Background Since a meta-analysis showed little or no effect of second-line injectables on treatment success, and using injectables may induce ototoxicity, injectable-free rifampicin-resistant ...tuberculosis (RR-TB) treatment regimens are recommended. However, acquired resistance preventing activity was overlooked. No previous study assessed the effect of shortening the duration of kanamycin administration to 2 months during the intensive phase of the RR-TB shorter treatment regimen (STR). Methods Retrospective cohort study of the effect of using 2 months of kanamycin instead of the standard 4(+) months (extension if lack of smear conversion at 4 months) on recurrence (either treatment failure or relapse) and fluoroquinolone acquired drug resistance, in patients treated with a gatifloxacin-based STR in Damien Foundation supported clinics in Bangladesh. Logistic regression was used to estimate associations. Results Five of 52 (9.6%) treated with a STR containing two months of kanamycin had recurrence, compared to 21 of 738 (2.8%) patients treated with the standard STR containing 4(+) months of kanamycin (OR 3.7; 95%CI:1.5-10.3). In those with initially fluoroquinolone-susceptible TB, acquired resistance to fluoroquinolone was detected in none of 639 patients treated with 4(+) months of kanamycin and two (4.5%) of 44 treated with two months of kanamycin (OR 75.2; 95%CI:3.6-1592.1). Conclusion Two months of kanamycin was insufficient to prevent recurrence with acquired resistance to gatifloxacin, the core drug of the most effective RR-TB STR. Injectable mediated resistance prevention is important to reach high effectiveness, to safeguard all treatment options after recurrence, and to prevent the spread of resistant TB. Studies on all-oral regimens should also assess the effect of regimen composition on resistance acquisition. Until evidence shows that other drugs can assure at least the same strong resistance preventing activity of the injectables, it seems wise to continue using this group of drugs, and adapt the regimen if any ototoxicity is detected.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Abstract Background Neglected zoonoses continue to significantly affect human health in low-resource countries. A symposium was organised in Antwerp, Belgium, on 5 November 2010 to evaluate how ...intersectoral collaboration among educational and research institutions could improve the situation. Results Brucellosis and echinococcosis were presented as models for intersectoral collaboration. Low-resource societies face evident knowledge gaps on disease distribution, transmission within and across species and impact on human and animal health, precluding the development of integrated control strategies. Recommendations While veterinarians have been the main driver of the One Health initiative, the medical profession does not seem to be fully aware of how veterinary science can contribute to human public health. It was postulated that transdisciplinarity could help fill knowledge gaps and that encouraging such transdisciplinarity should start with undergraduate students. Furthermore, intersectoral collaboration on zoonoses should not ignore the social sciences (e.g. assessment of indigenous knowledge and perception; participatory surveillance), which can contribute to a better understanding of the transmission of diseases and improve communities’ participation in disease control activities.
In contrast to horses in pastures, it is thought that free-ranging horses do not perform latrine behaviour, i.e. a behavioural pattern whereby the animals graze and defecate in separate areas. ...However, few studies deal with this particular subject, reporting contrasting conclusions. We hypothesize that horses free-ranging in large heterogeneous areas do not perform latrine behaviour. Thus, we believe that grazing and elimination behaviour are spatially related: where horses graze, they will also defecate. Behavioural data were collected from Konik horses, Haflinger horses, Shetland ponies and donkeys, grazing in different nature reserves (54–80
ha). Data for the different equids were analyzed separately, as well as data for mares and stallions (Konik and donkey stallions only). We investigated the proportion of the number of defecations/urinations while grazing on the total number of defecations/urinations; furthermore, we searched for the sequence of behaviours representing latrine behaviour in the strict sense. Additionally, we analyzed the correlation between grazing behaviour and eliminative behaviour on both vegetation type level and patch level. All the female equids often continued grazing while defecating. During urination, grazing ceases in the majority of instances. Cases where a mare terminated grazing in a certain vegetation type and sward height to eliminate in another vegetation type or in another sward height within the same vegetation type were rarely observed. On the vegetation type level as well as on the patch level, there was a highly significant (
P<0.001) positive correlation between grazing time and number of eliminations (or eliminating time). The high values of the correlation coefficients (in case of the defecation variables
r ranges between 0.553 and 0.955; in case of the urination variables
r ranges between 0.370 and 0.839) illustrate that the spatial distribution of the eliminative behaviour can be explained to a high degree by the spatial distribution of the grazing behaviour. Results in the case of the stallions are preliminary, but indicate the same pattern. Horses, free-ranging in large heterogeneous areas, do not perform latrine behaviour, but defecate where they graze. Possibly, animal density is of major importance to explain this behavioural difference with horses in pastures. We suggest that also spatial vegetation heterogeneity and plant productivity of the grazed area, as well as parasite status of the grazing animals could play a role.
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