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Schwartzbord J.R.,Cornell University | Leroy J.L.,International Food Policy Research Institute | Severe L.,Centers | Brown D.L.,Cornell University
Food Additives and Contaminants - Part A Chemistry, Analysis, Control, Exposure and Risk Assessment | Year: 2016

Aflatoxins (AFs) are hepatocarcinogenic mycotoxins that can contaminate grains and oil seeds in tropical and sub-tropical areas and have been detected in maize and peanut products of Haiti. The first objective was to assess human exposure to AFs among Haitians at an urban hospital (GHESKIO) and a rural health centre (HCBH). The second objective was to test the association between AF exposure and reported dietary intake of potentially contaminated foods, such as maize, peanut products and milk. Measurement of urinary AFM1 by HPLC revealed that among 367 participants 14% and 22% at GHESKIO and HCBH, respectively, had detectable AFM1. The maximum and median AFM1 concentrations for all detected samples were 700 pg AFM1 ml–1 and 11.7 pg ml–1, respectively. Detection of AFM1 was significantly associated with peanut consumption (p < 0.05). Controlling for diet and age group in a logit model, patients who reported peanut consumption the day of the survey and patients from HCBH had greater log odds of excreting detectable AFM1 (p < 0.001 and 0.002, respectively); females had lower log odds (p = 0.020). Recalled frequency of consuming non-dairy animal-sourced foods, an indicator of diet quality, approached significance (p = 0.056) as an inverse predictor of urinary AFM1 detection. The findings augur the need for interventions that will improve food safety in Haiti and limit exposure to AFs, particularly among rural communities. © 2016 Informa UK Limited, trading as Taylor & Francis Group.

Schwartzbord J.,Cornell University | Severe L.,Centers | Brown D.,Cornell University
Biomarkers | Year: 2016

Aflatoxin is a liver carcinogen, and rapid, inexpensive methods to detect its urinary biomarkers are needed. We used a commercial enzyme-linked immuno-sorbent assay (ELISA) for aflatoxin M1 in urine (Helica Biosystems) to test 52 Haitian samples. Using this ELISA, we detected traces above the limit of detection (0.2 ng/ml urine) but below the limit of quantitation (0.4 ng/ml) in 14 samples. Liquid chromatography of all 52 Haitian urine samples revealed that only 11 had quantifiable AFM1 (mean: 29.5 pg/ml, standard error: 10.8, range: 2.94–96.5 pg/ml). The Helica ELISA may have detected forms of aflatoxin other than AFM1 in the Haitian samples, or matrix enhancement may have affected results at low AFM1 concentrations. This ELISA may serve as an initial, qualitative indicator of aflatoxin exposure for epidemiological purposes. But this method’s utility as a precise and specific indicator of AFM1 concentrations will require additional refinement and validation. © 2016 Informa UK Limited, trading as Taylor & Francis Group

May J.P.,Armor Correctional Health Services | Joseph P.,Centers | Pape J.W.,Centers | Binswanger I.A.,University of Colorado at Denver
Annals of Internal Medicine | Year: 2010

Prisoners have disproportionate health care needs. Meeting those needs in a prison environment is challenging, especially in such resource-poor countries as Haiti. Even so, before the January 2010 earthquake, local and international organizations, in collaboration with the Haitian government, had been making significant progress to provide for the health needs of prisoners. The effort screened and identified prisoners for infectious disease, initiated appropriate care and treatment, and prepared prisoners for release to the community. Not only is it possible to establish an adequate prison health care program in a resource-poor country, it is necessary. Without adequate management of prisoners' health needs, especially for such infectious diseases as HIV and tuberculosis, disease burden increases. Infectious disease can spread among prisoners and impact the public's health. Recovery for postearthquake Haiti, as any nation rebuilding following natural disaster or conflict, requires respect for rule of law. This includes humane detention and the delivery of justice and adequate health care for prisoners. © 2010 American College of Physicians.

Graham S.M.,University of Melbourne | Ahmed T.,International Center for Diarrhoeal Disease Research | Amanullah F.,Indus Hospital | Browning R.,U.S. National Institutes of Health | And 31 more authors.
Journal of Infectious Diseases | Year: 2012

There is a critical need for improved diagnosis of tuberculosis in children, particularly in young children with intrathoracic disease as this represents the most common type of tuberculosis in children and the greatest diagnostic challenge. There is also a need for standardized clinical case definitions for the evaluation of diagnostics in prospective clinical research studies that include children in whom tuberculosis is suspected but not confirmed by culture of Mycobacterium tuberculosis. A panel representing a wide range of expertise and child tuberculosis research experience aimed to develop standardized clinical research case definitions for intrathoracic tuberculosis in children to enable harmonized evaluation of new tuberculosis diagnostic technologies in pediatric populations. Draft definitions and statements were proposed and circulated widely for feedback. An expert panel then considered each of the proposed definitions and statements relating to clinical definitions. Formal group consensus rules were established and consensus was reached for each statement. The definitions presented in this article are intended for use in clinical research to evaluate diagnostic assays and not for individual patient diagnosis or treatment decisions. A complementary article addresses methodological issues to consider for research of diagnostics in children with suspected tuberculosis. © 2012 The Author.

Al-Bishri J.,Taif University | Attar S.M.,King Abdulaziz University | Bassuni N.,King Abdulaziz Medical City | Al-Nofaiey Y.,Centers | And 3 more authors.
Clinical Medicine Insights: Arthritis and Musculoskeletal Disorders | Year: 2013

Comorbid conditions play a pivotal role in rheumatoid arthritis management and outcomes. We estimated the percentage of comorbid illness among rheumatoid arthritis patients and explored the relationship between this comorbidity and different prescriptions. A cross-sectional study of patients with rheumatoid arthritis in three centers in Saudi Arabia was carried out. Comorbidity and antirheumatoid medication regimens prescribed were recorded on a specially designed Performa. The association between comorbidity and different drugs was analyzed. A total of 340 patients were included. The most comorbidities were hypertension 122 (35.9%), diabetes 105 (30.9%), osteoporosis 88 (25.8%), and dyslipidemia in 66 (19.4). The most common drug prescribed was prednisolone in 275 (80.8%) patients followed by methotrexate in 253 (74.4%) and biological therapy in 142 (41.5%) patients. Glucocorticoids were prescribed considerably more frequently in hypertensive and diabetic patients as well as in patients with osteoporosis and dyslipidemia. Most patients with rheumatoid arthritis suffered from comorbid diseases. © the author(s), publisher and licensee Libertas Academica Ltd.

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