Assessment of minimum inhibitory concentration to vancomycin, tigecycline, linezolid, daptomycin, ceftaroline and mupirocin against methicillin resistant Staphylococcus aureus clinical isolates by antibiotic gradient strips

Background: Staphylococcus aureus infections are one of the most common and serious hospital-acquired infections seen in developing countries. Methicillin resistant Staphylococcus aureus (MRSA) is an important human pathogen and normally colonized in body parts including skin, nose, perineum and throat. MRSA is resistant not only to all ?-lactam groups but also other antibiotics including aminoglycosides, tetracycline and macrolides. In the present study the efficacy of agents used in the management of MRSA infections was determined by antibiotic gradient testing. Methods: A total of 60 clinical isolates of MRSA strains were collected from various diagnostic labs in central Kerala. Clinical isolates were reconfirmed as MRSA by gram staining, yellow-coloured colonies on mannitol salt Agar (MSA). Antibiotic susceptibility testing was done by disc diffusion method as recommended by CLSI guidelines. S. aureus isolates resistant to cefoxitin (30 µg) was identified as MRSA. Antibiotic gradient testing was performed to determine the MIC of vancomycin, tigecycline, linezolid, daptomycin, ceftaroline and mupirocin against MRSA isolates. Results: All the 60 MRSA isolates tested were sensitive to vancomycin, tigecycline, linezolid, daptomycin, ceftaroline and mupirocin (100%) and none of the MRSA isolates show resistance. Conclusions: Results of present study indicates that these agents may be used alongside vancomycin in management of infection caused by MRSA.

Prediction of visceral leishmaniasis incidence using the Seasonal Autoregressive Integrated Moving Average model (SARIMA) in the state of Maranhão, Brazil

Abstract Visceral leishmaniasis (VL) is an infectious disease predominant in countries located in the tropics. The prediction of occurrence of infectious diseases through epidemiologic modeling has revealed to be an important tool in the understanding of its occurrence dynamic. The objective of this study was to develop a forecasting model for the incidence of VL in Maranhão using the Seasonal Autoregressive Integrated Moving Average model (SARIMA). We collected monthly data regarding VL cases from the National Disease Notification System (SINAN) corresponding to the period between 2001 and 2018. The Box-Jenkins method was applied in order to adjust a SARIMA prediction model for VL general incidence and by sex (male or female) for the period between January 2019 and December 2013. For 216 months of this time series, 10,431 cases of VL were notified in Maranhão, with an average of 579 cases per year. With regard to age range, there was a higher incidence among the pediatric public (0 to 14 years of age). There was a predominance in male cases, 6437 (61.71%). The Box-Pierce test figures for overall, male and female genders supported by the results of the Ljung-Box test suggest that the autocorrelations of residual values act as white noise. Regarding monthly occurrences in general and by gender, the SARIMA models (2,0,0) (2,0,0), (0,1,1) (0,1,1) and (0,1,1) (2, 0, 0) were the ones that mostly adjusted to the data respectively. The model SARIMA has proven to be an adequate tool for predicting and analyzing the trends in VL incidence in Maranhão. The time variation determination and its prediction are decisive in providing guidance in health measure intervention.

Resumo A leishmaniose visceral (LV) é uma doença de natureza infecciosa, predominante em países de zonas tropicais. A predição de ocorrência de doenças infecciosas através da modelagem epidemiológica tem se revelado uma importante ferramenta no entendimento de sua dinâmica de ocorrência. O objetivo deste estudo foi desenvolver um modelo de previsão da incidência da LV no Maranhão usando o modelo de Média Móvel Integrada Autocorrelacionada Sazonal (SARIMA). Foram coletados os dados mensais de casos de LV através do Sistema de Informação de Agravos de Notificação (SINAN) correspondentes ao período de 2001 a 2018. O método de Box-Jenkins foi aplicado para ajustar um modelo de predição SARIMA para incidência geral e por sexo (masculino e feminino) de LV para o período de janeiro de 2019 a dezembro de 2023. Durante o período de 216 meses dessa série temporal, foram registrados 10.431 casos de LV no Maranhão, com uma média de 579 casos por ano. Em relação à faixa etária, houve maior registro no público pediátrico (0 a 14 anos). Houve predominância do sexo masculino, com 6437 casos (61,71%). Os valores do teste de Box-Pierce para incidência geral, sexo masculino e feminino reforçados pelos resultados do teste Ljung-Box sugerem que as autocorrelações de resíduos apresentam um comportamento de ruído branco. Para incidência mensal geral e por sexo masculino e feminino, os modelos SARIMA (2,0,0) (2,0,0), (0,1,1) (0,1,1) e (0,1,1) (2, 0, 0) foram os que mais se ajustaram aos dados, respectivamente. O modelo SARIMA se mostrou uma ferramenta adequada de previsão e análise da tendência de incidência da LV no Maranhão. A determinação da variação temporal e sua predição são determinantes no norteamento de medidas de intervenção em saúde.

Prediction of visceral leishmaniasis incidence using the Seasonal Autoregressive Integrated Moving Average model (SARIMA) in the state of Maranhão, Brazil / Previsão da incidência da leishmaniose visceral usando o modelo de média móvel integrado autorregressivo sazonal (SARIMA) no Maranhão, Brasil

Abstract Visceral leishmaniasis (VL) is an infectious disease predominant in countries located in the tropics. The prediction of occurrence of infectious diseases through epidemiologic modeling has revealed to be an important tool in the understanding of its occurrence dynamic. The objective of this study was to develop a forecasting model for the incidence of VL in Maranhão using the Seasonal Autoregressive Integrated Moving Average model (SARIMA). We collected monthly data regarding VL cases from the National Disease Notification System (SINAN) corresponding to the period between 2001 and 2018. The Box-Jenkins method was applied in order to adjust a SARIMA prediction model for VL general incidence and by sex (male or female) for the period between January 2019 and December 2013. For 216 months of this time series, 10,431 cases of VL were notified in Maranhão, with an average of 579 cases per year. With regard to age range, there was a higher incidence among the pediatric public (0 to 14 years of age). There was a predominance in male cases, 6437 (61.71%). The Box-Pierce test figures for overall, male and female genders supported by the results of the Ljung-Box test suggest that the autocorrelations of residual values act as white noise. Regarding monthly occurrences in general and by gender, the SARIMA models (2,0,0) (2,0,0), (0,1,1) (0,1,1) and (0,1,1) (2, 0, 0) were the ones that mostly adjusted to the data respectively. The model SARIMA has proven to be an adequate tool for predicting and analyzing the trends in VL incidence in Maranhão. The time variation determination and its prediction are decisive in providing guidance in health measure intervention.

Resumo A leishmaniose visceral (LV) é uma doença de natureza infecciosa, predominante em países de zonas tropicais. A predição de ocorrência de doenças infecciosas através da modelagem epidemiológica tem se revelado uma importante ferramenta no entendimento de sua dinâmica de ocorrência. O objetivo deste estudo foi desenvolver um modelo de previsão da incidência da LV no Maranhão usando o modelo de Média Móvel Integrada Autocorrelacionada Sazonal (SARIMA). Foram coletados os dados mensais de casos de LV através do Sistema de Informação de Agravos de Notificação (SINAN) correspondentes ao período de 2001 a 2018. O método de Box-Jenkins foi aplicado para ajustar um modelo de predição SARIMA para incidência geral e por sexo (masculino e feminino) de LV para o período de janeiro de 2019 a dezembro de 2023. Durante o período de 216 meses dessa série temporal, foram registrados 10.431 casos de LV no Maranhão, com uma média de 579 casos por ano. Em relação à faixa etária, houve maior registro no público pediátrico (0 a 14 anos). Houve predominância do sexo masculino, com 6437 casos (61,71%). Os valores do teste de Box-Pierce para incidência geral, sexo masculino e feminino reforçados pelos resultados do teste Ljung-Box sugerem que as autocorrelações de resíduos apresentam um comportamento de ruído branco. Para incidência mensal geral e por sexo masculino e feminino, os modelos SARIMA (2,0,0) (2,0,0), (0,1,1) (0,1,1) e (0,1,1) (2, 0, 0) foram os que mais se ajustaram aos dados, respectivamente. O modelo SARIMA se mostrou uma ferramenta adequada de previsão e análise da tendência de incidência da LV no Maranhão. A determinação da variação temporal e sua predição são determinantes no norteamento de medidas de intervenção em saúde.

Clinical, epidemiological and climatic factors related to the occurrence of cutaneous leishmaniasis in an endemic area in northeastern Brazil / Fatores clínicos, epidemiológicos e climáticos relacionados à ocorrência de leishmaniose cutânea em área endêmica no nordeste do Brasil

Abstract Cutaneous leishmaniasis (CL) is a neglected tropical disease with a wide distribution in the Americas. Brazil is an endemic country and present cases in all states. This study aimed to describe the occurrence, the underlying clinical and epidemiological factors, and the correlation of climatic variables with the frequency of reported CL cases in the municipality of Caxias, state of Maranhão, Brazil. This is a retrospective and descriptive epidemiological study based on data extracted from the Brazilian Information System of Diseases Notification, from 2007 to 2017. Maximum and minimum temperature, precipitation, and relative air humidity data were provided by the Brazilian National Institute of Meteorology. A total of 201 reported autochthonous CL cases were analyzed. The predominance of cases was observed in males (70.1%). The age range between 31 and 60 years old was the most affected, with 96 cases (47.9%). Of the total number of registered cases, 38.8% of the affected individuals were engaged in agriculture-related activities. The georeferenced distribution revealed the heterogeneity of disease occurrence, with cases concentrated in the Western and Southern regions of the municipality. An association was detected between relative air humidity (monthly mean) and the number of CL cases per month (p = 0.04). CL continues to be a concerning public health issue in Caxias. In this context, there is a pressing need to strengthen measures of prevention and control of the disease through the network of health services of the municipality, considering local and regional particularities.

Resumo A leishmaniose cutânea (CL) é uma doença tropical negligenciada, com ampla distribuição nas Américas. O Brasil é um país endêmico e apresenta casos em todos os estados. Este estudo teve como objetivo descrever a ocorrência, os fatores clínicos e epidemiológicos subjacentes e a correlação de variáveis climáticas com a frequência de casos de CL notificados no município de Caxias, estado do Maranhão, Brasil. Este é um estudo epidemiológico retrospectivo e descritivo, com base em dados extraídos da Notificação do Sistema Brasileiro de Informação de Doenças, de 2007 a 2017. Dados máximos e mínimos de temperatura, precipitação e umidade relativa do ar foram fornecidos pelo Instituto Nacional de Meteorologia. Foram analisados 201 casos de CL autóctones relatados. A predominância de casos foi observada no sexo masculino (70,1%). A faixa etária entre 31 e 60 anos foi a mais afetada, com 96 casos (47,9%). Do número total de casos registrados, 38,8% dos indivíduos afetados estavam envolvidos em atividades relacionadas à agricultura. A distribuição georreferenciada revelou a heterogeneidade da ocorrência da doença, com casos concentrados nas regiões oeste e sul do município. Foi detectada associação entre a umidade relativa do ar (média mensal) e o número de casos de CL por mês (p = 0,04). O CL continua sendo uma questão preocupante de saúde pública em Caxias. Nesse contexto, há uma necessidade premente de fortalecer medidas de prevenção e controle da doença por meio da rede de serviços de saúde do município, considerando as particularidades locais e regionais.

Effect of chromium-methionine supplementation on meat quality of broilers reared under heat stress / [Efeito da suplementação de cromo-metionina na qualidade da carne de frangos de corte criados em estresse por calor]

Objetivou-se avaliar o efeito da suplementação de cromo-metionina em dietas para frangos de corte criados em estresse por calor, no período de 22 a 43 dias de idade, nos parâmetros de qualidade da carne. Foram utilizados 336 frangos de corte, machos, da linhagem Cobb 500, com 21 dias de idade, distribuídos em delineamento em blocos inteiramente ao acaso, com quatro blocos (cada câmara climática), seis tratamentos (0; 0,10; 0,20; 0,40; 0,80 e 1,20mgkg-1 de Cr na forma de Cr-metionina), oito repetições e sete aves por unidade experimental. Aos 43 dias de idade, duas aves por unidade experimental foram selecionadas e abatidas para avaliação da qualidade da carne de peito, por meio dos parâmetros de pH15min, pH24h, luminosidade (L*), teor de vermelho (a*), teor de amarelo (b*), croma (C*), ângulo hue (Hº), capacidade de retenção de água, perda de peso por cozimento e força de cisalhamento. Houve efeito quadrático (P=0,0070) na capacidade de retenção de água da carne de peito. A suplementação de CrMet não afetou (P>0,05) os demais parâmetros de qualidade da carne. Assim, recomenda-se a suplementação de 0,59mgkg-1 de CrMet para frangos de corte para melhoria da capacidade de retenção de água do peito.(AU)

Effects of Highly Active Antiretroviral Treatment on Liver and Kidney Functions

Aim:This study assesses the effects of HAART on liver and renal functions in HIV infected individuals on HAART.Study Design:Cross sectional study.Place and Methods:This study was conducted in Tamale, Ghana from August, 2015 to November 2017. Original Research Article Methodology:A total of 300 HIV infected participants with ages ranging from 19 to 79 years who have been administered with HAART for at least 6 months were recruited. Pre-HAART administration (baseline) demographic and clinical information, with initial liver and renal function test results were retrieved from the medical records of the participants present at the ART center. Post HAART administration blood sample (5mLs) was taken from each participant into a gel separated vacutainer tube, allowed to clot and spun at 3000rpm for 3 minutes to produce serum. The product (serum) was used for liver and renal function test analysis using a fully automated chemistry analyser (Vital Scientific Selectra Flexor XL). Results: Of the study population, 72% were administered with AZT/3TC/EFV, 13% with AZT/3TC/NVP, 6.7% with TDF/3TC/LPV/r and TDF/3TC/NVP, 1% with AZT/3TC/EFV while 0.7% were administered with TDF/FTC/EFV. The following parameters were significantly increased post HAART administration; ALT (25.53 ± 16.90 to 30.87 ± 19.28 U/L), ALP (163.7 ± 141.0 to 215.2 ± 143.4 U/L), GGT (37.27 ± 25.21 to 53.19 ± 41.71 U/L), Total protein (73.97 ± 17.08 to 82.31 ± 11.62 g/L), Albumin (38.02 ±9.331 to 41.01 ± 7.471 g/L), Globulin 38.02 ± 15.71 to 42.79 ± 25.20 (g/L). There were however significant reductions in Total bilirubin (12.13 ± 10.85 to 9.434 ± 4.560 μmol/L), Direct bilirubin (6.616 ± 5.770 to 4.184 ± 2.806 μmol/L), (Creatinine 73.19 ±36.13 to 63.14 ± 27.14 μmol/L) and Urea (3.515 ± 2.552 to 3.011±1.274 mmol/L).Conclusion: HAART improves renal function, induces elevation in liver enzymes, stimulates the production of plasma proteins and reduces serum bilirubin concentration

Effects of Highly Active Antiretroviral Treatment on Complete Blood Count Parameters

Aim:This study assesses the effects of HAART on complete blood count parameters among HIV infected participants.Study Design:Case control study. Place and Methods:This study was conducted inTamale, Ghana from August, 2016to December,2017. Methodology:A total of 300 HIV infected participants with ages ranging from 19–79 years, administered with HAART for at least 6 months were recruited. Pre-HAART administration (baseline) demographic andclinical information, with initial full blood count results were retrieved from the medical records of the participants. Post HAART administration blood sample (5mLs) was taken from each participant into an EDTA vacutainer tube andcomplete blood count (CBC) performed usingURIT 5250 haematology analyser.Participants transfused with blood overthe last 4 months were excluded from the study.Results: The study recorded significant decreases in WBCand Neutrophil (%)post HAART administration. Lymphocyte (%),Haemoglobin, Haematocrit, MCV, MCHC, RDW-SD were all significantly higher post HAART administration. Total Platelets count, MPV, PDW-SD, PCT and P-LCR were significantly lower post-HAART administration.A comparison of the effects of EFV and NVP administered with AZT/3TC backbone yielded the following results. The NVP group recorded a significantly higher HCT compared with the EFV group (p-0.0073). A significantly higher mean PCT, MPV, P-LCR,PLCC, PDW-SD were recorded in the EFV group comparedto the NVP group respectively.Conclusion: The administration of HAART is associated with significant improvements in erythroid and lymphoid lineages, reduce anaemia, improves immunity and general patient well-being. NVP improve erythroid cell indices while EFV ameliorate platelet indices. HAART regimen should be chosen based on the pre-HAART laboratory tests conducted on the individual

Clinical, epidemiological and climatic factors related to the occurrence of cutaneous leishmaniasis in an endemic area in northeastern Brazil

Abstract Cutaneous leishmaniasis (CL) is a neglected tropical disease with a wide distribution in the Americas. Brazil is an endemic country and present cases in all states. This study aimed to describe the occurrence, the underlying clinical and epidemiological factors, and the correlation of climatic variables with the frequency of reported CL cases in the municipality of Caxias, state of Maranhão, Brazil. This is a retrospective and descriptive epidemiological study based on data extracted from the Brazilian Information System of Diseases Notification, from 2007 to 2017. Maximum and minimum temperature, precipitation, and relative air humidity data were provided by the Brazilian National Institute of Meteorology. A total of 201 reported autochthonous CL cases were analyzed. The predominance of cases was observed in males (70.1%). The age range between 31 and 60 years old was the most affected, with 96 cases (47.9%). Of the total number of registered cases, 38.8% of the affected individuals were engaged in agriculture-related activities. The georeferenced distribution revealed the heterogeneity of disease occurrence, with cases concentrated in the Western and Southern regions of the municipality. An association was detected between relative air humidity (monthly mean) and the number of CL cases per month (p = 0.04). CL continues to be a concerning public health issue in Caxias. In this context, there is a pressing need to strengthen measures of prevention and control of the disease through the network of health services of the municipality, considering local and regional particularities.

Resumo A leishmaniose cutânea (CL) é uma doença tropical negligenciada, com ampla distribuição nas Américas. O Brasil é um país endêmico e apresenta casos em todos os estados. Este estudo teve como objetivo descrever a ocorrência, os fatores clínicos e epidemiológicos subjacentes e a correlação de variáveis climáticas com a frequência de casos de CL notificados no município de Caxias, estado do Maranhão, Brasil. Este é um estudo epidemiológico retrospectivo e descritivo, com base em dados extraídos da Notificação do Sistema Brasileiro de Informação de Doenças, de 2007 a 2017. Dados máximos e mínimos de temperatura, precipitação e umidade relativa do ar foram fornecidos pelo Instituto Nacional de Meteorologia. Foram analisados 201 casos de CL autóctones relatados. A predominância de casos foi observada no sexo masculino (70,1%). A faixa etária entre 31 e 60 anos foi a mais afetada, com 96 casos (47,9%). Do número total de casos registrados, 38,8% dos indivíduos afetados estavam envolvidos em atividades relacionadas à agricultura. A distribuição georreferenciada revelou a heterogeneidade da ocorrência da doença, com casos concentrados nas regiões oeste e sul do município. Foi detectada associação entre a umidade relativa do ar (média mensal) e o número de casos de CL por mês (p = 0,04). O CL continua sendo uma questão preocupante de saúde pública em Caxias. Nesse contexto, há uma necessidade premente de fortalecer medidas de prevenção e controle da doença por meio da rede de serviços de saúde do município, considerando as particularidades locais e regionais.

Oxidative Stress in Ghanaians Presenting with Prostate Cancer.

Introduction: The latest estimates of global cancer incidence show that prostate cancer has become the second most common cancer among men in the world. A number of reports have linked oxidative stress to prostate cancer. Although oxidative stress has been found to be much prevalent among the Ghanaian population, no data exist on its prevalence among prostate cancer patients in Ghana. This study therefore sought to investigate oxidative stress in Ghanaians presenting with prostate cancer. Methods: This cross-sectional study was conducted at the out-patient department of the department of surgery, Komfo Anokye Teaching Hospital, Kumasi, between the period of November, 2010 and April, 2012. In all, one hundred and twenty four (124) adult males (87 case subjects and 37 control subjects) aged at least forty two years were enrolled. Results: Malondialdehyde, an oxidative stress marker, and uric acid were significantly raised whereas the measured antioxidant (vitamin C) was significantly reduced among the prostate cancer patients compared to the controls. The indication is that oxidative stress with reduced antioxidant levels is common in prostate cancer patients. Conclusion: Oxidative stress may have a significant role in prostate cancer. Based on the findings, it may seem reasonable to propose that therapeutic regimens aimed at beefing up the antioxidant defences could help offer some degree of protection for prostate cancer patients against oxidative stress.

Obesity and Hypertension among Christian Religious Subgroups: Pentecostal vs. Orthodox.

Aims: The aim of this study was to determine the impact of religious practices and diet doctrines on obesity and hypertension among Pentecostal and orthodox Christians in the Tamale metropolis. Study Design: This study was a cross sectional study. Place and Duration of Study: This study was conducted between January and June 2014, at the Tamale metropolis, Ghana. Methodology: Three hundred (300) Ghanaian subjects (50.3% Pentecostal participants from the Perez Chapel International and the Church of Pentecost and 49.7% Orthodox participants from the Presbyterian Church and Bethel Methodist Church), 18-72 years of age were recruited for this study. Anthropometric measurements including height, weight, waist and hip circumference as well as blood pressure were measured for each of the study participants. Results: The male participants were taller, heavier with higher mean WHR as well as higher mean SBP as compared to the female participants. The females however, had broader hips as compared to the male participants. The males were more likely to fully comply with the religious prescription on fasting (52.6% vs. 40.7%; p = 0.0397) and diet (30.8% vs. 20.4%; p = 0.0375) as compared to the female. The prevalence of obesity among the population in this study ranged from 17% to 28% depending on the criteria used in the weight classification (i.e. BMI, WHR and WC) and the prevalence of hypertension was 15.0% with no significant difference between both genders. Conclusion: This study highlights the significant increase in the prevalence of obesity and hypertension among both males and female populations, with obesity being more prevalent among females. Compliance to religious doctrines on fasting and or diet does not have an impact on the prevalence of obesity and hypertension from this study.

Iron Status and Hematological Profile of Ghanaian Women with Fibroids.

Uterine leiomyomas are the most common gynecologic tumors and though mostly asymptomatic, they may present with heavy or abnormal uterine bleeding, pelvic pain or pressure, subfertility, and recurrent pregnancy loss. Heavy bleeding is often a reason to prescribe iron supplements in a bid to maintain normal hemoglobin levels. These hematinics are also sometimes prescribed for several months prior to surgery even though menorrhagia may not be the complaint. These women tend to stay on these supplements for long periods of time often without any laboratory investigation follow ups. Therefore a possibility of them developing iron overload exists especially if bleeding is not the presenting complaint. The aim of the present study was to determine the hematological profile of women with fibroids in Ghana. Between May 2005 and March 2009, in a case-control study of premenopausal Ghanaian women aged 20–40 years at Komfo Anokye Teaching Hospital,(KATH) Kumasi, the hematologic profile of women with fibroid in Ghana was studied. Two hundred women with confirmed uterine fibroids and two hundred women with non-observable fibroids as controls were recruited for the study. Results of the study showed that women with fibroids had higher red cell counts and red cell indices compared to women who had no fibroids. The mean Hematocrit (HCT), Mean Cell Hemoglobin (MCH), Mean Cell Hemoglobin Concentration (MCHC), and Red Blood Cell Count (RBC) were all significantly higher among patients compared to controls. Mean Cell Volume (MCV), Platelet (PLT) and Total White Blood Cell (WBC) count did not differ significantly between the two groups. Total serum iron (FE) was significantly higher while total iron binding capacity was significantly lower among patients compared to the control group. The results of the study revealed that the number of the patients who were on hematinics was significantly higher than that of the control group. Findings of this study show that women with fibroids in Ghana had higher hemoglobin and serum iron levels compared to their compatriots who did not have the condition. Prescription of iron supplements should therefore be done with care and only after reviewing their hematology laboratory results so as to prevent the development of iron overload among these women.

Analysis of Atherogenic and Anthropometric Profiles of Normotensive and Hypertensive Ghanaians in the Kumasi Metropolis.

Ghana is undergoing a rapid epidemiological transition from solely communicable to a double burden of infectious and chronic disease such as hypertension. Aims: We aimed to compare the association between different lifestyle practices, adiposity indices, atherogenic dyslipidaemic parameters and hypertension as well as the prognostic implications for the levels of these parameters on target cardiac organ damage among hypertensives. We also determined the optimal threshold points and the discriminative power of these parameters on this urban Ghanaian hypertensive population. Study Design: A hospital-based case–control study was conducted. Methodology: The study purposively recruited 241 Ghanaian indigenes in the Kumasi metropolis, with 180 hypertensives as cases and 61 normotensives as controls. In addition to sociodemographic data captured, all participants underwent standard haemodynamic, anthropometric, atherogenic lipid and cardiac organ damage assessment. Results: In general, the case group presented with a significantly poorer atherogenic lipid profile compared to their counterparts in the control group. Participants presenting with significantly higher multiple atherogenic scores were found to cluster at the upper quartiles of systolic blood pressure, diastolic blood pressure and pulse rate. Population-specific threshold for waist circumference of >75 cm for females and >80 cm for male were the best adiposity indices for discriminating hypertension. Increasing atherogenic dyslipidaemia was more prevalent with the presence of cardiac target organ damage. Conclusion: In this urban population, higher altered lipid scores and abdominal obesity aggravated by lifestyle choices including alcohol consumption, smoking and physical inactivity may constitute significant risk for cardiovascular complications among hypertensives.

Accuracy of Blood Loss Determination after Vaginal Delivery: Visual Estimation versus Calibrated Measurement.

Background: The ability to determine accurately, the blood loss during childbirth is of extreme importance in the diagnosis and management of primary postpartum haemorrhage (PPH). Aims: In this study, we evaluate the effectiveness of visual estimation of blood loss, as a method of diagnosing primary postpartum haemorrhage. Methodology: A cross-sectional study on 271 participants was conducted between April and October 2012, at the Komfo Anokye Teaching Hospital. Women who went through spontaneous vaginal delivery were monitored and blood loss after delivery was visually estimated and then measured with a graduated receptacle, up to 1 hour post-delivery. The paired t-test and Bland- Altman plot was used to compare outcomes of the two methods. P<0.05 was considered significant. Results: Mean age of study participants was 27.7±5.7. As per visual estimation, most participants were reported to have lost <200 ml of blood (45.0%) as opposed to that of measured losses where most participants had lost between 200-500 ml of blood (48.7%). The mean measured blood loss was 306.09±218.39 ml against a 250±188.78 ml mean visually estimated blood loss (P < 0.0001). Prevalence of primary PPH as estimated with measured blood losses was 20.3% (55/271). Visual estimation, however gave a prevalence of 15.9% (43/271), an underestimation by 4.4%. A Bland- Altman plot showed a clinical bias large enough to cause significant differences in diagnosis of primary PPH. Conclusion: This study adds to existing evidence that the visual estimation of blood loss in clinical settings underestimates losses and is not reliable. This can lead to misdiagnosis of primary PPH and thus an underestimation of the condition. Health care workers should therefore base diagnosis on calibrated measurement methods.

Putative Risk Factors among Ghanaian Women Presenting with Leiomyoma.

Aims: The objective of the current study was to investigate potential demographic, lifestyle, and medical history risk factors for leiomyoma in a sample of Ghanaian women. Study Design: A case-control study was conducted among women who attended the Gynecology department of Komfo Anokye Teaching Hospital (KATH), Kumasi, Ghana. Place and Duration of Study: The study took place between May 2005 and March 2009 at the Obstetrics and Gynecology Department of the Komfo Anokye Teaching Hospital (KATH), Kumasi. Methodology: Premenopausal Ghanaian women aged 20-40 years were studied for the role of putative socio-demographic, lifestyle, and medical history risk factors in the development of leiomyoma. Two hundred women with confirmed uterine fibroids and two hundred women with no observable fibroids were recruited as controls for the study. Results: Family history (OR 2.21, 95% CI:2.21-5.9) and obesity (OR 3.60, 95% CI:1.74- 7.47), nulliparity (OR6.5, 95%CI:4.18-10.0), age at first birth (OR 2.82, 95%CI:1.60- 4.98), induced abortion (OR 3.33, 95%CI:1.11-9.99), and history of sexually transmitted infections (OR 2.27, 95%CI:1.21-4.28), all greatly increased the risk of fibroids, not married (OR1.62, 95%CI:1.07-2.44), alcohol intake (OR1.69, 95%CI:1.13-2.53), and contraceptive use (OR1.66, 95%CI:1.11-2.46) also significantly increased the risk of fibroids. Conclusion: The results of this study describe the association of fibroids with specific lifestyle and medical history risk factors. The present study also revealed that past induced abortions is a significant risk factors for the development of leiomyoma among Ghanaian women.

Oxidative stress and dyslipidaemia among ghanaian HAART-Naive HIV Patients and those on HAART

"Background: Pharmacogenomics/pharmacogenetics has the potential to mitigate adverse drug reactions and optimize pharmacotherapy in individuals. Over the past several years; there has been increasing attention towards the characterization of pharmacogenomic biomarkers in African populations; both locally and internationally. However; the perceptions of the African health care community towards pharmacogenomic testing have not been studied. Objectives: To assess knowledge and perceptions of pharmacogenomics among health care professionals in Benin City; Nigeria. Methods: In this preliminary and pilot investigation; we used a semi-structured qualitative survey methodology to understand the perceptions of pharmacists and pharmacologists towards pharmacogenomics in an academic care centre in Benin City; Nigeria. Three themes were explored: Knowledge and experience with pharmacogenetics; Expectations about how a pharmacogenetic testing service could be used; and Capacity building for pharmacogenetic service delivery.Results: Though none of the participants had received training or undertaken research in pharmaco-genomics; all participants were familiar with the field and listed beneficial outcomes associated with pharmacogenetic testing. Participants identified factors such as lack of funding; infrastructure; and manpower for limitations of pharmacogenomic testing in Nigeria. Participants listed numerous ethical issues and concerns in recruiting participants for research and introducing pharmacogenetics in the clinic; including the need to ""win the confidence of the people."" Conclusion: Pharmacists and pharmacologists in an academic centre in Nigeria are aware of the benefits of pharmacogenomics; but cite many hurdles to overcome before this field can become a routine part of patient care in their communities."

Chloroquine resistant falciparum malaria among security forces personnel in the Northern Province of Sri Lanka.

OBJECTIVE: To determine the occurrence and species distribution of malaria and the extent of chloroquine resistance among security forces personnel in a selected region of the Northern Province of Sri Lanka. DESIGN: A descriptive study. SETTING: Mannar District in the Northern Province. METHODS: Nine hundred and seventy five security personnel were screened for malaria by microscopy. Those who were positive were treated with chloroquine and were subjected to 28 day in vivo assay to determine chloroquine resistance. In vitro microtest assay was performed to determine the response of Plasmodium falciparum isolates to chloroquine in vitro. RESULTS: Of the 975 personnel screened, 181 (18.6%) were positive for malaria. P. falciparum was the predominant species (n = 125; 69.1%). The rest were due to P. vivax (n = 42; 23.2%) and mixed infections (n = 14; 7.7%). This was an inversion of the usual species distribution pattern in the country. In vivo assay revealed 38 (53.5%) P. falciparum infections as chloroquine resistant. Fifteen of 23 (65.2%) P. falciparum isolates showed evidence of resistance in vitro. None of the P. vivax infections showed evidence of chloroquine resistance. There was no significant difference in the severity of clinical disease between chloroquine resistant and sensitive infections at first presentation. Recrudescent P. falciparum infections had significantly lower mean parasite densities as well as lower clinical scores at recrudescence than at first presentation. CONCLUSION: Results demonstrate the high prevalence of malaria and chloroquine resistance in the study area and explains several contributory factors for this. There is an urgent need to review antimalarial drug policies in Sri Lanka.

A novel reverse transcriptase-polymerase chain reaction based-liquid hybridisation (RT-PCR-LH) assay for early diagnosis of dengue infection.

BACKGROUND: Early definitive laboratory diagnosis of dengue is difficult with the tests in routine use at present. OBJECTIVE: To develop a reverse transcriptase-polymerase chain reaction based liquid hybridisation (RT-PCR-LH) technique for the rapid and early diagnosis of dengue. RESEARCH DESIGN: RT-PCR products of the NS3 gene of dengue virus prototypes and of a few positive sera for dengue virus by culture, were allowed to hybridise in liquid phase with a mixture of dengue specific radiolabelled oligonucleotides. The products were separated by PAGE and visualised by autoradiography. 78 suspected dengue sera were also tested by RT-PCR-LH method, and by IgM-ELISA and HAI tests, for comparison. RESULTS: Two DNA bands (approximately equal to 470 bp and approximately equal to 455 bp) specific to dengue virus, were observed. RT-PCR-LH assay takes only 24 h. Of the 78 suspected dengue acute sera tested, 45/78 were positive by RT-PCR-LH, 31/78 were positive by IgM-ELISA, and 14/78 had a HAI titre > or = 2560. Duration of fever was known in 72 cases, and infection was detected by RT-PCR-LH in 11/22 of cases with < 5 d fever and by IgM-ELISA in 1/22. In cases with 5 to 15 d fever RT-PCR-LH and IgM-ELISA/HAI titre > or = 2560 detected infection in 30/50 and 27/50 respectively. The 10 sera which were negative by RT-PCR-LH, but were positive by either IgM-ELISA or HAI titre > or = 2560 were all > 5 d fever cases. RT-PCR-LH together with IgM-ELISA were capable of detecting dengue infection in 56/78 of the suspected cases. CONCLUSION: RT-PCR-LH assay developed in this study appears to have an advantage over other diagnostic techniques for the early detection of dengue.