Assessment of antimicrobial resistance laboratory-based surveillance capacity of hospitals in Zambia: findings and implications for system strengthening.

BACKGROUND: A well-established antimicrobial resistance (AMR) laboratory-based surveillance (LBS) is of utmost importance in a country like Zambia which bears a significant proportion of the world's communicable disease burden. This study assessed the capacity of laboratories in selected hospitals to conduct AMR surveillance in Zambia. METHODS: This cross-sectional exploratory study was conducted among eight purposively selected hospitals in Zambia between August 2023 and December 2023. Data were collected using the self-scoring Laboratory Assessment of Antibiotic Resistance Testing Capacity (LAARC) tool. FINDINGS: Of the assessed facilities, none had full capacity to conduct AMR surveillance with varying capacities ranging from moderate (63% (5/8)) to low (38% (3/8)). Some of the barriers of AMR-LBS were the lack of an electronic laboratory information system (63% (5/8)) and the lack of locally generated antibiograms (75% (6/8)). Quality control for antimicrobial susceptibility testing (AST), pathogen identification and media preparation had the lowest overall score among all of the facilities with a score of 14%, 20% and 44%, respectively. The highest overall scores were in specimen processing (79%), data management (78%), specimen collection, transport and management (71%), and safety (70%). Most facilities had standard operating procedures in place but lacked specimen-specific standard operating procedures. CONCLUSION: The absence of laboratories with full capacity to conduct AMR surveillance hinders efforts to combat AMR and further complicates the treatment outcomes of infectious diseases. Establishing and strengthening LBS systems are essential in quantifying the burden of AMR and supporting the development of local antibiograms and treatment guidelines.

A logic framework for addressing medical racism in academic medicine: an analysis of qualitative data.

BACKGROUND: Despite decades of anti-racism and equity, diversity, and inclusion (EDI) interventions in academic medicine, medical racism continues to harm patients and healthcare providers. We sought to deeply explore experiences and beliefs about medical racism among academic clinicians to understand the drivers of persistent medical racism and to inform intervention design. METHODS: We interviewed academically-affiliated clinicians with any racial identity from the Departments of Family Medicine, Cardiac Sciences, Emergency Medicine, and Medicine to understand their experiences and perceptions of medical racism. We performed thematic content analysis of semi-structured interview data to understand the barriers and facilitators of ongoing medical racism. Based on participant narratives, we developed a logic framework that demonstrates the necessary steps in the process of addressing racism using if/then logic. This framework was then applied to all narratives and the barriers to addressing medical racism were aligned with each step in the logic framework. Proposed interventions, as suggested by participants or study team members and/or identified in the literature, were matched to these identified barriers to addressing racism. RESULTS: Participant narratives of their experiences of medical racism demonstrated multiple barriers to addressing racism, such as a perceived lack of empathy from white colleagues. Few potential facilitators to addressing racism were also identified, including shared language to understand racism. The logic framework suggested that addressing racism requires individuals to understand, recognize, name, and confront medical racism. CONCLUSIONS: Organizations can use this logic framework to understand their local context and select targeted anti-racism or EDI interventions. Theory-informed approaches to medical racism may be more effective than interventions that do not address local barriers or facilitators for persistent medical racism.

Commonly associated aerobic microbial pathogens and their antibiotic susceptibility profile in diabetic foot ulcers in tertiary care centre in Western Maharashtra.

PURPOSE: Diabetes mellitus (DM-II) is a metabolic disorder either due to reduced insulin production or reduced insulin sensitivity. Diabetic foot ulcer (DFU) is one of the most devastating complications of DM-II. This study was performed to assess commonly isolated micro-organisms and their anti-microbial sensitivity pattern in diabetic foot ulcers in a tertiary care centre in Western Maharashtra. METHODS: Adult patients with a known case of DM-II with foot lesions, suspected to be a Diabetic Foot Infections (DFIs) at the tertiary care hospital from Aug 2022 to Sept 2022 were included in the study. After obtaining informed written consent, pus sample was collected with sterile swab from lesion's base and submitted to Microbiology Laboratory for aerobic culture and sensitivity. RESULTS: Out of 56 enrolled patients, 47 (83.9%) patients tested positive for bacteriological growth and there was 'no growth' in 9 (16.07%) patients at the end of 48 h of aerobic incubation. There was male preponderance and patients were in age group of 35-85 years. The most commonly isolated micro-organisms were P. aeruginosa (17.8%), followed by S. aureus (14.2%), K. pneumonia and P. mirabilis (12.5% each). The resistance markers observed was ESBL producer, AmpC producer, MBL producer, Methicillin resistance and Inducible Clindamycin Resistance (ICR). CONCLUSION: Due to the injudicious use of antibiotics, antibiotic resistance has been increased in all types of soft tissue infections. The empirical formula for the treatment of DFIs should be decided for given geographical reasons according to antimicrobial susceptibility profile from particular geographical area or health care institute.

Role of GeneXpert MTB/RIF assay for the diagnosis of cervical lymph node tuberculosis and rifampicin resistance.

Objectives: Tuberculosis (TB) of lymph node (TB lymphadenitis) is one of the most common forms of extrapulmonary TB (EPTB) whose diagnosis is critically challenging. Although new diagnostic methods have been developed, especially in patients without a history of TB, the cervical tuberculous lymphadenitis diagnosis is still elusive. This study assessed the applicability of GeneXpert in early diagnosis of EPTB, especially cervical lymphadenopathy. Materials and Methods: The study was conducted in a tertiary care hospital from January 2018 to December 2020 at the department of microbiology. All the samples of cervical lymph node tissue and lymph node aspirate were followed as per the routine protocol for mycobacterial identification. The sample was divided into two parts: one was used for the new molecular-based GeneXpert MTB/RIF assay and the second one was tested by direct and concentrated acid-fast bacilli microscopy by Z-N staining and culture for the detection of MTB. Results: Among the 145 samples tested, the GeneXpert detected the DNA of MTB in 89 samples (61.37%), whereas the culture test was positive in 42 (28.93%) specimens. GeneXpert also detected 7 rifampicin resistance cases. GeneXpert sensitivity and specificity results were assessed according to culture results. The sensitivity and specificity of the GeneXpert assay were 85.71% and 48.54%, respectively. Conclusion: GeneXpert MTB/RIF should be used in conjunction with clinical presentation and other molecular investigation in nonrespiratory specimens.

Imaging Features of Craniofacial Giant Cell Granulomas: A Large Retrospective Analysis from a Tertiary Care Center.

BACKGROUND AND PURPOSE: Craniofacial giant cell granulomas are rare lesions with varied appearances on imaging. We aimed to describe the imaging features of giant cell granulomas of the craniofacial bones. MATERIALS AND METHODS: A retrospective analysis of the clinical features and imaging findings of 20 histopathology-proved cases of craniofacial giant cell granulomas, dating from 2006 to 2022, was performed. RESULTS: Of the 20 cases, 10 each were seen in men and women. The epicenter of the lesions varied in location: in the maxilla in 8 patients, in the mandible in 5, in the temporal bone in 3, in the sphenoid/clivus in 3, and in the orbit in 1 patient. On the radiographs, the lesions appeared well-circumscribed, expansile, and lytic. On CT, the lesions were predominantly multiloculated, with thin septa, a soft-tissue component, and with expansion and remodeling of the underlying bone. On MR imaging, the solid component of the lesions was isointense on T1WI and hypointense on T2WI, with heterogeneous enhancement of the solid component and rim enhancement of the locules. Fluid-fluid levels were present in 3 patients. CONCLUSIONS: Giant cell granulomas commonly present as locally aggressive, expansile, multiloculated lytic lesions, with solid as well as cystic areas. The solid component is typically hypointense on T2WI. Certain key imaging features of giant cell granulomas can aid the radiologist in narrowing the differential diagnosis.

Comparison of the Diagnostic Image Quality of the Canine Maxillary Dentoalveolar Structures Obtained by Cone Beam Computed Tomography and 64-Multidetector Row Computed Tomography.

The objective of this blinded study was to validate the use of cone beam computed tomography (C) for imaging of the canine maxillary dentoalveolar structures by comparing its diagnostic image quality with that of 64-multidetector row CT Sagittal slices of a tooth-bearing segment of the maxilla of a commercially purchased dog skull embedded in methylmethacrylate were obtained along a line parallel with the dental arch using a commercial histology diamond saw. The slice of tooth-bearing bone that best depicted the dentoalveolar structures was chosen and photographed. The maxillary segment was imaged with cone beam CT and 64-multidetector row CT. Four blinded evaluators compared the cone beam CT and 64-multidetector row CT images and image quality was scored as it related to the anatomy of dentoalveolar structures. Trabecular bone, enamel, dentin, pulp cavity, periodontal ligament space, and lamina dura were scored In addition, a score depicting the evaluators overall impression of the image was recorded. Images acquired with cone beam CT were found to be significantly superior in image quality to images acquired with 64-multidetector row CT overall, and in all scored categories. In our study setting cone beam CT was found to be a valid and clinically superior imaging modality for the canine maxillary dentoalveolar structures when compared to 64-multidetector row CT.

Review of the regulation of veterinary drugs and residues in South Africa.

The food safety risk analysis framework of the FAO/WHO is used in the review of veterinary drug and residue regulation in South Africa to determine possible inefficiencies within this system. Results indicate that a variety of challenges relating to the processes of risk assessment, management, and communication do exist, although these occur within a fragmented system of legislation, functions, and structures. Addressing these challenges therefore requires a change to a more collaborative and integrated system. It is indicated that for such a change, the underlying challenges of inadequate horizontal communication, poor conceptualization, and awareness of functions of the system are required to be dealt with.

Evaluation and selection of indicators for land degradation and desertification monitoring: methodological approach.

An approach to derive relationships for defining land degradation and desertification risk and developing appropriate tools for assessing the effectiveness of the various land management practices using indicators is presented in the present paper. In order to investigate which indicators are most effective in assessing the level of desertification risk, a total of 70 candidate indicators was selected providing information for the biophysical environment, socio-economic conditions, and land management characteristics. The indicators were defined in 1,672 field sites located in 17 study areas in the Mediterranean region, Eastern Europe, Latin America, Africa, and Asia. Based on an existing geo-referenced database, classes were designated for each indicator and a sensitivity score to desertification was assigned to each class based on existing research. The obtained data were analyzed for the various processes of land degradation at farm level. The derived methodology was assessed using independent indicators, such as the measured soil erosion rate, and the organic matter content of the soil. Based on regression analyses, the collected indicator set can be reduced to a number of effective indicators ranging from 8 to 17 in the various processes of land degradation. Among the most important indicators identified as affecting land degradation and desertification risk were rain seasonality, slope gradient, plant cover, rate of land abandonment, land-use intensity, and the level of policy implementation.

Evaluation and selection of indicators for land degradation and desertification monitoring: types of degradation, causes, and implications for management.

Indicator-based approaches are often used to monitor land degradation and desertification from the global to the very local scale. However, there is still little agreement on which indicators may best reflect both status and trends of these phenomena. In this study, various processes of land degradation and desertification have been analyzed in 17 study sites around the world using a wide set of biophysical and socioeconomic indicators. The database described earlier in this issue by Kosmas and others (Environ Manage, 2013) for defining desertification risk was further analyzed to define the most important indicators related to the following degradation processes: water erosion in various land uses, tillage erosion, soil salinization, water stress, forest fires, and overgrazing. A correlation analysis was applied to the selected indicators in order to identify the most important variables contributing to each land degradation process. The analysis indicates that the most important indicators are: (i) rain seasonality affecting water erosion, water stress, and forest fires, (ii) slope gradient affecting water erosion, tillage erosion and water stress, and (iii) water scarcity soil salinization, water stress, and forest fires. Implementation of existing regulations or policies concerned with resources development and environmental sustainability was identified as the most important indicator of land protection.

Primary splenic tubercular abscess in an immunocompromised patient-rapid diagnosis by line probe assay.

Diagnosing extra-pulmonary tuberculosis is a challenge that can confound even the most practiced clinicians as clinical manifestations are vague, non-specific and typical chest radiograph findings may not be evident till late in the disease. Conventional methods for mycobacteriological culture and drug susceptibility testing are slow and cumbersome. Novel technologies for rapid detection of Mycobacterium tuberculosis and its anti-TB drug resistance have therefore become a priority hence with the development of molecular line probe assays are most advanced. Herewith we are reporting a case of splenic tuberculosis in an immunocompromised patient for its rarity and to emphasis the fact that such patients can be diagnosed early for better treatment outcome to enhance the longevity if a health setup possesses all the modern diagnostic services.

An automated approach to network features of protein structure ensembles.

Network theory applied to protein structures provides insights into numerous problems of biological relevance. The explosion in structural data available from PDB and simulations establishes a need to introduce a standalone-efficient program that assembles network concepts/parameters under one hood in an automated manner. Herein, we discuss the development/application of an exhaustive, user-friendly, standalone program package named PSN-Ensemble, which can handle structural ensembles generated through molecular dynamics (MD) simulation/NMR studies or from multiple X-ray structures. The novelty in network construction lies in the explicit consideration of side-chain interactions among amino acids. The program evaluates network parameters dealing with topological organization and long-range allosteric communication. The introduction of a flexible weighing scheme in terms of residue pairwise cross-correlation/interaction energy in PSN-Ensemble brings in dynamical/chemical knowledge into the network representation. Also, the results are mapped on a graphical display of the structure, allowing an easy access of network analysis to a general biological community. The potential of PSN-Ensemble toward examining structural ensemble is exemplified using MD trajectories of an ubiquitin-conjugating enzyme (UbcH5b). Furthermore, insights derived from network parameters evaluated using PSN-Ensemble for single-static structures of active/inactive states of ß2-adrenergic receptor and the ternary tRNA complexes of tyrosyl tRNA synthetases (from organisms across kingdoms) are discussed. PSN-Ensemble is freely available from http://vishgraph.mbu.iisc.ernet.in/PSN-Ensemble/psn_index.html.

Quality of life among people with epilepsy: a cross-sectional study from rural southern India.

BACKGROUND: Epilepsy can be associated with profound physical, social and psychological consequences and it has an impact on a person's quality of life. We assessed the quality of life and factors associated with a poor quality of life, among adults with epilepsy in a rural block of Tamil Nadu. METHODS: We interviewed 91 epilepsy patients from 20 randomly selected villages using a structured questionnaire including World Health Organization Quality of Life BREF (WHOQOL-BREF), Patient Health Questionnaire 2 (PHQ-2) and Generalized Anxiety Disorder 7 (GAD-7) questionnaires. RESULTS: The mean (SD) total score of the quality of life scale was 61.49 (12.56). Those who were single, separated or widowed (t statistic= -2.71, p<0.01), had not completed primary education (t statistic=-2.308, p<0.05), not currently going for work (t statistic=-2.748, p<0.01), had seizure in the past one year (t statistic=-4.068, p<0.01),had depressive symptoms (t statistic=-3.207, p<0.01),had higher anxiety scores (t statistic=-2.727, p<0.01), had low scores in the quality of life questionnaire. Multivariate analysis showed increasing age, education less than grade V, being unmarried, widowed or separated, lower per capita income, a high anxiety score and experiencing a seizure episode in the past one year to be significantly associated with a low score in the WHOQOL-BREF questionnaire (adjusted R²=0.378, SE 9.90). CONCLUSION: The presence of anxiety, lack of primary education, being single, separated or widowed, increasing age, low per capita income and having a seizure episode in the past year are associated with lower quality of life among people with epilepsy.

Number, maturity and phagocytic activity of neutrophils in the three trimesters of pregnancy.

Specific immunity decreases markedly in pregnancy. This study was designed to determine whether the non-specific immunity mediated by neutrophils plays any role in coping with this immunosuppressed condition. The number of leukocytes and neutrophils, especially the number of young band neutrophils, increased gradually with the advancement of pregnancy. The phagocytic activity of neutrophils increased in the 2nd and 3rd trimesters. Neutrophils may compensate in part for the weakened specific immunity of pregnant women.

Number, maturity and phagocytic activity of neutrophils in the three trimesters of pregnancy

Specific immunity decreases markedly in pregnancy. This study was designed to determine whether the non-specific immunity mediated by neutrophils plays any role in coping with this immunosuppressed condition. The number of leukocytes and neutrophils, especially the number of young band neutrophils, increased gradually with the advancement of pregnancy. The phagocytic activity of neutrophils increased in the 2nd and 3rd trimesters. Neutrophils may compensate in part for the weakened specific immunity of pregnant womena

In vivo glucose measurement by surface-enhanced Raman spectroscopy.

This paper presents the first in vivo application of surface-enhanced Raman scattering (SERS). SERS was used to obtain quantitative in vivo glucose measurements from an animal model. Silver film over nanosphere surfaces were functionalized with a two-component self-assembled monolayer, and subcutaneously implanted in a Sprague-Dawley rat such that the glucose concentration of the interstitial fluid could be measured by spectroscopically addressing the sensor through an optical window. The sensor had relatively low error (RMSEC = 7.46 mg/dL (0.41 mM) and RMSEP = 53.42 mg/dL (2.97 mM).

Surface enhanced Raman spectroscopy: new materials, concepts, characterization tools, and applications.

Surface-enhanced Raman spectroscopy (SERS) is currently experiencing a renaissance in its development driven by the remarkable discovery of single molecule SERS (SMSERS) and the explosion of interest in nanophotonics and plasmonics. Because excitation of the localized surface plasmon resonance (LSPR) of a nanostructured surface or nanoparticle lies at the heart of SERS, it is important to control all of the factors influencing the LSPR in order to maximize signal strength and ensure reproducibility. These factors include material, size, shape, interparticle spacing, and dielectric environment. All of these factors must be carefully controlled to ensure that the incident laser light maximally excites the LSPR in a reproducible manner. This article describes the use of nanosphere lithography for the fabrication of highly reproducible and robust SERS substrates for both fundamental studies and applications. Atomic layer deposition (ALD) is introduced as a novel fabrication method for dielectric spacers to study the SERS distance dependence and control the nanoscale dielectric environment. Wavelength scanned SER excitation spectroscopy (WS SERES) measurements show that enhancement factors approximately 10(8) are obtainable from NSL-fabricated surfaces and provide new insight into the electromagneticfield enhancement mechanism. Tip-enhanced Raman spectroscopy (TERS) is an extremely promising new development to improve the generality and information content of SERS. A 2D correlation analysis is applied to SMSERS data. Finally, the first in vivo SERS glucose sensing study is presented.

Postage stamps as a health promotion tool in the Nepalese community.

Over the last 15 years the government of Nepal has issued postage stamps as a way of raising awareness of health issues in the general population and especially in remote communities. The topics covered by 8 different stamps are good child health care practices, combating drug abuse, hazards of smoking, prevention of AIDS, prevention of blindness due to cataract, fighting cancer and rehabilitation of disabled people.

Postage stamps as a health promotion tool in the Nepalese community

Over the last 15 years the government of Nepal has issued postage stamps as a way of raising awareness of health issues in the general population and especially in remote communities. The topics covered by 8 different stamps are good child health care practices, combating drug abuse, hazards of smoking, prevention of AIDS, prevention of blindness due to cataract, fighting cancer and rehabilitation of disabled people

Climate- and human-induced woody vegetation changes in Botswana and their implications for human adaptation.

For purposes of suggesting adaptive and policy options regarding the sustained use of forestry resources in Botswana, an analysis of the whole countrywide satellite data (showing the mean present distribution of vegetation in terms of species abundance and over all density) and the projection of vegetation cover changes using a simulation approach under different climatic scenarios were undertaken. The analysis revealed that changes in vegetation cover types due to human and natural causes have taken place since the first vegetation map was produced in 1971. In the southwest, the changes appear to be more towards an increasing prevalence of thorn trees; in the eastern part of the country where widespread bush encroachment is taking place, the higher population density suggests more human induced (agrarian-degradation) effects, while in the sparsely settled central Kalahari region, changes from tree savanna to shrubs may be indicative of the possible influence of climate with the associated effects of fires and local adaptations. Projection of future vegetation changes to about 2050 indicates degeneration of the major vegetation types due to the expected drying. Based on the projected changes in vegetation, current adaptive and policy arrangements are not adequate and as such a shift from the traditional adaptive approaches to community-based types is suggested. Defining forestry management units and adopting different management plans for the main vegetation stands that are found in Botswana are the major policy options.