Implementation of a perioperative registry in Ethiopia to enhance surgical quality improvement.

BACKGROUND: Despite a glaring need and proven efficacy, prospective surgical registries are lacking in low- and middle-income countries. The objective of this study was to design and implement a comprehensive prospective perioperative registry in a low-income country. METHODS: This study was conducted at Hawassa University Comprehensive Specialized Hospital in Hawassa, Ethiopia. Design of the registry occurred from June 2021 to May 2022 and pilot implementation from May 2022 to May 2023. All patients undergoing elective or emergent general surgery were included. Following one year, operability and fidelity of the registry were analyzed by assessing capture rate, incidence of missing data, and accuracy. RESULTS: A total of 67 variables were included in the registry including demographics, preoperative, operative, post-operative, and 30-day data. Of 440 eligible patients, 226 (51.4%) were successfully captured. Overall incidence of missing data and accuracy was 5.4% and 90.2% respectively. Post pilot modifications enhanced capture rate to 70.5% and further optimized data collection processes. CONCLUSION: The establishment of a low-cost electronic prospective perioperative registry in a low-income country represents a significant step forward in enhancing surgical care in under-resourced settings. The initial success of this registry highlights the feasibility of such endeavors when strong partnerships and local context are at the center of implementation. Continuous efforts to refine this registry are ongoing, which will ultimately lead to enhanced surgical quality, research output, and expansion to other sites.

Anticuerpos contra el SARS-CoV-2 tras la dosis de vacuna de recuerdo. Identificación de subgrupos con respuesta insuficiente / SARS-CoV-2 antibodies after booster vaccination. Identification of subgroups with poor response

Objetivo Identificar dentro del grupo de pacientes de alto riesgo a aquellos que presentan más posibilidad de presentar inmunidad postvacunal insuficiente. Método Determinación de títulos de IgG frente a SARS-CoV-2 después de la dosis de recuerdo. Se clasificó la respuesta vacunal como negativa (títulos IgG <34 BAU/ml), indeterminada (títulos 34 - 259 BAU/ml) o positiva (≥260 BAU/ml). Resultados Se incluyeron 765 pacientes (31,25% de los vacunados): 54 (7,1%) en tratamiento con fármacos biológicos, 90 (11,8%) con enfermedad hematológica, 299 (39,1%) con patología oncológica, 304 (39,7%) con trasplante de órgano sólido y 18 (2,4%) con inmunosupresión por otros motivos. Un total de 74 pacientes (9,7%) tuvieron una serología negativa y 45 (5,9%) obtuvieron títulos indeterminados. Por grupo diagnóstico, los pacientes con mayor porcentaje de serología negativa o indeterminada fueron pacientes bajo tratamiento con fármacos biológicos (55,6%, fundamentalmente a expensas de antiCD20), hematológicos (35,4%) y los trasplantados (17,8%, principalmente pulmón y riñón). Los pacientes oncológicos y otros pacientes inmunosuprimidos tuvieron buena respuesta vacunal. Conclusión Los pacientes tratados con fármacos antiCD20, los hematológicos y los trasplantados (fundamentalmente de pulmón y riñón) presentaron mayor riesgo de no desarrollar inmunidad postvacunal. Es fundamental su identificación de cara a individualizar y mejorar su manejo (AU)

Objective To determine which patients within the high-risk group are most likely to have insufficient post-vaccination immunity. Methods Determination of IgG titers against SARS-CoV-2 after the booster dose. Vaccine response was categorized as negative (IgG titers <34 BAU/ml), indeterminate (titers 34 - 259 BAU/ml) or positive (≥ 260 BAU/ml). Results 765 patients were included (31.25% of those vaccinated). 54 (7.1%) on treatment with biologics, 90 (11.8%) with hematologic disease, 299 (39.1%) with oncologic pathology, 304 (39.7%) with solid organ transplant and 18 (2.4%) with immunosuppression for other reasons. 74 patients (9.7%) had negative serology and 45 (5.9%) had indeterminate titers. By diagnostic group, the patients with the highest proportion of negative or indeterminate serology were patients with biologic treatment (55.6%, mainly at expense of antiCD20), hematologic (35.4%) and transplant patients (17.8%, mainly lung and kidney). Oncology and other immunosuppressed patients had a favorable response to vaccination. Conclusion Patients treated with antiCD20 drugs, hematologic patients and transplanted patients (mainly lung and kidney) have a higher risk of not achieving post-vaccination immunity. It is essential to identify them in order to individualize and optimize their management (AU)

[SARS-CoV-2 antibodies after booster vaccination. Identification of subgroups with poor response]. / Anticuerpos contra el SARS-CoV-2 tras la dosis de vacuna de recuerdo. Identificación de subgrupos con respuesta insuficiente.

Objective: To determine which patients within the high-risk group are most likely to have insufficient post-vaccination immunity. Methods: Determination of IgG titers against SARS-CoV-2 after the booster dose. Vaccine response was categorized as negative (IgG titers < 34 BAU/ml), indeterminate (titers 34 - 259 BAU/ml) or positive (≥ 260 BAU/ml). Results: 765 patients were included (31.25% of those vaccinated). 54 (7.1%) on treatment with biologics, 90 (11.8%) with hematologic disease, 299 (39.1%) with oncologic pathology, 304 (39.7%) with solid organ transplant and 18 (2.4%) with immunosuppression for other reasons. 74 patients (9.7%) had negative serology and 45 (5.9%) had indeterminate titers. By diagnostic group, the patients with the highest proportion of negative or indeterminate serology were patients with biologic treatment (55.6%, mainly at expense of antiCD20), hematologic (35.4%) and transplant patients (17.8%, mainly lung and kidney). Oncology and other immunosuppressed patients had a favorable response to vaccination. Conclusion: Patients treated with antiCD20 drugs, hematologic patients and transplanted patients (mainly lung and kidney) have a higher risk of not achieving post-vaccination immunity. It is essential to identify them in order to individualize and optimize their management.

SARS-COV-2 antibodies after booster vaccination. Identification of subgroups with poor response.

OBJECTIVE: To determine which patients within the high-risk group are most likely to have insufficient post-vaccination immunity. METHODS: Determination of IgG titers against SARS-CoV-2 after the booster dose. Vaccine response was categorized as negative (IgG titers < 34 BAU/ml), indeterminate (titers 34-259 BAU/ml) or positive (≥260 BAU/ml). RESULTS: 765 patients were included (31.25% of those vaccinated). 54 (7.1%) on treatment with biologics, 90 (11.8%) with hematologic disease, 299 (39.1%) with oncologic pathology, 304 (39.7%) with solid organ transplant and 18 (2.4%) with immunosuppression for other reasons. 74 patients (9.7%) had negative serology and 45 (5.9%) had indeterminate titers. By diagnostic group, the patients with the highest proportion of negative or indeterminate serology were patients with biologic treatment (55.6%, mainly at expense of antiCD20), hematologic (35.4%) and transplant patients (17.8%, mainly lung and kidney). Oncology and other immunosuppressed patients had a favorable response to vaccination. CONCLUSION: Patients treated with antiCD20 drugs, hematologic patients and transplanted patients (mainly lung and kidney) have a higher risk of not achieving post-vaccination immunity. It is essential to identify them in order to individualize and optimize their management.

Association of ESAT-6/CFP-10-induced IFN-γ, TNF-α and IL-10 with clinical tuberculosis: evidence from cohorts of pulmonary tuberculosis patients, household contacts and community controls in an endemic setting.

Mycobacterium tuberculosis (Mtb) early secreted protein antigen 6 (ESAT-6) and culture filtrate protein 10 (CFP-10) are among candidate vaccines against tuberculosis (TB). Results of experimental animal models show that these antigens are associated with induction of strong T cell immunity [interferon (IFN)-γ production], while others report that these proteins as virulent factors involved in pathogenicity of Mtb infection. However, the role of ESAT-6/CFP-10 during natural Mtb infections in humans has not been established. In this paper we present results of a longitudinal study from an Mtb-infected human population from an endemic setting. Whole blood assay was used to determine levels of IFN-γ, tumour necrosis factor (TNF)-α and interleukin (IL)-10 against rESAT-6/CFP-10 in TB patients, household contacts and community controls. The levels of IFN-γ, TNF-α and IL-10 against rESAT-6/CFP-10 at baseline were significantly higher in patients and community controls than in household contacts. In patients, no significant difference was observed in the level of these cytokines before and after chemotherapy whereas, in contacts, the level of these cytokines increased significantly and progressively over time. The study shows that the levels of IFN-γ, TNF-α and IL-10 against rESAT-6/CFP-10 are depressed during Mtb infection or exposure but are elevated during clinical TB. Our findings from a study of naturally infected human population suggest that IFN-γ, TNF-α and IL-10 against rESAT-6/CFP-10 are markers for clinical TB but not for protective immunity.

Intestinal Parasitic Infections among Under-Five Children and Maternal Awareness about the Infections in Shesha Kekele; Wondo Genet; Southern Ethiopia

Background: Few studies have reported the magnitude of intestinal parasitic infections among under-five children in tropical countries. Moreover; there is little information on maternal awareness about intestinal parasitosis. Objective: To determine the prevalence of intestinal parasitosis among under-five children; and assess maternal awareness about it in Shesha Kebkele; Wondo Genet; Southern Ethiopia. Methods: A cross-sectional study involving 288 under-five children was conducted and stool samples were collected and examined for intestinal parasites using Kato-Katz and formol-ether concentration methods. In addition; a total of 130 mothers of under-five children were interviewed regarding their awareness about intestinal parasitic infections. Results: Of the 288 children; 245 (85.1) were found infected with one or more intestinal parasites. The prevalence of Trichuris trichiura; Schistosoma mansoni and Ascaris lumbricoides; hookworm; and Hymenolepis nana infections as determined by Kato-Katz were 74.7; 37.2; 25.7; 5.9; and 4.5; respectively. On the other hand; the prevalence of Strongyloides stercoralis; Giardia lamblia; Entamoeba histolytica/dispar; and Entamoeba coli infections as determined by formol-ether concentration method were 0.69; 13.2; 0.35; and 2.1; respectively. Most mothers were reasonably aware of the mode of transmission of ascariasis; amoebiasis and giardiasis while they had very limited knowledge of bilharzia and hookworm transmission. Almost all of the respondents reported that infections with intestinal parasites could cause retardation of growth and death in children unless treated. Conclusion: Intestinal parasitic infections were prevalent in varying magnitude among under-five children in Wondo Genet area; Southern Ethiopia. Mothers in the study area had a fairly good knowledge of the impact of infections but limited knowledge of the mode of transmission of intestinal parasitic infections. Improvement of sanitation and health education are required besides preventive chemotherapy to control worms (except for schistosomiasis in under-five which need treatment on an individual basis) and other intestinal parasitic infections in the area. (Ethiop. J. Health Dev. 2010;24(3):185-190)

[Fundamentals of the biomechanics of hard tissues]. / Grundsätzliches zur Biomechanik von Hartgeweben.

On the basis of an analysis of such methods that have led to the establishment of the Newtonian laws some problems of the interdisciplinary agreement between mechanics and biology, especially those concerning hard tissues, were discussed. In the light of examples it is shown that comparisons with technical constructions to explain form and function of bones are not sufficient since similarity of form is no proof of identical function. Mechanical phenomena of living matter can be investigated merely by their own movements whereby the differing qualities and reactions of the material have to be taken into priority consideration.

[Biomechanics of the bones and skeleton. III. Microstructure]. / K otázkám biomechaniky kosti a kostry. III. (Mikrostruktúra).

The authors analyzed micro- and ultrastructure of Haversian system--osteon--from the aspect of mechanics--biomechanics. The evaluation takes into account biological factors and instead of mathematical formulae and calculations prefer a comparison with technical constructions, particularly for emphasizing differences or similarities. The analysis of osteon revealed that it consists of fibres, net and tubes. The orientation of tube-like lamellae is in the direction of compressive strain, whereas the resultant course of torison and bending stress may be well observed in the direction of collagen fibres. A slight assymetry of osteons suggests that they are stressed by pressure in a slightly excentric direction. In the course of stress lengthwise there is the development of extension of the Haversian canal supporting the blood flow in the capillary. In the course of stress in the osteon lengthwise there are developing pressure, torsion and bending strains. Liquid phase can, together with collagen, absorb considerable portion of kinetic energy, thereby decreasing the strain of external strengths to act on the fragile mineralized component. Without the viscous and collagen elements the mineralized component would not be able to resist the dynamic forces which develop during the stresses in the bone tissue. Identification of mechanic phenomena of osteon provides information on structural principle of the whole bones. The authors applied in their study the knowledge from the discovery of USSR No. 181 and a discovery of CSSR No. 43.

Hydrolytic enzymes in healthy and unhealthy periodontal tissue.

Periodontal diseases belong to the group of diseases, by which are humans very often affected. Despite of the public health and economic significance of periodontal diseases, some aspects associated with their etiology and pathogenesis have not been consequently solved as yet. The main task in periodontology according to the experts of World Health Organization is "to express th opinion to the etiological factors of periodontal diseases as well as to the possibilities of their prevention and therapy". One of the possibilities to fulfil this task consists, besides, the clinical approach in laboratory studies of enzymatic, hormonal and immunological effects on the processes taking place in periodontal tissue under physiological and pathological conditions.

Contribution to the knowledge on the ultrastructure of marginal gingivae.

A total of 51 bioptic specimens of marginal gingivae from young healthy donors were subjected to the light and electron microscopic study. Clinical and morphological findings indicated that the gingiva should be studied as a whole. Description of the healthy epithelium cannot be separated from the knowledge of the actual state of lamina propria mucosae. As healthy can be considered only those gingival specimens, which do not contain any lymphocytes, leukocytes and other cells typical of inflammatory infiltrate, respectively. The epithelial basal membrane is considered as a light microscopic concept. Topographic orientation, particularly in the layers of epithelial cells not connected with lamina basalis or with the surface, presents a problem in electron microscopic examinations. Morphological pendent of mucopolysaccharides can be found in lamina propria mucosae. Hemidesosomal structures of stratum basale of the epithelial layer may reflect physiological requirements counterbalancing the mechanical pulls in a given area.