Dot-in-circle sign in cervical actinomycotic mycetoma: An extremely rare case report.

Actinomycosis is an unusual, chronic granulomatous infection caused by Actinomycetes spp. The organism also causes mycetoma, a neglected tropical disease in endemic regions. We present a very uncommon case of extensive actinomycosis of the soft tissues in the neck with perivertebral extension that showed the dot-in-circle sign on magnetic resonance imaging. A 29-year-old male patient presented with progressively enlarging hard posterior neck swelling of 4 years duration. Subsequently, magnetic resonance imaging showed the dot-in-circle sign in an avidly enhancing infiltrative lesion with extensive involvement of the neck and perivertebral soft tissue. The pathologic examination was in line with actinomycosis. The patient responded to high doses of combination parenteral and oral antibiotics.

Correction: Environmentally responsive hydrogel composites for dynamic body thermoregulation.

Correction for 'Environmentally responsive hydrogel composites for dynamic body thermoregulation' by M. Garzón Altamirano et al., Soft Matter, 2023, 19, 2360-2369, https://doi.org/10.1039/D2SM01548J.

Environmentally responsive hydrogel composites for dynamic body thermoregulation.

Hydrogel composites exhibiting dynamic thermo-hydro responsive modulation of infrared radiation (IR) in the 5-15 µm range are designed for personalized body thermoregulation. Fabrication of the proposed system relies on the periodic arrangement of submicron-sized spherical fine silica (SiO2) particles within poly(N-isopropylacrylamide) (PNIPAM)-based hydrogels. The dependence of the SiO2 particles content on the IR reflection, followed by its modulation in response to any immediate environmental changes are thereby investigated. The addition of 20 wt% of SiO2 allowed the hydrogel composites to reflect 20% of the IR emitted by the human body at constant temperature (i.e. T = 20 °C) and relative humidity (i.e. RH = 0%). According to Bragg's law, we found that the smaller the distance between the SiO2 particles, the higher the IR reflection. The IR reflection further increased to a maximum of 42% when the resulting hydrogel composites are subjected to changes in relative humidity (i.e. RH = 60%) and temperature (i.e. T = 35 °C). Thermography is used to map the IR radiation emitted from the hydrogel composites when placed on the skin of the human body, demonstrating that the composite is actually reflecting IR. The latter results are supported by theoretical models that define the IR reflection profile of the resulting hydrogel composites with respect to the silica content, relative humidity and temperature.

Virtual Adaptation of Resident I-PASS Training Session During COVID-19.

Introduction: Effective communication during the patient handoff process is critical for ensuring patient safety. At our academic medical center, first-year interns complete hand-off training before starting clinical rotations. The purpose of this study was to evaluate a virtual handoff training for residents as an alternative to in-person sessions due to limitations imposed by COVID-19. Methods: Fifty residents were administered pre/post surveys to gauge the helpfulness of the training for clinical practice, familiarity and confidence in providing a hand-off, and whether they would recommend the virtual format for incoming interns. Additionally, faculty rated the virtual form of the hand-off activity, made comparisons to in-person sessions, and assessed the helpfulness of the session for residents in clinical practice. Results: Forty-four residents (88%) and 11 faculty (85%) completed surveys. After the training session, residents who received instruction and feedback reported significant improvements in familiarity with the hand-off tool and confidence in their hand-off abilities (both p < 0.001). Both residents and faculty were satisfied with the virtual format of hand-off training. Most faculty felt the virtual platform was comparable to in-person sessions and would recommend ongoing use of the virtual platform when in-person sessions were not possible. Conclusions: Teaching hospitals mandate resident training to include strategies for a uniform hand-off method to avoid medical errors. Adaptation to a virtual platform can be a successful instruction strategy, allowing for didactic and interactive sessions with direct faculty observation and feedback.

Occupational safety and health development and challenges in Ethiopia: a case study of the Hawassa Industrial Park

Background: In Ethiopia, industrial parks that specialise in garment production are increasing in number and have created job opportunities for more than 45 000 workers. However, healthcare services, including occupational safety and health (OSH), are not commensurate with the growth and needs of the industry. Objectives: We assessed the supply and demand, barriers, governance, and regulation of health services and OSH at Hawassa Industrial Park, the largest industrial park in Ethiopia. Methods: Qualitative and quantitative data were collected via interviews with 260 randomly selected workers, focus group discussions with workers and health professionals, and key informant interviews with industrial park management, and government and non-government stakeholders. Ethiopian OHS polices, regulations, guidelines, directives, and strategies were also reviewed. Results: Hawassa Industrial Park hosts 21 globally known companies and more than 23 000 workers. Of the 260 workers interviewed, most (83.1%) were aged 18-24 years. Findings included that the delivery of OSH and primary healthcare is inadequate to ensure safety and meet workers' needs. Use of personal protective equipment is erratic; conditions in the cafeteria are unsanitary, as is the water; use of bathrooms is restricted; workers work long shifts with short breaks; wages are low; and healthcare is expensive, increasing the risk of occupational injuries and diseases. Workers have no OSH committee or trade unions, and Ethiopian Government regulations and enforcement are weak. There is no collaboration between the Park and the Ministry of Health to provide primary healthcare services for the workers. Conclusion: The workers in Hawassa Industrial Park urgently need improved access to, and coverage for, primary healthcare, including OSH; higher wages; and empowerment to exercise their right to organise. All stakeholders need capacity building to enable them to implement OSH.

High-throughput analysis of T cell-monocyte interaction in human tuberculosis.

The lack of efficient tools for identifying immunological correlates of tuberculosis (TB) protection or risk of disease progression impedes the development of improved control strategies. To more clearly understand the host response in TB, we recently established an imaging flow cytometer-based in-vitro assay, which assesses multiple aspects of T cell-monocyte interaction. Here, we extended our previous work and characterized communication between T cells and monocytes using clinical samples from individuals with different TB infection status and healthy controls from a TB endemic setting. To identify T cell-monocyte conjugates, peripheral blood mononuclear cells (PBMC) were stimulated with ds-Red-expressing Mycobacterium bovis bacille Calmette-Guérin or 6-kDa early secreted antigenic target (ESAT 6) peptides for 6 h, and analyzed by imaging flow cytometer (IFC). We then enumerated T cell-monocyte conjugates using polarization of T cell receptor (TCR) and F-actin as markers for synapse formation, and nuclear factor kappa B (NF-κB) nuclear translocation in the T cells. We observed a reduced frequency of T cell-monocyte conjugates in cells from patients with active pulmonary tuberculosis (pTB) compared to latent TB-infected (LTBI) and healthy controls. When we monitored NF-κB nuclear translocation in T cells interacting with monocytes, the proportion of responding cells was significantly higher in active pTB compared with LTBI and controls. Overall, these data underscore the need to consider multiple immunological parameters against TB, where IFC could be a valuable tool.

Age at diagnosis, but not HPV type, is strongly associated with clinical course in recurrent respiratory papillomatosis.

BACKGROUND: Recurrent Respiratory Papillomatosis (RRP) is a rare disease characterized by the growth of papillomas in the airway and especially the larynx. The clinical course is highly variable among individuals and there is poor understanding of the factors that drive an aggressive vs an indolent course. METHODS: A convenience cohort of 339 affected subjects with papillomas positive for only HPV6 or HPV11 and clinical course data available for 1 year or more, from a large multicenter international study were included. Exploratory data analysis was conducted followed by inferential analyses with frequentist and Bayesian statistics. RESULTS: We examined 339 subjects: 82% were diagnosed prior to the age of 18 years, 65% were infected with HPV6, and 69% had an aggressive clinical course. When comparing age at diagnosis with clinical course, the probability of aggressiveness is high for children under five years of age then drops rapidly. For patients diagnosed after the age of 10 years, an indolent course is more common. After accounting for confounding between HPV11 and young age, HPV type was minimally associated with aggressiveness. Fast and Frugal Trees (FFTs) were utilized to determine which algorithms yield the highest accuracy to classify patients as having an indolent or aggressive clinical course and consistently created a branch for diagnostic age at ~5 years old. There was no reliable strong association between clinical course and socioeconomic or parental factors. CONCLUSION: In the largest cohort of its type, we have identified a critical age at diagnosis which demarcates a more aggressive from less aggressive clinical course.

Enset in Ethiopia: a poorly characterized but resilient starch staple.

BACKGROUND: Enset (Ensete ventricosum, Musaceae) is an African crop that currently provides the staple food for approx. 20 million Ethiopians. Whilst wild enset grows over much of East and Southern Africa and the genus extends across Asia to China, it has only ever been domesticated in the Ethiopian Highlands. Here, smallholder farmers cultivate hundreds of landraces across diverse climatic and agroecological systems. SCOPE: Enset has several important food security traits. It grows over a relatively wide range of conditions, is somewhat drought-tolerant, and can be harvested at any time of the year, over several years. It provides an important dietary starch source, as well as fibres, medicines, animal fodder, roofing and packaging. It stabilizes soils and microclimates and has significant cultural importance. In contrast to the other cultivated species in the family Musaceae (banana), enset has received relatively little research attention. Here, we review and critically evaluate existing research, outline available genomic and germplasm resources, aspects of pathology, and explore avenues for crop development. CONCLUSION: Enset is an underexploited starch crop with significant potential in Ethiopia and beyond. Research is lacking in several key areas: empirical studies on the efficacy of current agronomic practices, the genetic diversity of landraces, approaches to systematic breeding, characterization of existing and emerging diseases, adaptability to new ranges and land-use change, the projected impact of climate change, conservation of crop wild relatives, by-products or co-products or non-starch uses, and the enset microbiome. We also highlight the limited availability of enset germplasm in living collections and seedbanks, and the lack of knowledge of reproductive and germination biology needed to underpin future breeding. By reviewing the current state of the art in enset research and identifying gaps and opportunities, we hope to catalyse the development and sustainable exploitation of this neglected starch crop.

High utility of active tuberculosis case finding in an Ethiopian prison.

SETTING: Hawassa Prison, Southern Region of Ethiopia. OBJECTIVE: To determine the burden of pulmonary tuberculosis (TB) using active case finding among prisoners. DESIGN: In this cross-sectional study, prisoners were screened for TB using a symptom screen. Those with cough of 2 weeks had spot and morning sputum samples collected for acid-fast bacilli (AFB) smear microscopy and molecular diagnostic testing (Xpert® MTB/RIF). RESULTS: Among 2068 prisoners, 372 (18%) had a positive cough screen. The median age of these 372 persons was 23 years, 97% were male and 63% were from urban areas. Among those with a positive symptom screen, 8 (2%) were AFB sputum smear-positive and 31 (8%) were Xpert-positive. The point prevalence of pulmonary TB at the prison was 1748 per 100 000 persons. In multivariate analysis, persons with cough >4 weeks were more likely to have TB (OR 3.34, 95%CI 1.54-7.23). CONCLUSION: A high prevalence of TB was detected among inmates at a large Ethiopian prison. Active case finding using a cough symptom screen in combination with Xpert had high utility, and has the potential to interrupt transmission of Mycobacterium tuberculosis in correctional facilities in low- and middle-income, high-burden countries.

Chronic maternal inflammation during late gestation impairs subsequent ß-cell function but not islet growth in fetal sheep.

Intrauterine growth restriction (IUGR) greatly increases perinatal mortality and morbidity rates, and leads to much greater risk for metabolic complications later in life. One such complication is the development of glucose intolerance or diabetes, which typically develops concurrently with abhorrent patterns of insulin secretions due to diminished ß-cell mass and impaired function as well as an overall reduction in pancreatic endocrine tissue. The mechanisms by which IUGR causes problems with health and function of the pancreatic islets are not well understood. Therefore, our goal for this study was to determine how materno-fetal inflammation (MI) affects ß-cell growth and function. To do this, we compared the average islet areas, plasma insulin concentrations, and blood glucose concentrations between MI-IUGR fetal lambs (n = 7) and control fetal lambs (n = 7). Pregnant ewes were injected with saline (controls) or 0.1-µg/kg bacterial lipopolysaccharide (LPS) every 3 d from days 100 to 115 of gestation (term = 150 d). Throughout late gestation, arterial blood of the fetus was periodically drawn and analyzed for plasma insulin (ELISA) and blood glucose (ABL90 FLEX) levels. On day 125 of gestation, ewes were euthanized and fetal pancreas was extracted. Sections of the fetal pancreas were then fixed in 4% paraformaldehyde, sectioned (cryostat) at a thickness of 8 µm, stained for insulin-positive area, and imaged on 20x magnification for analysis of average islet area. Between MI-IUGR and control fetuses, there were no differences in average islet areas (1675 ± 286 and 1678 ± 287 µm2, respectively), which indicates that MI did not impair growth and physical development of fetal islets. In addition, blood glucose was similar in all fetuses. However, results showed less (P ≤ 0.05) plasma insulin concentration in MI-IUGR fetuses (0.39 ± 0.07 ng/mL) than in controls (0.70 ± 0.09 ng/mL). This indicates impaired ß-cell functional capacity in MI-IUGR fetuses despite normal growth, which is quantified by a tendency (P = 0.08) for strong positive correlation (r = 0.91) between plasma insulin and islet area in control fetuses but an absence of correlation in MI-IUGR fetuses. From this study, we can conclude that MI-IUGR has no effect on the growth and physical development of ß cells; however, it does greatly affect their function.

Living with parents and risky sexual behaviors among preparatory school students in Jimma zone, South west Ethiopia.

BACKGROUND: Risky sexual behavior is any behavior that increases the probability of negative consequences associated with sexual contact. Family environment, peer influence, community factors and school attachment seem an important factor affecting sexual risk behavior and decision of in-school youths. OBJECTIVE: To assess sexual risk behaviors and associated factors among students living with parents in Jimma zone preparatory schools. METHODS: A cross sectional study designs both qualitative and quantitative approaches was conducted in 5 randomly selected preparatory schools. A total of 273 students were randomly selected. Multiple logistic regressions were performed to identify the independent predictor of risk sexual behavior. RESULT: One hundred fiten (42.1%) students had sexual risk behavior. Thirty six (30.8%) student's reports they had two or more sexual partners in their lifetime. Out of 117 students, 13 (11.2%) students used condom always. One hundred one (37%) students were consumed alcohol. Higher likelihood of risky sexual behavior significantly associated with higher levels of alcohol consumption and low frequency of religious visit. CONCLUSION: Alcohol consumption and religious visit were the major predictors of risky sexual behaviors. Therefore, Behavior change communication should consider family environment and other factors which predict risk sexual behaviors.

Incidence of smear-positive tuberculosis in Dabat, northern Ethiopia.

OBJECTIVE: To determine the incidence of smear-positive tuberculosis (TB) in Dabat District, northern Ethiopia. METHODS: Using a population-based longitudinal design, a TB surveillance system was initiated among 46,165 residents at the Dabat Health and Demographic Surveillance System site. Trained field workers visited each household every third month and interviewed all individuals aged ≥14 years using a uniform questionnaire to detect suspected cases of TB (cough ≥15 days), at which time two sputum (spot-morning) samples were collected for smear microscopy. RESULTS: A total of 281,820 person-months were observed during the 1-year period, which generated 74 smear-positive TB cases. The incidence of smear-positive TB was calculated at 311 per 100,000 person-years (95%CI 240-382). Higher rates were observed among females (incidence rate ratio [IRR] 2.08, 95%CI 1.24-3.52), persons with no schooling (IRR 2.74, 95%CI 1.11-6.78) and urban residents (IRR 2.39, 95%CI 1.39-4.12). CONCLUSION: The incidence of smear-positive TB is high in Dabat District, suggesting a high risk of transmission in the communities. TB control programmes thus need to improve case-finding mechanisms at the community level in Ethiopia, with greater emphasis on risk groups.

Modern lineages of Mycobacterium tuberculosis in Addis Ababa, Ethiopia: implications for the tuberculosis control programe.

BACKGROUND: The genotyping of Mycobacterium tuberculosis strains is important to have unique insights into the dissemination dynamics and evolutionary genetics of this pathogen and for TB control as it allows the detection of suspected outbreaks and the tracing of transmission chains. OBJECTIVE: To characterize M. tuberculois isolates collected from newly diagnosed pulmonary TB patients in Addis Ababa METHODS: One hundred and ninety two sputum samples were cultured on Löwenstein-Jensen (LJ) slants and isolates were heat killed for molecular genotyping. The isolates were characterized using spoligotyping and were compared with the International SpoIDB4 database. RESULT: T genotype constitutes the most predominant in our study (95, 49.5%) followed by the CAS genotype (42, 21.9%). Other genotypes found were Haarlem (H) (24, 12.5%), the LAM (3, 1.5%), the Beijing genotype (1, 0.5%); four (2.1%) isolates were designated as Unknown. CONCLUSION: All the isolates belong to the modern lineage and there is high clustering in the genotype of isolates which indicated the presence of recent TB transmission. Therefore, the Tuberculosis Control Programme needs to do more in advocating and strengthening the health system for early detection and treatment of active TB cases as delay in treatment is the key factor in disease transmission.

Survival of calicivirus in foods and on surfaces: experiments with feline calicivirus as a surrogate for norovirus.

Although there is a large body of evidence incriminating foods as vehicles in the transmission of norovirus, little is known about virus survival in foods and on surfaces. Feline calicivirus was used as a surrogate for norovirus to investigate its survival in representative foods of plant and animal origin and on metal surfaces. Known concentrations of feline calicivirus in a natural fecal suspension were deposited onto lettuce, strawberries, ham, or stainless steel and incubated for 7 days at refrigeration or room temperatures. Virus was recovered at 1-day intervals, and the titers of the virus were determined by plaque assay. Infectious virus was recoverable until day 7 from lettuce, ham, and stainless steel. Statistically higher titers of feline calicivirus (P < 0.05) were recovered from ham under all conditions than from lettuce, strawberries, or stainless steel. These data provide valuable information for epidemiological and monitoring purposes as well as for the development of food processing practices and appropriate strategies to inactivate norovirus and control its transmission via foods and surfaces.

Female genital tuberculosis in Ethiopia.

OBJECTIVES: To study the occurrence of female genital tuberculosis (FGTB) in Ethiopia and to compare the different methods available for its diagnosis. METHODS: Biopsy or curettage samples from 25 clinically suspected cases of FGTB were investigated with histopathology, smear microscopy, TB culture and PCR for mycobacteria. HIV status was determined by ELISA. CD4:CD8 ratio was evaluated by flow cytometry. RESULTS: Among the 25 clinically suspected patients investigated, only one was AFB smear positive, three were culture positive, seven were histology positive and 12 were positive by PCR (a total of 16 positives). Samples taken from the fallopian tube were more frequently positive than those from the endometrium. CONCLUSIONS: The results showed that FGTB is a significant clinical problem in Ethiopia. A combination of PCR with the other available methods was found to be the best alternative to achieve sufficient sensitivity and specificity for the diagnosis of FGTB in this setting.

Female genital tuberculosis in Ethiopia.

UNLABELLED: To study the occurrence of female genital tuberculosis (FGTB) in Ethiopia and to compare the different methods available for its diagnosis. METHODS: Biopsy or curettage samples from twenty-five clinically suspected cases of FGTB were investigated with histopathology, smear microscopy, TB culture and PCR for mycobacteria. HIV status was determined by ELISA. CD4:CD8 ratio was evaluated by flow cytometry. RESULTS: Among the 25 clinically suspected patients investigated, only one was AFB smear positive, three were culture positive, seven were histology positive and 12 were positive by PCR (a total of 16 positives). Samples taken from the fallopian tube were more frequently positive than those from the endometrium. CONCLUSIONS: The results showed that FGTB is a significant clinical problem in Ethiopia. A combination of PCR with the other available methods was found to be the best alternative to achieve sufficient sensitivity and specificity for the diagnosis of FGTB in this setting.

Activity of an alcohol-based hand gel against human adeno-, rhino-, and rotaviruses using the fingerpad method.

OBJECTIVE: To assess the activity against three non-enveloped viruses (an adeno-, a rhino- and a rotavirus) of a gel containing 60% ethanol, using experimentally contaminated thumb- and fingerpads of 12 panelists, as per standard procedure E-1838-96 of the American Society of Testing and Materials. DESIGN: Each digit received 10 microL of the test virus suspension. The inoculum from the thumbs was eluted immediately with 990 microL of Earle's balanced salt solution (EBSS) to assess the amount of virus on each digit (0-minute control). The inoculum on the fingers was allowed to dry (20-25 minutes), and virus was eluted from two fingerpads to determine the loss in virus infectivity upon drying (baseline titer). Then the dried inoculum on randomly selected fingers was exposed to 1 mL of the test product or standard hard water (200-ppm calcium carbonate) for 20 seconds. The virus remaining was eluted with 1 mL of EBSS, titrated to determine the amounts eliminated, and compared to the baseline titer. RESULTS: Each digit received at least 10(4) plaque-forming units of virus in 10 microL. The amounts of adeno-, rhino-, and rotaviruses surviving the drying were 30%, 75%, and 42%, respectively. The product reduced the infectivity titers of the three viruses by 3 to >4 log10 when compared to a reduction of < or =1 log10 for the hard-water rinse. CONCLUSION: The level of virus reduction by gel was statistically significantly higher than that seen with the water control. Evidence for such activity against non-enveloped viruses supports further investigation of the benefits of this product.

Novel anticoagulant from salivary glands of Simulium vittatum (Diptera: Simuliidae) inhibits activity of coagulation factor V.

Anticoagulant activity was detected in fractions of a reversed phase-high-performance liquid chromatography (RP-HPLC) of salivary gland lysate from Simulium vittatum Zetterstedt. Using a plasma recalcification time assay, these fractions did not inhibit factor Xa or thrombin. HPLC-purified fractions showing the anticoagulant property were pooled and examined using the activated partial thromboplastin time test conducted on normal plasma and plasmas deficient in factors V, VIII, IX, XI, and XII. The anticoagulant prolonged the clotting time of all the plasmas, except plasma deficient in factor V. The detection of antifactor V activity, together with other anticoagulants reported from Simulium spp. indicates a feeding strategy that targets enzymes in the terminal portion of the coagulation cascade.

Anticoagulant activity in salivary gland extracts of black flies (Diptera: Simuliidae).

Anticoagulant activity was determined in salivary gland extracts from four species of black flies, i.e., Simulium vittatum Zetterstedt, Simulium argus Williston, Simulium metallicum Bellardi, and Simulium ochraceum Walker. Inhibition of coagulation factor Xa occurred among all four, whereas thrombin inhibition was detected in S. argus and S. vittatum only. Both bovine and human alpha-thrombins were inhibited with the highest activity occurring with S. argus salivary gland extracts. Factor Xa inhibition was highest in S. ochraceum, an anthropophilic species and vector of Onchocerca volvulus, and lowest in S. vittatum, a primiparous autogenous species that is also zoophilic. Total soluble salivary gland extract protein also varied among the four species with the highest concentration measured in S. ochraceum and the lowest in S. vittatum. A positive correlation was observed between the amount of soluble protein and percentage of inhibition of factor Xa for the four species.

Plasmodium vivax and P. falciparum epidemiology in Gambella, south-west Ethiopia.

Plasmodium vivax and P. falciparum epidemiology were studied for parasitological and entomological samples collected during the period 1989 and 1990, respectively, from Gambella, South West Ethiopia. Of the total population examined (n = 1091), 147 (13.5%) were found to be positive for malaria parasites. Prevalence rates among males and females were 13.8% and 13.1%, respectively. Differences in the prevalence rates of malaria in the eleven villages were observed, the highest (33.3%) being in Ukuna 2 and the lowest (3.9%) in Ukuna 22. The dominant species of malaria found were both P. falciparum and P. vivax. 88.9% and 11.1% of the malaria cases of the general population were due to these parasites, respectively. It was also recognized that P. falciparum and P. vivax were prevalent in 81.6% and 18.4% of the Anuak population, respectively. The mosquito species responsible for malaria transmission were the indoor-resting A. gambiae s. l. and A. pharoensis. The parasite infection rates of these species were 0.76% and 0.46% and they were found to be the exclusive vectors of P. falciparum and P. vivax, respectively. The present findings are not in accord with the study results previously reported twenty years ago by Armstrong (1972) and Krafsur (1971). The most probable contributing factors for such switch of malaria transmission patterns were, the rehabilitation and resettlement programmes and agricultural activities undertaken in Gambella for the past 10 years that may have brought changes of the socio-economic situation and environmental factors.