Magnitude of peripheral sensory neuropathy and associated factors among HIV/AIDS clients receiving care at public health institutions, Northwest Ethiopia.

BACKGROUND: In the mid-1990s, the development of combination antiretroviral therapy converted HIV infection into a chronic condition, with newly diagnosed patients now living longer than the general population. HIV affects both the central and peripheral nerve systems, resulting in a variety of clinical problems, including peripheral neuropathy, which is a common neurological consequence. Despite this, there is a scarcity of data on the extent of peripheral sensory neuropathy and its underlying factors in Ethiopia, necessitating this study. OBJECTIVE: The primary goal of this study is to assess the degree of peripheral sensory neuropathy and its related factors among HIV/AIDS clients on follow up at public health institutions in Northwest Ethiopia. METHODOLOGY: Institution based cross-sectional study was conducted from November 1 to 30 December 2020 at selected south Gondar zone public health institutions ART clinic. Multistage sampling technique was used to select the study participants. Standardized Questioner adapted from other study was used to collect the data. Moreover, Brief Peripheral Neuropathy Screening tool (BPNS) was used to assess peripheral sensory neuropathy. The data were entered with epi-data manager version 4.4 and analyzed using STATA version 16. RESULT: A total of 555 adult PLWHIV agreed to participate in the study, resulting in a response rate of 96.8%. The prevalence of Peripheral sensory neuropathy was 32.25, 95% CI (28.28, 36.26). The participant's age, DM comorbidity, viral load level, and disease clinical stage were all found to have a statistically significant association with peripheral sensory neuropathy. CONCLUSION: Peripheral sensory neuropathy was incredibly common. Accordingly, peripheral sensory neuropathy was found considerably associated with age, viral load level, stage of the disease, and DM comorbidity. It is vital to integrate routine peripheral sensory neuropathy screening strategies for clients who are on ART follow up for prevention and early identification of the problem.

Milk production, quality, and consumption in Jimma (Ethiopia): Facts and producers', retailers', and consumers' perspectives.

Four studies were performed to quantify milk production, quality and consumption in the town Jimma, Ethiopia. First, 47 dairy farmers and 44 milk retailers were interviewed to gain more insights in dairy farming and marketing, and associated constraints. Second, bulk milk samples (n=188) were collected for 4 consecutive weeks to investigate milk quality [Total Bacterial Counts (TBC), Coliform Counts (CC), Somatic Cell Counts (SCC), and antimicrobial residues]. Third, (bulk) milk samples from 32 farms, 46 milk retailers and the 3 local milk collection centers were collected to determine the presence of oxacillin susceptible-and oxacillin resistant Staphylococcus aureus. Fourth, 208 adult inhabitants were interviewed to gain more insight in milk consumption and associated concerns of consumers. The average dairy farm included in the studies consisted of 5 lactating cows, produced 43 liters of milk per day and was owned by male, literate adults. Milk was sold to retailers (71% of the production) and directly to customers (25%) without any quality control, whereas 4% was self-consumed. Shortage of animal nutrition and adulteration of the milk were the main constraints for farmers and retailers, respectively. The median TBC, CC and SCC were 122,500CFU/mL, 1,005CFU/mL and 609,500cells/mL, respectively. Antimicrobial residues were detected in 20% of all samples. In general, the milk quality was considered to be poor (TBC>10,000CFU/mL, and/or CC>100CFU/mL, and/or SCC>400,000cells/mL and/or presence of antimicrobial residues) in 97% of all samples. S. aureus was isolated from 12 (38%), 13 (33%), and 2 out of 3 of the milk samples originating from the dairy farms, the milk retailers, and the milk collection centers, respectively. Seven (26%) of the isolates were resistant to oxacillin suggesting the presence of MRSA (Lee, 2003). Local milk is occasionally consumed by adults but more frequently by children. Adults mainly drink spontaneously fermented milk (57% of 105 interviewees consuming local milk) whereas most milk for children is boiled (86% of 110 households with children consuming local milk). Most consumers are concerned about adulteration and milk borne diseases but not about antimicrobial residues. Educated consumers (secondary school or higher) were more likely to boil milk for own consumption, to be concerned about antimicrobial residues in milk, to be concerned about milk borne diseases and to be willing to pay more for milk with proven good quality compared to poorly educated consumers. We conclude that milk quality incentives should be introduced in Jimma, and investments should be made in knowledge transfer, training, milk collection systems and a central milk quality lab.

Characterization and risk factors of vancomycin-resistant Enterococci (VRE) among animal-affiliated workers in Malaysia.

AIMS: This study determined the risk factors and characteristics of vancomycin-resistant Enterococci (VRE) among individuals working with animals in Malaysia. METHODS AND RESULTS: Targeted cross-sectional studies accompanied with laboratory analysis for the identification and characterization of resistance and virulence genes and with genotype of VRE were performed. VRE were detected in 9·4% (95% CI: 6·46-13·12) of the sampled populations. Enterococcus faecium, Enterococcus faecalis and Enterococcus gallinarum were isolated, and vanA was detected in 70% of the isolates. Enterococcus faecalis with vanB was obtained from one foreign poultry worker. At least one virulence gene was detected in >50% of Ent. faecium and Ent. faecalis isolates. The esp and gelE genes were common among Ent. faecium (58·3%) and Ent. faecalis (78%), respectively. The VRE species showed diverse RAPD profiles with some clustering of strains based on the individual's background. However, the risk factors found to be significantly associated with the prevalence of VRE were age (OR: 5·39, 95% CI: 1·98-14·61) and previous hospitalization (OR: 4·06, 95% CI: 1·33-12·35). CONCLUSION: VRE species isolated from individuals in this study have high level of vancomycin resistance, were genetically diverse and possessed the virulence traits. Age of individuals and history of hospitalization rather than occupational background determined VRE colonization. SIGNIFICANCE AND IMPACT OF THE STUDY: This study provides comprehensive findings on the epidemiological and molecular features of VRE among healthy individuals working with animals.

Characterization of vancomycin-resistant Enterococcus isolates from broilers in Selangor, Malaysia.

Vancomycin-resistant Enterococcus (VRE) is an emerging nosocomial pathogen in humans. The use of antibiotics in human therapy and in the production of food animals has been incriminated in the emergence of this organism. The present study describes the distribution of VRE species, the vancomycin-resistant genes detected, the vancomycin resistance pattern observed, and the genetic diversity of the isolates found in live broiler chickens in Malaysia. Overall 140 VRE were isolated with species comprising Enterococcus faecalis (48%), Enterococcus faecium (25.7%), Enterococcus gallinarum (12.1%), Enterococcus casseliflavus (1.4%) and other Enterococcus species (12.8%). Vancomycin resistance gene vanA and intrinsic genes vanC1 and vanC2/3 were detected in the study population. VanA was detected in 15 (63.9%) of E. faecium, 23 (22.4%) of E. faecalis and in 3 (17.6%) E. gallinarum isolates. E-test was conducted on randomly selected 41 of the isolates and the minimum inhibition concentration (MIC) of vancomycin for five (11.9%) of tested isolates is more than 256 µg/ml. Genotypic analysis using random amplified polymorphic DNA (RAPD) showed genetic diversity within the Enterococcus species.

Combination therapy for the treatment of hepatitis C in the veteran population: higher than expected rates of therapy discontinuation.

AIM: To compare the efficacy of high-dose induction with standard dose interferon therapy for the treatment of chronic hepatitis C virus at the Dallas Veterans Affairs Medical Center. METHODS: Patients were randomized to receive 5 million units daily interferon-alpha2b for 4-weeks followed by 44-weeks for genotype 1 or 20 weeks for non-genotype 1 of standard dose therapy (3 million units three times a week) or standard dose therapy for total treatment duration. Daily weight-based ribavirin was used for entire therapy interval. RESULTS: Forty-five patients were enrolled in the trial with genotype 1 comprising 75.6% of the sample. Cirrhosis or bridging-fibrosis was present in 69% of the patients. Of the 29 liver biopsies available for Knodell scoring, 41% and 51% had scores of 6-10 and 11-15, respectively. Rates of sustained virological response did not differ significantly between the two treatment groups. Therapy type and/or early intervention for depression did not affect the rate of therapy discontinuation, which was 26.6%. CONCLUSION: The rate of sustained virological response was similar between the two treatment groups and higher than anticipated among patients with cirrhosis or bridging-fibrosis. The rate of therapy discontinuation was also higher than anticipated but was not attributable to therapy type or untreated depression.