BackgroundTuberculosis (TB) is difficult to diagnose in children using molecular tests, because children have difficulty providing respiratory samples. Stool could replace sputum for diagnostic TB testing if adequate sample processing techniques were available.MethodsWe developed a rapid method to process large volumes of stool for downstream testing by the Xpert MTB/RIF (Xpert) TB-detection assay. The method was tested and optimized on stool samples spiked with known numbers of M. tuberculosis colony forming units (CFU), and stools from M. tuberculosis-infected cynomolgus macaques (Macaca fascicularis). Performance was scored on number of positive Xpert tests, the cycle thresholds (Cts) of the Xpert sample-processing control (SPC), and the Cts of the M. tuberculosis-specific rpoB probes. The method was then validated on 20 confirmed TB cases and 20 controls in Durban, South Africa.ResultsThe assay’s analytical limit of detection was 1,000 CFU/g of stool. As much as one gram of spiked stool could be tested without showing increased PCR inhibition. In analytical spiking experiments using human stool, 1g samples provided the best sensitivity compared to smaller amounts of sample. However, in Macaques with TB, 0.6g stool samples performed better than either 0.2g or 1.2g samples. Testing the stool of pediatric TB suspects and controls suggested an assay sensitivity of 85% (95% CI 0.6–0.9) and 84% (95% CI 0.6–0.96) for 0.6g and 1.2g stool samples, respectively, and a specificity of 100% (95% CI 0.77–1) and 94% (95% CI 0.7–0.99), respectively.ConclusionThis novel approach may permit simple and rapid detection of TB using pediatric stool samples.
Background: Suicidal behaviour is highly prevalent and increasing at an alarming rate among all socio-demographic groupings in South Africa. Approximately 9.5% of all unnatural deaths in young people in South Africa are due to suicide. The ratio of non-fatal suicide attempts to attempts with fatal outcomes varies between 20:1 and 40:1 depending on the geographical region and the community composition being studied. Although depression is a common co-existing finding in many studies involving patients with suicidal behaviour, current evidence suggests that it is either not detected or it is inappropriately managed in clinical practice. Aim: This study compared self-reported perceived and objectively assessed personal physical and mental well-being of adults attempting suicide and being admitted to two local community-based public hospitals in South Africa. Method: Validated questionnaires were used to elicit relevant data from 688 adults attempting suicide and being admitted to two community-based public hospitals in Durban which was analysed using SPSS®. Results: The majority of participants were female, single, younger age group, unemployed, low education and low income level. Only 30.3% of participants reported long-standing illnesses lasting more than 6 months. The majority perceived their physical and mental health to be normal. However, an objective assessment revealed a large number of participants to be suffering from varying levels of depression. Conclusion:The study population comprised mainly the younger age group in both sexes, and showed that depression is an important co-morbid risk factor in suicidal behaviour in this and other groups. This finding cannot be ignored, and the authors endorse the call for a scaling up of screening strategies to diagnose depression, and for an improved prevention and management framework.
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