Nurse-client relationships are inherently valued in descriptions of the nature of public health practice and require consideration as intentional work that demands knowledge, skill, and personal engagement. They are also matters of place. In public health, they are largely taken-for-granted, particularly in the area of infectious diseases and the tuberculosis (TB) program specifically. TB nursing is structured within an explicit population focus, which challenges such relationship ideals as client-centered care, autonomy, and empowerment in everyday practice. This interpretive phenomenological study (Benner, 1994) of the relational work of TB nurses was undertaken to understand the nature of nurses’ relational work, wherever it happened, and how it was understood within the mix of assigned program tasks. Carried out in one of Canada’s largest TB programs, this study involved observing nine nurses and 24 clients in their respective visits over time, and interviewing 16 participants. Visits happened in homes and cars, and other assorted locations, highlighting how place shows up in these relationships and how nurses help clients to make sense of TB and broader life concerns shaping the experience of it. How they involve themselves interpersonally in these situations is the stuff that relational work is made of. Through the use of thematic analysis (Benner, 1994; Chesla, 1994), notes and transcripts were analyzed. The resulting interpretation of the nature of relational work is that of ‘welcome intrusions’, a notion that along with three key thematic dimensions: ‘getting through the door’, ‘doing TB but more than that’, and ‘beyond a professional’, addresses the central control-care tone of relational work. Together these themes identify key areas of knowledge and skill. That is, honesty and respect for privacy, ‘expertise’ in TB, dismantling the effects of stigma and displacement, and socializing-with-purpose. This emphasizes the value of articulating the everyday practices of nurses in population-focused programs that can contribute to successful treatment, and client healing and well-being. This relational work of TB nurses may be supported and enhanced when framed as the skill of involvement (Benner et al, 1996; Benner et al, 1999) and critically examined as part of providing comfort and enacting surveillance.

Submitted by Automação e Estatística (sst@bczm.ufrn.br) on 2018-07-26T16:46:39Z No. of bitstreams: 1 LauraXimenaLovisa_TESE.pdf: 2713163 bytes, checksum: 72a30a3d8b6dfabe41949596578d2427 (MD5) / Approved for entry into archive by Arlan Eloi Leite Silva (eloihistoriador@yahoo.com.br) on 2018-07-26T19:02:52Z (GMT) No. of bitstreams: 1 LauraXimenaLovisa_TESE.pdf: 2713163 bytes, checksum: 72a30a3d8b6dfabe41949596578d2427 (MD5) / Made available in DSpace on 2018-07-26T19:02:52Z (GMT). No. of bitstreams: 1 LauraXimenaLovisa_TESE.pdf: 2713163 bytes, checksum: 72a30a3d8b6dfabe41949596578d2427 (MD5) Previous issue date: 2018-02-09 / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES) / Uma nova classe de materiais inorgânicos, que surgem como uma opção promissora em aplicações de alto desempenho no campo da fotoluminescência, tem ganhado uma atenção especial. Este grupo é constituído pelos molibdatos, XMoO4 (X: íon metálico), dopados com elementos de terras raras (TR). As características que descrevem estes materiais são: alta eficiência luminosa, longo tempo de decaimento e apresentação de emissões no visível. Neste trabalho foram sintetizadas partículas de ZnMoO4 e a série ZnMoO4: 1% Tm+3 , 1% Tb+3, x Eu+3 (x = 1, 1.5, 2, 2.5 e 3%mola partir do método sonoquímico. Foram investigadas as influências causadas pelo teor dos dopantes e pelo tratamento térmico no comportamento fotoluminescente. Os resultados de difração de raios X confirmaram a formação da fase α- ZnMoO4 com estrutura cristalina triclínica para as partículas. Os valores da energia de gap estão na faixa de 3.58 e 4.22 eV. As imagens do MEV-FEG apresentam uma mudança na morfologia das partículas em conformidade com o aumento da dopagem. A morfologia das partículas foi interpretada com base em uma análise comparativa entre as imagens modeladas teoricamente e as experimentais de microscopia eletrônica de varredura de emissão de campo. Os cálculos de primeiro princípio em um nível de teoria funcional de densidade foram realizados para obter os valores de energias de superfície e estabilidade relativa das superfícies (120), (001), (011), (201) e (100) usando a construção de Wulff. Os resultados de fotoluminescência mostram as emissões específicas do Tb+3 e do Eu+3.Os valores das coordenadas de cromaticidade sofreram bastante influencia com aumento da temperatura de tratamento, exibindo emissão na região do amarelo – laranja, do verde e do branco. / A new class of inorganic materials, which emerge as a promising option in highperformance applications in the field of photoluminescence, has gained special attention. This group consists of the molybdates, XMoO4 (X: metal ion), doped with rare earth elements (RE). The characteristics that describe these materials are: high luminous efficiency, long decay time and emission presentation in the visible. In this work ZnMoO4 and ZnMoO4: 1% Tm3+, 1% Tb3+, x Eu3+ (x = 1, 1.5, 2, 2.5 and 3 mol%) particles were synthesized from the sonochemical method. The influence of dopant content and heat treatment on photoluminescent behavior was investigated. The X-ray diffraction results confirmed the formation of α- ZnMoO4 phase with triclinic crystalline structure for the particles. The values of the gap energy are in the range of 3.58 and 4.22 eV. The images of the FESEM show a change in particle morphology in accordance with increased doping. The morphology of the particles was interpreted based on a comparative analysis between the theoretically and experimentally modeled images of field emission scanning electron microscopy. First-principle calculations at a density functional theory level were performed to obtain the values of surface energies and relative stability of the (120), (001), (011), (201), and (100) surfaces by employing the Wulff construction. The results of photoluminescence clearly show the specific emissions of Tb3+ and Eu3+. The values of the chromaticity coordinates were influenced by the increase in the treatment temperature, showing emission in the yellowish orange, green and white regions.

Made available in DSpace on 2014-06-11T19:27:21Z (GMT). No. of bitstreams: 0 Previous issue date: 2008-03-14Bitstream added on 2014-06-13T20:16:36Z : No. of bitstreams: 1 pedro_hsp_me_sjrp.pdf: 1004378 bytes, checksum: d89276d95fd4738ef5918762497df5ea (MD5) / São José do Rio Preto (SJRP), localizada na região Noroeste do Estado de São Paulo, Sudeste do Brasil, é considerada Município prioritário pelo Programa Nacional de Controle da Tuberculose e da AIDS. O objetivo deste trabalho foi avaliar retrospectivamente pacientes infectados pelo HIV com pelo menos um isolamento de Mycobacterium sp., atendidos em unidades de saúde de referência de SJRP e região, bem como descrever seus aspectos clínicos e sócio–demográficos. Foram avaliados no período de janeiro de 2000 a dezembro de 2006, 198 indivíduos soropositivos para o HIV com culturas positivas no Instituto Adolfo Lutz de SJRP. Houve uma correlação positiva entre a tuberculose e o registro de detenção (p=0.021). O uso do tabaco reduziu o tempo de vida entre o diagnóstico e o óbito (p=0.05). Houve associação entre o isolamento de M. tuberculosis (MT) e os níveis de linfócitos TCD4+ bem como o achado difuso para RX de tórax (p=0.014 e 0.000, respectivamente). Aproximadamente 11% de todas as cepas de MT mostraram resistência a pelo menos uma droga, enquanto 3.1% foram multiresistentes. Micobactérias não tuberculosas (MNT) totalizaram 35.19% de todos os isolamentos e a maioria das espécies pertence ao complexo Mycobacterium avium (MAC; 22.3%), seguido por M. fortuitum (5.2%) e M.gordonae (3.1%). Conclui-se que a população HIV estudada tem alta prevalência de colonização por MNT. Em um país com extensão continental como o Brasil, o conhecimento das diferenças regionais na distribuição de MNT em populações infectadas pelo HIV pode contribuir para o controle e tratamento dessas infecções oportunistas. / São José do Rio Preto city (SJRP), Northwestern São Paulo State, Southeast Brazil, is considered “priority” by the National Programs of Tuberculosis and AIDS Control. Our purpose was to retrospectively evaluate Mycobacterium sp. isolated from HIV-infected patients attending the HIV/TB reference health care units from SJRP and region, as well as to describe their clinical and socio-demographic aspects. One hundred and ninetyeigth HIV-seropositive individuals provided 287 positives cultures from January 2000 to December 2006. There was a positive correlation between tuberculosis and prison record (p=0.021) and tobacco use reduced the mean lifetime from tuberculosis diagnosis to obit (p = 0.05). TCD4+ levels and a diffuse chest X-ray finding were associated to Mycobacterium tuberculosis (MT) isolation (p = 0.014 and 0.000, respectively). Approximately eleven percent of all MT strains showed resistance to at least one drug while 3.1% were multidrug resistant. Non-tuberculous mycobacteria (NTM) totalized 35.19% of all species and the most frequently isolated ones were Mycobacterium avium complex (MAC; 22.3%), M. fortuitum (5.2%) and M. gordonae (3.1%). We conclude that the HIV-infected population studied has a high prevalence of NTM colonization. In a wide country like Brazil, regional differences on NTM distribution in HIV-infected individuals must be further evaluated in order to improve control and treatment of these opportunistic infections.

Orientador: Antonio Carlos Paes / Resumo: A tuberculose causada por Mycobacterium bovis (bTB) é uma zoonose de distribuição mundial com ampla gama de hospedeiros. Nos países onde a bTB é prevalente, 10 a 20% dos casos de tuberculose humana são causados por M. bovis. São escassos em todo o mundo estudos que investigam a resistência à isoniazida (INH) e rifampicina (RMP) em linhagens de M. bovis de origem bovina, reservatórios silvestres, e em casos humanos de tuberculose. Foi investigada a diversidade genotípica de 67 linhagens de M. bovis isoladas de bovinos de abatedouro, obtidas de 100 linfonodos com lesão caseosa, pelas técnicas de Spoligotyping e MIRU-VNTR, bem como foi determinado o perfil fenotípico de resistência à INH e RMP pela técnica de REMA, e pesquisadas possíveis bases genéticas para resistência aos antimicrobianos. Dentre os isolados, 11 (16%) foram classificados como MDR-TB, 8 (12%) resistentes à INH e 2 (3%) resistentes à RMP. A pesquisa pelo GenoType MTBDRplus ver. 2.0 não acusou a presença de mutações em nenhum dos isolados fenotipicamente resistentes. Foram identificados 16 spoligotipos entre as linhagens. A subfamília BOV_1 predominou com 52 (77,6%) isolados, com os SIT 481, 482, 594, 665, 691, 698, 1021, 1667, 1852, 2141 e dois isolados sem shared type. A BOV_2 foi identificada em 8 (11,9%) isolados, com o SIT 683. Os SIT 982, 1851 e 1853 foram agrupados na família BOV. Dois isolados não foram classificados em família ou subfamília. A análise de MIRU-VNTR com painel de 12 MIRUs, identificou 31 i... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: Tuberculosis caused by Mycobacterium bovis (bTB) is a zoonosis of worldwide distribution with broad host range. In countries where bTB is prevalent, 10-20% of the human cases of tuberculosis are caused by M. bovis. All over the world there are few studies investigating the resistance to isoniazid (INH) and rifampicin (RMP) in M. bovis strains from cattle, wild reservoirs, and human cases of tuberculosis. The genotypic diversity of 67 M. bovis strains obtained out of 100 lymph nodes with caseous lesions from slaughtered animals was investigated by Spoligotyping and MIRU-VNTR techniques, as well as the assessment of their phenotypic profile of resistance to INH and RMP by REMA method and the search of possible genetic basis for antimicrobial resistance. Among the obtained isolates, 11 (16%) were classified as MDR-TB, 8 (12%) INH-resistant and 2 (3%) RMP-resistant. The use of GenoType MTBDRplus ver. 2.0 did not pointed the presence of genetic mutations in any of the phenotypically resistant isolates. Sixteen different spoligotype patterns were identified. The BOV_1 subfamily predominated with 52 (77.6%) isolates, with SITs 481, 482, 594, 665, 691, 698, 1021, 1667, 1852, 2141 and two isolates without a given SIT. BOV_2 was identified in 8 (11.9%) isolates, within SIT 683. The SITs 982, 1851 and 1853 were grouped in BOV family. Two isolates were not classified in family or subfamily. The MIRU-VNTR analysis using the 12 classical MIRUs, identified a cluster of 31 isolates belonging... (Complete abstract click electronic access below) / Doutor

Magister Curationis - MCur / Globally, tuberculosis (TB) and AIDS are the leading causes of morbidity and mortality of people, particularly in many developing countries. South Africa is among those countries with a high double burden of TB and HIV infections in the world. Although policy guidelines have been developed to mitigate the problems of TB and HIV coinfection, there are still challenges with their implementation. The aim of this study was to analyse the implementation of the integrated TB and HIV policy in a rural sub-district of the Western Cape. The study applied a descriptive survey method to collect data from 60 respondents selected using an all-inclusive sampling strategy. A self-reporting questionnaire was used, and data were analysed using the Statistical Package for Social Sciences (SPSS) program version 23. Descriptive statistics are presented with graphs and percentages. All ethical principles were adhered to. The results showed that 86% of the respondents were female nurses, 59% were registered nurses, and the rest were enrolled and assistant nurses. The general view of participants was that implementation of the integrated TB and HIV policy was poor, as only 25% (11) felt that they have sufficient knowledge and skills to implement it, while 50% (22) did not feel equipped to implement the integrated policy. These perceptions of inadequacy were justified by a lack of sufficient training, with only 32% of the respondents having attended training on integrated TB and HIV management. The nurses’ responses on actual practices ranged from poor to sufficient, and example being the management of HIV-positive TB patients with CD4 count of <100/μl, where 27.9% were unsure when to initiate antiretroviral therapy and 44.7% were unsure when isoniazid prophylaxis could not be given to HIVpositive patients. However, the findings indicated that TB and HIV policy guidelines were 86% and 85.7% accessible respectively. The study concluded that nurses do not implement the integrated TB and HIV policy guidelines sufficiently, mainly due to lack of adequate training which resulted in limited knowledge thus poor practice. It is recommended that a continuous staff capacity development programme, which includes suitable pre-service and in-service training in TB and HIV/AIDS management be developed and implemented as it has the potential to address the current knowledge and skills gaps which impact on implementation of the integrated TB and HIV policy.

Magister Public Health - MPH / Tuberculosis (TB) is a major health problem worldwide, with an estimated 9 million new cases accounting for an estimated 1.5 million deaths in 2012. Non-compliance with TB treatment has become a major barrier to achieving global TB control targets. Namibia is one of the worst affected countries in Africa with a high case notification rate (CNR) of all forms of TB and relatively low treatment success rate compared to the WHO targets. The study aimed at investigating TB treatment compliance and measuring its association to patient characteristics and treatment outcomes, in determining the effects of compliance on treatment outcomes in Windhoek District. This information is crucial for TB programme management and development of targeted strategies. A quantitative observational analytic study using a retrospective cohort design was adopted. New adult Pulmonary Tuberculosis (PTB) patients treated under DOTS in Windhoek District between 1st January 2013 and 31st December 2013 were included in the study based on specified criteria. Data was collected from the patients TB treatment cards using an extraction tool. Selection and information bias was eliminated by using clearly defined inclusion and exclusion criteria using a pre-tested standardised tool. Statistical analysis using descriptive and analytic statistics was done using Epi Info 7 to determine compliance, treatment outcomes and to measure the associations. Overall treatment compliance (89%), initial phase compliance (97.2%) and continuation phase compliance (88.1%) were reported in the study. Age (OR=4.3 95% CI (1.72 – 9.90), p-value=<0.01) and type of area (OR=0.02 95% CI (1.00 – 1.13), p-value=0.05) were associated with compliance in the continuation phase. Overall, type of area (OR=0.03 95% CI (0.00 – 0.91), p-value=0.04) remains associated with treatment compliance. Treatment success is reported among 86.1% of patients. Poor treatment outcomes are associated with non-compliance in the initial phase ( =49.98, p-value=<0.01), continuation phase ( =98.81, p-value=<0.01) and overall ( =110.02, p-value=<0.01). Overall treatment compliance (89%) although higher than expected was lower than the WHO recommended 90% compliance. Very high compliance (97.2%) were reported in the initial phase of treatment whilst compliance was also lower than desired (88.1%) in the continuation phase. Non-compliance recorded in the continuation phase is in agreement with the literature. Age and type of area are associated with compliance as reported in the continuation phase and overall in this study is new contribution of knowledge. The findings suggest that treatment compliance is associated with treatment success in both phases of treatment and overall. Low compliance especially in the continuation phase could lead to poor treatment outcomes such as prolonged infections, relapse, high TB mortality and drug resistance leading to increased programme costs. The study concludes that non-compliance results in poor treatment outcomes highlighting the need for interventions that address compliance in all phases but specifically within the continuation phase and amongst those at risk of having reduced compliance such as those in rural areas and young adult patients aged (15 – 34 years). Recommendations to the District Management Team and TB Programme Managers include: identification of measures that promote treatment compliance; support and monitoring of TB patients’ compliance continuously; strengthening CB-DOT by increasing CB-DOT points and enhancing CB-DOT supporters’ capacity as well as strengthening record keeping as a monitoring tool to increase compliance and improve treatment outcomes.

Background: A post-exposure regrowth model utilizing the well-tried Bactec radiometric system, which would simulate in vivo situations at the site of invasive disease, was developed to measure drug activity against multiplying Mycobacterium tuberculosis. Aims: The aims of this dissertation were to (a) construct a radiometric model simulating drug efficacy relating to the combined bactericidal activity and delays in regrowth due to the action of anti¬tuberculosis (TB) agents, (b) compare the killing kinetics of drugs singly and in combinations by the time-kill curve method, with the radiometrically-determined regrowth model, and (c) assess whether the Bactec radiometric regrowth model could predict likely bactericidal activities of drugs. Design and methods: Drug concentrations in the time-kill curve method were in a range of achievable drug concentrations at the site of infection and in multiples of the minimal inhibitory concentration (MIC), (1x, 2x or 3x, and 8x). Exposure times of 6h, 24h, 48h and 72h were used and these were based on pharmacokinetic data reflecting likely periods of in vivo exposure in TB lesions. Standardized inocula of approximately 106CFU/mi of actively multiplying M. tuberculosis strains were used. The same concentrations, exposure times and bacterial concentrations were used for the assessment of radiometrically-determined post-exposure regrowth times of M. tuberculosis. Growth times were recorded as the number of days required to reach a predetermined growth index (GI) level in the Bactec system, and were expressed as T400 readings in days. Simple linear regression and a mathematical logistic model were used to assess whether the radiometric post-exposure regrowth model could predict the bactericidal activity of the drugs. For drug combination studies, 1MIC of isoniazid (INH) and rifampicin (RMP) were used singly and in combination while 2MIC of ethambutol (EMB), streptomycin (SM), ofloxacin (OFL) and amikacin (AMK) were used in combinations studies. Colony counts at Oh and following 24h exposures were performed and regrowth patterns were determined using the T400 method. M. tuberculosis H37Rv was tested and subsequently resistant strains. Results: INH and RMP were highly bactericidal while EMS showed moderate activity in the time-kill curve method. The three drugs produced the best curves, showing longer regrowth times and markedly depressed rates of regrowth in the Sactec post-exposure regrowth model. Using simple linear regression, a linear relationship between bacterial survivors and the radiometric regrowth times, T400, was achieved for all drugs tested. Even better agreement was found when control-related regrowth times, (T-C) 400, were used in the analysis. Conditions compromising the linear relationsbip in the radiometric regrowth model, for OFL and less markedly EMS and AMK, were likely postantibiotic effects (PAEs) brought on by the short exposure time (6h), and drug carry-over effects due to concentrations ≥ 8 MIC for INH, RMP and 8M (10x and 20x MICs). The mathematical logistic model showed good correlation between bactericidal activity and regrowth for INH and RMP but not for EMB, SM, OFL and AMK. Drug combination effects in the two techniques depended on the criteria used to describe synergy. Generally, it was found in drug combination experiments that the drugs did not influence each other to a meaningful extent. Discussion and conclusions: For prediction of bactericidal activity, interpretation of the radiometrically-determined regrowth model needs to accommodate PAEs and the effect of subinhibitory concentrations. The validity of the mathematical logistic model is not clear. Technical aspects of future studies such as better organism dispersal, need to be improved to achieve a more reliable evaluation based on the logistic model. For drug combination studies, the radiometric regrowth model yielded findings that were difficult to interpret in relation to published data, reinforcing the need for the use of internationally standardized techniques which would give statistically reliable data. The radiometrically-determined regrowth model showed good discrimination between the standard activities of anti- TB agents, correlating with clinical efficacy. It is simple to perform and could prove to be useful for the screening of candidate anti- TB drugs. Improved technical stringency and the evaluation of poorly active control drugs, are however needed before proof of validity of the model can be established. / Dissertation (MSc (Medical Microbiology))--University of Pretoria, 2007. / Medical Microbiology / unrestricted

Objective: The objective of this cross sectional study was to compare the clinical presentation and response to treatments, in HIV positive and TB smear positive patients treated during the pre-Highly Active Antiretroviral Therapy (HAART) and Highly Active Antiretroviral Therapy (HAART) era (2004 and 2007), in St Joseph’s hospital Roma Lesotho. Comparison was done in terms of age, sex, sputum conversion at 2months and 6months end of TB treatment, baseline and 6 months end of TB treatment weight, weight gained and radiological presentation and resolution. Method : It was a cross sectional study design. Data was captured from the TB/HIV register, for pre-HAART era data of patients registered in the 2004 TB/HIV was captured and for the HAART era data of patients registered in the 2007 TB/HIV was captured. Cases were individuals with sputum smear positive tuberculosis and confirmed HIV infection, presenting in the pre HAART era (2004) and in the HAART era (2007). For inclusion in the HAART era, an individual had to be on HAART for at least2 weeks or more. A total of 113 Patients were analysed and 85 patients the HAART era. Comparison of continuous measurements was done with a t-test and categorical measurement was done with a chi-square test. Multivariable logistic regression was used to detect differences between the pre-HAART and HAART era Result: One hundred and thirteen (113) patients were analysed in the pre-HAART era and eighty five (85) in the HAART era. Mean age of presentation was lower in the pre-HAART era 36.1 years compared to HAART era 39.3 years with statistically significant result (p=0.0362). Pattern of sex distribution was similar in both era, (p-value=0.85). Sputum conversion showed statistically significant differences at 2 months, 95.2% of the HAART patients had sputum reverted whereas, 83.2% of the pre-HAART had sputum reversion (p-value=0.009), but no statistically significant result was seen at 6 months (p-value=0.38). Weight did not differ significantly between the two time periods, but there was a statistically significant difference in terms of mean weight gained in Haart era. Patients in the HAART era gained 0.92kg at the end of treatment compared to pre HAART era (p-value=0.001). Radiological presentation and resolution did not differ significantly between the two time periods. (p-value= 0.36). Conclusion : Smear positive TB/HIV co-infected patients in the HAART era were older at presentation, had better sputum conversion at 2 months and improved weight gain at 6 months end of TB treatment. Comparison with a historical control group alone however does not conclusively prove that this effect is due to HAART. Copyright / Dissertation (MSc)--University of Pretoria, 2010. / School of Health Systems and Public Health (SHSPH) / Unrestricted

Accurate diagnosis of active tuberculosis is required to improve treatment, reduce transmission of the disease and control the emergence of drug resistance. A rapid and reliable test would make a considerable contribution to the management of the TB epidemic, especially in HIV-burdened and resource-poor countries where access to diagnostic laboratories are limited. Surrogate marker antibody detection to mycobacterial lipid cell wall antigens gave promising results, in particular with cord factor. The specific advantage of using mycolic acids as lipid antigens in comparison to protein antigens is that mycolic acid is a CD1 restricted antigen with the ability to induce proliferation of CD4/CD8 double negative T-cells, which may explain the sustained antibody production in AIDS patients. Traditional end-point assays to detect anti-MA antibodies showed an unacceptable number of false positive and negative test results. Here a much improved biosensor method (the MARTI-assay, i.e. Mycolic acid Antibody Real-Time Inhibition assay) was developed to detect antibodies to mycolic acid in patient sera as surrogate markers of active tuberculosis. The test was assessed on an IAsys optical biosensor and gave an accuracy of 82%. The technology was transferred to an SPR (ESPRIT) biosensor to economise and simplify the assay. Mycolic acid containing liposomes were immobilized on the SPR gold surface pre-coated with octadecanethiol. The following parameters were optimized on the ESPRIT biosensor to enable reliable TB diagnosis: effect of degassed buffer, saponin blocking, first exposure to serum at low concentration and second exposure to antigen inhibited serum at high concentration. The IAsys biosensor system has a weakness in the double channel cuvette system, in which the channels often do not give matching results, while being ten times more expensive than the gold discs provided for the ESPRIT biosensor. The ESPRIT biosensor is provided with an adjustable laser setting to compensate for differences in the channel readings as well as an automated fluidic system that reduces variance from one sample to the next. First indications are that the test can also be used for prognosis of TB during treatment. It is hoped that the ESPRIT biosensor will improve the accuracy of the test to more than 90%. If the MARTI-assay technology could be made amenable for high throughput screening, it may provide the solution to the serodiagnosis of tuberculosis and monitoring of progress during TB treatment both in adult and children, thereby reducing the spread of TB within the communities. / Thesis (PhD)--University of Pretoria, 2009. / Biochemistry / unrestricted

Tuberculosis (TB) is a disease caused by the infection of Mycobacterium tuberculosis, which is progressively becoming multi-drug resistant (MDR). Understanding the mechanism by which the organism interacts with host lipids, infect macrophages and how components redistribute within the host could open the investigation of new ways of inhibiting and eradicating the infection suffered by patients world wide. Flow fluorometry of liposomes containing mycolic acids, which are â-hydroxy fatty acids with a long á-alkyl side chain of mycobacteria, may be useful to determine the dynamics of interaction of these lipids with the host membrane lipids and with cholesterol. This will increase the understanding about the structure-function relationship of mycolic acids in M.tb. It was shown in this thesis that natural mycolic acids had a unique property, it could exchange rapidly between liposomes in the presence and absence of cholesterol even at low temperatures. Rapid exchange of mycolic acids within the host could be the mechanism by which trafficking of mycobacterial lipids comes about, ultimately leading to immune response modulation beyond the infected cell. It also provides direction for future investigation to bring about new serodiagnostic tests based on lipid antigens. Although flow fluorometry as a modern technique was unable to resolve the exchange of mycolic acids in relation with other lipids, a unique property of mycolic acids was demonstrated for the first time, that of rapid exchange. Copyright / Dissertation (MSc)--University of Pretoria, 2009. / Biochemistry / unrestricted