Peter Hallward’s recent critique, I will argue against the idea of Deleuze’s thought as an ascetic philosophy that calls for a dissolution of the material self in order to become the adequate vessel for the passage of a dematerialised thought. Rather, I will suggest that the reason why Deleuze is interested in the thought that emerges from illness is because it involves a heightened awareness of our capacity to affect and be affected by other material bodies.
Socio-demographic determinants of stigma among patients with pulmonary tuberculosis in Lagos, Nigeria
Abioye IA, Omotayo MO, Alakija W
Background: Patients living with tuberculosis (TB) experience significant disruption of their social life and are... more
Background: Patients living with tuberculosis (TB) experience significant disruption of their social life and are exposed to stigma and discrimination. This situation impacts on treatment adherence by individual patients and on disease control especially in developing nations. Different aetiological propositions have been propounded, including the relationship of tuberculosis with the Acquired Immune Deficiency Syndrome (AIDS).
Objectives: We sought to evaluate self-reported stigma experience among TB patients in Lagos and examine its sociodemographic determinants.
Method: This was a descriptive cross-sectional study, recruiting 205 patients on treatment at two government-owned referral centres for tuberculosis, using self-administered questionnaires to collect each respondent’s data.
Result: Eighteen percent reported a previous stigma experience. Stigma experience was observed to be significantly determined by age, low socio-economic status, level of education below secondary level, disclosure of status, history of weight loss, previous smoking and alcohol history. Also, patients unable to work on clinic days were more likely to experience stigma. Sexs, religion, marital status and ethnicity were not significant determinants.
Conclusion: Experience of stigma among patients with tuberculosis is common and may adversely affect treatment adherence. Healthcare workers and policy makers need to pay closer attention to the identified determinants for effective tuberculosis control.

