Last data update: Apr 22, 2024. (Total: 46599 publications since 2009)
Records 1-8 (of 8 Records) |
Query Trace: Tokarz RE [original query] |
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Adherence to national malaria clinical management and testing guidelines in selected private clinics of Gambela Town, Gambela Region, Ethiopia: a mixed method study
Gindola Y , Getahun D , Sugerman D , Tongren E , Tokarz R , Wossen M , Demissie K , Zemelak E , Okugn A , Wendimu J , Hailu G , Tegistu M , Begna D . Malar J 2022 21 (1) 164 BACKGROUND: The World Health Organization World Malaria Report of 2019 indicated an estimated 228 million cases of malaria occurred worldwide in 2018. More than 75% of the total area of Ethiopia is malarious, making malaria a leading public health problem in Ethiopia. Adherence to clinical guidelines improves the quality of care received by patients, thus improving patient outcomes. This study investigates healthcare workers' adherence to malaria testing and treatment guidelines in selected private clinics of Gambela Town, Ethiopia. METHODS: A mixed study design involving a retrospective review of 425 patient files and 20 healthcare worker interviews in private clinics was implemented. Data were collected using pre-tested data collection forms. The collected data were then cleaned and entered into statistical software for analysis, with a level of significance set at<0.05. A qualitative analysis was also conducted using healthcare worker interviews to identify the existing barriers to guideline adherence. RESULTS: Among the 430 cases of suspected malaria, only 65% were tested for malaria. Of those tested, 75% tested positive and 25% tested negative. The most common co-morbidity in patients treated for malaria was anaemia (30%), followed by gastroenteritis (10%). Patients with co-morbidities were more likely to receive appropriate treatment (p=0.03) compared to those without co-morbidities. All healthcare workers interviewed were aware of the existence of the malaria treatment guidelines. However, many were not aware of the contents of the guidelines and only 40% had been trained to understand the guidelines. Overall, 85% of the workers claimed to adhere to guidelines, with 15% claiming non-adherence. CONCLUSION: The gap between knowledge of the malaria treatment guidelines and their application by healthcare workers remains wide. The level of knowledge of these guidelines was also low. Continuous training, follow-up, supportive supervision, and improved adherence to the malaria guidelines are therefore recommended. |
Another dengue fever outbreak in Eastern Ethiopia-An emerging public health threat
Gutu MA , Bekele A , Seid Y , Mohammed Y , Gemechu F , Woyessa AB , Tayachew A , Dugasa Y , Gizachew L , Idosa M , Tokarz RE , Sugerman D . PLoS Negl Trop Dis 2021 15 (1) e0008992 BACKGROUND: Dengue Fever (DF) is a viral disease primarily transmitted by Aedes (Ae.) aegypti mosquitoes. Outbreaks in Eastern Ethiopia were reported during 2014-2016. In May 2017, we investigated the first suspected DF outbreak from Kabridahar Town, Somali region (Eastern Ethiopia) to describe its magnitude, assess risk factors, and implement control measures. METHODS: Suspected DF cases were defined as acute febrile illness plus ≥2 symptoms (headache, fever, retro-orbital pain, myalgia, arthralgia, rash, or hemorrhage) in Kabridahar District residents. All reported cases were identified through medical record review and active searches. Severe dengue was defined as DF with severe organ impairment, severe hemorrhage, or severe plasma leakage. We conducted a neighborhood-matched case-control study using a subset of suspected cases and conveniently-selected asymptomatic community controls and interviewed participants to collect demographic and risk factor data. We tested sera by RT-PCR to detect dengue virus (DENV) and identify serotypes. Entomologists conducted mosquito surveys at community households to identify species and estimate larval density using the house index (HI), container index (CI) and Breteau index (BI), with BI≥20 indicating high density. RESULTS: We identified 101 total cases from May 12-31, 2017, including five with severe dengue (one death). The attack rate (AR) was 17/10,000. Of 21 tested samples, 15 (72%) were DENV serotype 2 (DENV 2). In the case-control study with 50 cases and 100 controls, a lack of formal education (AOR [Adjusted Odds Ratio] = 4.2, 95% CI [Confidence Interval] 1.6-11.2) and open water containers near the home (AOR = 3.0, 95% CI 1.2-7.5) were risk factors, while long-lasting insecticide treated-net (LLITN) usage (AOR = 0.21, 95% CI 0.05-0.79) was protective. HI and BI were 66/136 (49%) and 147 per 100 homes (147%) respectively, with 151/167 (90%) adult mosquitoes identified as Ae. aegypti. CONCLUSION: The epidemiologic, entomologic, and laboratory investigation confirmed a DF outbreak. Mosquito indices were far above safe thresholds, indicating inadequate vector control. We recommended improved vector surveillance and control programs, including best practices in preserving water and disposal of open containers to reduce Aedes mosquito density. |
Antibodies to Enteroviruses in Cerebrospinal Fluid of Patients with Acute Flaccid Myelitis.
Mishra N , Ng TFF , Marine RL , Jain K , Ng J , Thakkar R , Caciula A , Price A , Garcia JA , Burns JC , Thakur KT , Hetzler KL , Routh JA , Konopka-Anstadt JL , Nix WA , Tokarz R , Briese T , Oberste MS , Lipkin WI . mBio 2019 10 (4) Acute flaccid myelitis (AFM) has caused motor paralysis in >560 children in the United States since 2014. The temporal association of enterovirus (EV) outbreaks with increases in AFM cases and reports of fever, respiratory, or gastrointestinal illness prior to AFM in >90% of cases suggest a role for infectious agents. Cerebrospinal fluid (CSF) from 14 AFM and 5 non-AFM patients with central nervous system (CNS) diseases in 2018 were investigated by viral-capture high-throughput sequencing (VirCapSeq-VERT system). These CSF and serum samples, as well as multiple controls, were tested for antibodies to human EVs using peptide microarrays. EV RNA was confirmed in CSF from only 1 adult AFM case and 1 non-AFM case. In contrast, antibodies to EV peptides were present in CSF of 11 of 14 AFM patients (79%), significantly higher than controls, including non-AFM patients (1/5 [20%]), children with Kawasaki disease (0/10), and adults with non-AFM CNS diseases (2/11 [18%]) (P = 0.023, 0.0001, and 0.0028, respectively). Six of 14 CSF samples (43%) and 8 of 11 sera (73%) from AFM patients were immunoreactive to an EV-D68-specific peptide, whereas the three control groups were not immunoreactive in either CSF (0/5, 0/10, and 0/11; P = 0.008, 0.0003, and 0.035, respectively) or sera (0/2, 0/8, and 0/5; P = 0.139, 0.002, and 0.009, respectively).IMPORTANCE The presence in cerebrospinal fluid of antibodies to EV peptides at higher levels than non-AFM controls supports the plausibility of a link between EV infection and AFM that warrants further investigation and has the potential to lead to strategies for diagnosis and prevention of disease. |
Role of p53 in the chronic pulmonary immune response to tangled or rod-like multi-walled carbon nanotubes
Duke KS , Thompson EA , Ihrie MD , Taylor-Just AJ , Ash EA , Shipkowski KA , Hall JR , Tokarz DA , Cesta MF , Hubbs AF , Porter DW , Sargent LM , Bonner JC . Nanotoxicology 2018 12 (9) 1-17 The fiber-like shape of multi-walled carbon nanotubes (MWCNTs) is reminiscent of asbestos, suggesting they pose similar health hazards when inhaled, including pulmonary fibrosis and mesothelioma. Mice deficient in the tumor suppressor p53 are susceptible to carcinogenesis. However, the chronic pathologic effect of MWCNTs delivered to the lungs of p53 heterozygous (p53(+/-)) mice has not been investigated. We hypothesized that p53(+/-) mice would be susceptible to lung tumor development after exposure to either tangled (t-) or rod-like (r-) MWCNTs. Wild-type (p53(+/+)) or p53(+/-) mice were exposed to MWCNTs (1 mg/kg) via oropharyngeal aspiration weekly over four consecutive weeks and evaluated for cellular and pathologic outcomes 11-months post-initial exposure. No lung or pleural tumors were observed in p53(+/+) or p53(+/-) mice exposed to either t- or rMWCNTs. In comparison to tMWCNTs, the rMWCNTs induced the formation of larger granulomas, a greater number of lymphoid aggregates and greater epithelial cell hyperplasia in terminal bronchioles in both p53(+/-) and p53(+/+) mice. A constitutively larger area of CD45R(+)/CD3(+) lymphoid tissue was observed in p53(+/-) mice compared to p53(+/+) mice. Importantly, p53(+/-) mice had larger granulomas induced by rMWCNTs as compared to p53(+/+) mice. These findings indicate that a combination of p53 deficiency and physicochemical characteristics including nanotube geometry are factors in susceptibility to MWCNT-induced lymphoid infiltration and granuloma formation. |
A multiplex serologic platform for diagnosis of tick-borne diseases
Tokarz R , Mishra N , Tagliafierro T , Sameroff S , Caciula A , Chauhan L , Patel J , Sullivan E , Gucwa A , Fallon B , Golightly M , Molins C , Schriefer M , Marques A , Briese T , Lipkin WI . Sci Rep 2018 8 (1) 3158 Tick-borne diseases are the most common vector-borne diseases in the United States, with serology being the primary method of diagnosis. We developed the first multiplex, array-based assay for serodiagnosis of tick-borne diseases called the TBD-Serochip. The TBD-Serochip was designed to discriminate antibody responses to 8 major tick-borne pathogens present in the United States, including Anaplasma phagocytophilum, Babesia microti, Borrelia burgdorferi, Borrelia miyamotoi, Ehrlichia chaffeensis, Rickettsia rickettsii, Heartland virus and Powassan virus. Each assay contains approximately 170,000 12-mer linear peptides that tile along the protein sequence of the major antigens from each agent with 11 amino acid overlap. This permits accurate identification of a wide range of specific immunodominant IgG and IgM epitopes that can then be used to enhance diagnostic accuracy and integrate differential diagnosis into a single assay. To test the performance of the TBD-Serochip, we examined sera from patients with confirmed Lyme disease, babesiosis, anaplasmosis, and Powassan virus disease. We identified a wide range of specific discriminatory epitopes that facilitated accurate diagnosis of each disease. We also identified previously undiagnosed infections. Our results indicate that the TBD-Serochip is a promising tool for a differential diagnosis not available with currently employed serologic assays for TBDs. |
Global, regional, and national disease burden estimates of acute lower respiratory infections due to respiratory syncytial virus in young children in 2015: a systematic review and modelling study
Shi T , McAllister DA , O'Brien KL , Simoes EAF , Madhi SA , Gessner BD , Polack FP , Balsells E , Acacio S , Aguayo C , Alassani I , Ali A , Antonio M , Awasthi S , Awori JO , Azziz-Baumgartner E , Baggett HC , Baillie VL , Balmaseda A , Barahona A , Basnet S , Bassat Q , Basualdo W , Bigogo G , Bont L , Breiman RF , Brooks WA , Broor S , Bruce N , Bruden D , Buchy P , Campbell S , Carosone-Link P , Chadha M , Chipeta J , Chou M , Clara W , Cohen C , de Cuellar E , Dang DA , Dash-Yandag B , Deloria-Knoll M , Dherani M , Eap T , Ebruke BE , Echavarria M , de Freitas Lazaro Emediato CC , Fasce RA , Feikin DR , Feng L , Gentile A , Gordon A , Goswami D , Goyet S , Groome M , Halasa N , Hirve S , Homaira N , Howie SRC , Jara J , Jroundi I , Kartasasmita CB , Khuri-Bulos N , Kotloff KL , Krishnan A , Libster R , Lopez O , Lucero MG , Lucion F , Lupisan SP , Marcone DN , McCracken JP , Mejia M , Moisi JC , Montgomery JM , Moore DP , Moraleda C , Moyes J , Munywoki P , Mutyara K , Nicol MP , Nokes DJ , Nymadawa P , da Costa Oliveira MT , Oshitani H , Pandey N , Paranhos-Baccala G , Phillips LN , Picot VS , Rahman M , Rakoto-Andrianarivelo M , Rasmussen ZA , Rath BA , Robinson A , Romero C , Russomando G , Salimi V , Sawatwong P , Scheltema N , Schweiger B , Scott JAG , Seidenberg P , Shen K , Singleton R , Sotomayor V , Strand TA , Sutanto A , Sylla M , Tapia MD , Thamthitiwat S , Thomas ED , Tokarz R , Turner C , Venter M , Waicharoen S , Wang J , Watthanaworawit W , Yoshida LM , Yu H , Zar HJ , Campbell H , Nair H . Lancet 2017 390 (10098) 946-958 BACKGROUND: We have previously estimated that respiratory syncytial virus (RSV) was associated with 22% of all episodes of (severe) acute lower respiratory infection (ALRI) resulting in 55 000 to 199 000 deaths in children younger than 5 years in 2005. In the past 5 years, major research activity on RSV has yielded substantial new data from developing countries. With a considerably expanded dataset from a large international collaboration, we aimed to estimate the global incidence, hospital admission rate, and mortality from RSV-ALRI episodes in young children in 2015. METHODS: We estimated the incidence and hospital admission rate of RSV-associated ALRI (RSV-ALRI) in children younger than 5 years stratified by age and World Bank income regions from a systematic review of studies published between Jan 1, 1995, and Dec 31, 2016, and unpublished data from 76 high quality population-based studies. We estimated the RSV-ALRI incidence for 132 developing countries using a risk factor-based model and 2015 population estimates. We estimated the in-hospital RSV-ALRI mortality by combining in-hospital case fatality ratios with hospital admission estimates from hospital-based (published and unpublished) studies. We also estimated overall RSV-ALRI mortality by identifying studies reporting monthly data for ALRI mortality in the community and RSV activity. FINDINGS: We estimated that globally in 2015, 33.1 million (uncertainty range [UR] 21.6-50.3) episodes of RSV-ALRI, resulted in about 3.2 million (2.7-3.8) hospital admissions, and 59 600 (48 000-74 500) in-hospital deaths in children younger than 5 years. In children younger than 6 months, 1.4 million (UR 1.2-1.7) hospital admissions, and 27 300 (UR 20 700-36 200) in-hospital deaths were due to RSV-ALRI. We also estimated that the overall RSV-ALRI mortality could be as high as 118 200 (UR 94 600-149 400). Incidence and mortality varied substantially from year to year in any given population. INTERPRETATION: Globally, RSV is a common cause of childhood ALRI and a major cause of hospital admissions in young children, resulting in a substantial burden on health-care services. About 45% of hospital admissions and in-hospital deaths due to RSV-ALRI occur in children younger than 6 months. An effective maternal RSV vaccine or monoclonal antibody could have a substantial effect on disease burden in this age group. FUNDING: The Bill & Melinda Gates Foundation. |
Andes hantavirus variant in rodents, southern Amazon Basin, Peru
Razuri H , Tokarz R , Ghersi BM , Salmon-Mulanovich G , Guezala MC , Albujar C , Mendoza AP , Tinoco YO , Cruz C , Silva M , Vasquez A , Pacheco V , Stroher U , Guerrero LW , Cannon D , Nichol ST , Hirschberg DL , Lipkin WI , Bausch DG , Montgomery JM . Emerg Infect Dis 2014 20 (2) 257-60 We investigated hantaviruses in rodents in the southern Amazon Basin of Peru and identified an Andes virus variant from Neacomys spinosus mice. This finding extends the known range of this virus in South America and the range of recognized hantaviruses in Peru. Further studies of the epizoology of hantaviruses in this region are warranted. |
Evaluation of a pilot respiratory virus surveillance system linking electronic health record and diagnostic data
Al-Samarrai T , Wu W , Begier E , Lurio J , Tokarz R , Plagianos M , Calman N , Mostashari F , Briese T , Lipkin WI , Greene C . J Public Health Manag Pract 2013 19 (4) 322-9 CONTEXT: During the onset of 2009 pandemic influenza A (H1N1) (pH1N1), the New York City Department of Health and Mental Hygiene implemented a pilot respiratory virus surveillance system. OBJECTIVES: We evaluated the performance of this pilot system, which linked electronic health record (EHR) clinical, epidemiologic, and diagnostic data to monitor influenza-like illness (ILI) in the community. DESIGN: Surveillance was conducted at 9 community health centers with EHRs. Clinical decision support system alerts encouraged diagnostic testing of patients. Rapid influenza diagnostic testing (RIDT) and multiplex polymerase chain reaction assay (MassTag PCR) were performed sequentially. SETTING: Nine Institute for Family Health (IFH) clinics in Manhattan and the Bronx during May 26 to June 30, 2009, the pH1N1 outbreak peak. PARTICIPANTS: Adult and pediatric patients presenting to IFH clinics during May 26 to June 30, 2009. MAIN OUTCOME MEASURES: By using Centers for Disease Control and Prevention guidelines, we evaluated the system's completeness, sensitivity, timeliness, and epidemiologic usefulness. RESULTS: Of 537 ILI visits (5.7% of all visits), 17% underwent diagnostic testing. Of the 132 specimens with both a RIDT and MassTag PCR result, 90 (68%) had a MassTag PCR-identified respiratory virus, most commonly pH1N1 (n = 69; 77%). Of the 81 specimens that met the ILI case definition, 58 (72%) were positive for a respiratory virus tested for by MassTag PCR; 48 (59%) were positive for pH1N1. Ninety-four percent of ILI patients positive for pH1N1 were 45 years or younger. Sensitivity and specificity of RIDT (29% and 94%) and ILI case definition (70% and 48%) for pH1N1 were calculated using MassTag PCR as the standard. Results of RIDT took a median of 6 days. CONCLUSIONS: Despite low RIDT sensitivity for pH1N1 and limited timeliness, integration of EHR and diagnostic data has potential to provide valuable epidemiologic information, guide public health response, and represents a new model for community surveillance for influenza and respiratory viruses. |
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