Yared Wondmikun

Alterations in serum levels of trace elements in tuberculosis and HIV infections

Objective:To evaluate serum concentrations of trace elements in tuberculosis (TB) patients with or with out human immunodeficiency virus (HIV) coinfection before and after anti-TB chemotherapy.Subjects:A total of 155 TB patients, 74 of which were coinfected with HIV, and 31 healthy controls from Gondar, Ethiopia.Methods:Serum levels of copper, zinc, selenium and iron were determined using an inductively coupled plasma mass spectrometer from all subjects at baseline and from 44 TB patients (22 with HIV coinfection) at the end of an intensive phase of anti-TB chemotherapy.Results:Compared with the control group, the concentrations of iron, zinc and selenium were significantly lower (P<0.05) while that of copper and copper/zinc ratio was significantly higher (P<0.05) in the serum of TB patients. TB patients with HIV coinfection had significantly lower serum zinc and selenium concentrations and significantly higher copper/zinc ratio compared to that in TB patients without HIV coinfection (P<0.05). The serum concentration of zinc had significantly increased at the end of intensive phase of anti-TB chemotherapy in patients without HIV coinfection (P<0.05). An increase in serum selenium level was observed in TB patients with or without HIV coinfection after therapy. On the contrary, serum copper concentration and copper/zinc ratio declined significantly after anti-TB chemotherapy irrespective of HIV serostatus (P<0.05).Conclusions:The results indicate that TB patients have altered profile of trace elements in their sera. This warrants the need for further investigations so that strategies for trace elements supplementation can be planned in addition to their potential as diagnostic parameters in monitoring responses to anti-TB chemotherapy.

Nitric oxide production in the exhaled air of patients with pulmonary tuberculosis in relation to HIV co-infection

BackgroundNitric oxide (NO) is essential for host defense in rodents, but the role of NO during tuberculosis (TB) in man remains controversial. However, earlier observations that arginine supplementation facilitates anti-TB treatment, supports the hypothesis that NO is important in the host defense against TB. Local production of NO measured in fractional exhaled air (FeNO) in TB patients with and without HIV co-infection has not been reported previously. Thus, our aim was to investigate levels of FeNO in relation to clinical symptoms and urinary NO metabolites (uNO).MethodsIn a cross sectional study, FeNO and uNO were measured and clinical symptoms, chest x-ray, together with serum levels of arginine, tumor necrosis factor alpha (TNF-alpha) and interleukin 12 (IL-12) were evaluated in sputum smear positive TB patients (HIV+/TB, n = 36, HIV-/TB, n = 59), their household contacts (n = 17) and blood donors (n = 46) from Gondar University Hospital, Ethiopia.ResultsThe proportion of HIV-/TB patients with an increased FeNO level (> 25 ppb) was significantly higher as compared to HIV+/TB patients, but HIV+/TB patients had significantly higher uNO than HIV-/TB patients. HIV+ and HIV-/TB patients both had lower levels of FeNO compared to blood donors and household contacts. The highest levels of both uNO and FeNO were found in household contacts. Less advanced findings on chest x-ray, as well as higher sedimentation rate were observed in HIV+/TB patients as compared to HIV-/TB patients. However, no significant correlation was found between FeNO and uNO, chest x-ray grading, clinical symptoms, TNF-alpha, IL-12, arginine levels or sedimentation rate.ConclusionIn both HIV negative and HIV co infected TB patients, low levels of exhaled NO compared to blood donors and household were observed. Future studies are needed to confirm whether low levels of exhaled NO could be a risk factor in acquiring TB and the relative importance of NO in human TB.

HIV and intestinal parasites in adult TB patients in a teaching hospital in Northwest Ethiopia

The level of HIV infection and intestinal parasitoses among TB patients was assessed in a hospital-based cross-sectional study involving 257 patients in Gondar, Ethiopia. In TB patients, our study reported co-infection with HIV (52.1%) and intestinal parasites (40.9%) The high prevalence of HIV and intestinal parasites indicates an increased morbidity inTB patients and emphasized the importance of continued HIV sero-surveillance, stool analysis and treatment.

Serum IgE levels of tuberculosis patients in a tropical setup with high prevalence of HIV and intestinal parasitoses

Tuberculosis remains a major health problem worldwide in the era of HIV/AIDS. Co‐infection with intestinal parasites has been suggested to worsen the outcome of infection by polarizing the immune response towards Th2. This study investigated serum IgE levels of 241 tuberculosis patients and compared the IgE profiles in the tuberculosis patients either with or without intestinal helminthic infection and/or HIV infection. The serum levels of IgE in tuberculosis patients before initiation of antimycobacterial chemotherapy were found to be 1722 ± 1290 IU/ml (Mean ± SD) in HIV seronegatives and 2366 ± 1849 IU/ml in HIV seropositives. Further, the IgE level was significantly higher in patients coinfected with intestinal helminthes and HIV compared to those infected with helminthes or without coinfection (P < 0·05). Anti‐tuberculosis chemotherapy significantly reduced serum IgE levels in HIV seronegative tuberculosis patients (P < 0·05). These findings might indicate an active role of therapy in shifting the immune response towards Th1 which is crucial for prognosis in tuberculosis patients.

Seroprevalence of human immunodeficiency virus among blood donors in Northwest Ethiopia, 1995-2002.

Data on age, sex, occupation, HIV serostatus and year of donation were collected from the blood donors log book of Gondar College of Medical Sciences Hospital, Northwest Ethiopia, for the period between January 1995 and December 2002 and analysed. The crude HIV seroprevalence was 9.9% (1109/11,204). A declining trend in the prevalence was observed from as high as 15.7% (207/1321) in 1995 to 9.3% (123/1327) in 1999 and down to 4.3% (68/1576) in 2002. The declining trend observed in recent years is encouraging and should further be strengthened by making use of the blood bank as an entry point for HIV testing and counselling services.

Successful coupling of community attachment of health science students with relief work for drought victims.

CONTEXT Recurrent drought is a major disaster affecting many countries. As a result of poor rain fall a major drought was forecast for Ethiopia in 2003. The country appealed for support to avert drought-related health problems. University of Gondar decided to respond to the appeal by sending students and staff to selected drought-affected areas. OBJECTIVES To illustrate how an institution has turned the response to a natural disaster into a service-learning educational opportunity while maintaining equilibrium between the two. METHODS The drought relief response of the institute was twined with the regular team-training programme and academic schedule of senior health science students and 190 of them were transferred to deployment sites. FINDINGS Students provided support for the national effort of reducing drought-related morbidity and mortality by participating in multifaceted public health and relief activities, and fulfilled their regular learning objectives at the same time. DISCUSSION This project demonstrated the use of a natural disaster as a learning method to expose students to a more realistic array of health problems and human conditions. It also demonstrated the feasibility of addressing social responsibility, while fulfilling academic responsibility through community-based approach. CONCLUSION Service-learning is a valuable learning method. Balancing the service and teaching objectives and maintaining the quality of both can be attained through careful twining of the objectives of both components.