Labour Care Guide implementation as a decision-making tool for monitoring labour among healthcare providers in Uganda: protocol for a mixed-methods study.

INTRODUCTION: The new WHO Labour Care Guide (LCG), also regarded as the 'next-generation partograph', is a core component of 2018 WHO consolidated guidelines on intrapartum care for positive childbirth experience. The Ugandan Ministry of Health is in the process of adopting the new WHO LCG with no local context-specific data to inform this transition. We will explore potential barriers and facilitators to healthcare providers' (HCPs) sustained engagement in labour monitoring in Mbarara city, Southwestern Uganda, and use the data to refine the new WHO LCG and develop a suitable implementation strategy to effectively integrate LCG into routine maternity care in Uganda. We shall then assess effectiveness, validity and other preliminary implementation outcomes of using the new LCG in detecting prolonged labour. METHODS AND ANALYSIS: The study will use a mixed-methods approach to identify key LCG user perspectives to refine and customise the WHO LCG among 120 HCPs and stakeholders involved in maternity care and labour monitoring within facilities in Southwestern Uganda. The refined prototype will be deployed and used to monitor labour in all 14 basic and comprehensive emergency obstetric and newborn care facilities in the study area. We will review labour outcomes of 520 patients monitored using the new LCG and compare these outcomes with a historical cohort of 520 patients monitored using the partograph. The main effectiveness outcome will be the proportion of women diagnosed with prolonged labour and/or obstructed labour. ETHICS AND DISSEMINATION: Ethical approval was obtained from the Mbarara University of Science and Technology Research Ethics Committee (MUST-2023-808) and Uganda National Council for Science and Technology (HS2864ES). We shall obtain written informed consent from each participant. The results of this study will be published in international peer-reviewed journals and presented to the Ugandan Ministry of Health as policy briefs and at selected national/international conferences. TRIAL REGISTRATION NUMBER: NCT05979194.

Fluctuations of the population of Daphnia laevis Birge 1878: a six-year study in a tropical lake.

The fluctuation of the population of Daphnia laevis in Lake Jacaré (Middle River Doce, Minas Gerais) was monitored monthly (at one point in the limnetic region) for six years (2002-2007) as part of the Program of Long-Term Ecological Research (LTER/UFMG). The following parameters were also monitored: water temperature, pH, electrical conductivity, dissolved oxygen, chlorophyll a, total phosphorus, phosphate, total nitrogen, nitrate, nitrite, ammonia, and densities of Chaoborus and ephippia of Daphnia laevis in the sediment. A seasonal pattern was observed in the fluctuation of D. laevis, with higher densities recorded during periods of circulation (May-August). A significant correlation was found between the density of D. laevis and temperature (r = -0.47, p = 0.0001), chlorophyll-a (r = -0.32, p = 0.016) and indicators of the lake's trophic status (total phosphorus, r = 0.32, p = 0.007 and trophic state, r = 0.36, p = 0.003), as well as Chaoborus density (r = 0.43 and p = 0.002). These results indicate that changes in the physical and chemical characteristics of the water related with stratification and circulation of the lake may have a direct (temperature, total phosphorous) or an indirect (food availability, presence of predators, ephippia eclosion) influence on the fluctuation of the D. laevis population.

Fluctuations of the population of Daphnia laevis Birge 1878: a six-year study in a tropical lake / Flutuações da população de Daphnia laevis Birge 1878: seis anos de estudo em um lago tropical

The fluctuation of the population of Daphnia laevis in Lake Jacaré (Middle River Doce, Minas Gerais) was monitored monthly (at one point in the limnetic region) for six years (2002-2007) as part of the Program of Long-Term Ecological Research (LTER/UFMG). The following parameters were also monitored: water temperature, pH, electrical conductivity, dissolved oxygen, chlorophyll a, total phosphorus, phosphate, total nitrogen, nitrate, nitrite, ammonia, and densities of Chaoborus and ephippia of Daphnia laevis in the sediment. A seasonal pattern was observed in the fluctuation of D. laevis, with higher densities recorded during periods of circulation (May-August). A significant correlation was found between the density of D. laevis and temperature (r = -0.47, p = 0.0001), chlorophyll-a (r = -0.32, p = 0.016) and indicators of the lake's trophic status (total phosphorus, r = 0.32, p = 0.007 and trophic state, r = 0.36, p = 0.003), as well as Chaoborus density (r = 0.43 and p = 0.002). These results indicate that changes in the physical and chemical characteristics of the water related with stratification and circulation of the lake may have a direct (temperature, total phosphorous) or an indirect (food availability, presence of predators, ephippia eclosion) influence on the fluctuation of the D. laevis population.

A flutuação da população de Daphnia laevis na Lagoa Jacaré (Médio Rio Doce, Minas Gerais) foi monitorada mensalmente, em um ponto na região limnética, por seis anos (2002 a 2007), como parte do Programa de Pesquisas Ecológicas de Longa Duração (PELD/UFMG). Os seguintes parâmetros foram monitorados: temperatura da água, pH, condutividade elétrica, oxigênio dissolvido, clorofila-a , fósforo total, fosfato, nitrogênio total, nitrato, nitrito, amônia e densidades de Chaoborus e de efípios de Daphnia laevis no sedimento. Um padrão sazonal foi observado na flutuação de D. laevis, com maiores densidades registradas durante períodos de circulação (maio a agosto). Correlações significativas foram observadas entre a densidade de D. laevis e a temperatura (r = -0.47, p = 0.0001) e a clorofila-a (r = -0.32, p = 0.016), e indicadores do estado trófico do lago (fósforo total, r = 0.32, p = 0.007 e estado trófico, r = 0.36, p = 0.003), além de densidade de Chaoborus (r = 0.43, p = 0.002). Esses resultados indicam que mudanças nas características físicas e químicas da água relacionadas com os periodos de estratificação e circulação do lago podem influenciar diretamente (temperatura, fósforo total) ou indiretamente (disponibilidade de alimento, presença de predadores, eclosão de efípios) a flutuação da população de D. laevis.

Serial measurement of serum cytokines, cytokine receptors and neopterin in leprosy patients with reversal reactions.

Serum levels of cytokines (IL-4, IL-5, IFN-gamma, TNF-alpha), cytokine receptors (TNFR I and II) and one monokine (neopterin) were estimated in seven leprosy patients to establish disease associated markers for reversal reactions (RR). Sera were collected at diagnosis of leprosy, at the onset of reversal reaction and at different time points during and at the end of prednisone treatment of reactions. It was expected that the serum cytokine and monokine profile before and at different time points during reactions would provide guidelines for the diagnosis and monitoring of reversal reactions in leprosy. The cytokines and cytokine receptors were measured by ELISA, whereas a radioimmunoassay was used for neopterin measurement. Six of the seven patients showed increased levels of neopterin either at the onset of RR or 1 month thereafter, and levels declined on prednisone treatment to that seen at the time of diagnosis without reactions. No consistent disease associated cytokine profile was observed in these patients. Interestingly, serum TNF-alpha levels were increased in the same patients even after completion of prednisone treatment, indicating ongoing immune activity. In conclusion, this study demonstrates that despite cytokines levels in leprosy serum being inconsistent in relation to reversal reactions, serum neopterin measurement appears to be an useful biomarker in monitoring RR patients during corticosteroid therapy.

Prospective study of serological conversion as a risk factor for development of leprosy among household contacts.

Although the prevalence of leprosy has declined over the years, there is no evidence that incidence rates are falling. A method of early detection of those people prone to develop the most infectious form of leprosy would contribute to breaking the chain of transmission. Prophylactic treatment of serologically identified high-risk contacts of incident patients should be an operationally feasible approach for routine control programs. In addition, classification of high-risk household contacts will allow control program resources to be more focused. In this prospective study, we examined the ability of serology used for the detection of antibodies to phenolic glycolipid I of Mycobacterium leprae to identify those household contacts of multibacillary leprosy patients who had the highest risk of developing leprosy. After the start of multidrug therapy for the index case, a new case of leprosy developed in one in seven of the 178 households studied. In households where new cases appeared, the seropositivity rates were significantly higher (P < 0.001) than those in households without new cases. Seropositive household contacts had a significantly higher risk of developing leprosy (relative hazard adjusted for age and sex [aRH], 7.2), notably multibacillary leprosy (aRH = 24), than seronegative contacts.

Prospective study of serological conversion as a risk factor for development of leprosy among household contacts

Although the prevalence of leprosy has decline over the years, there is no evidence that incidence rates are falling. A method of early detection of those people prone to develop the mosth infectious form of leprosy would contribute to breaking the chain of transmission. Prophylactic treatment of serologically idenfified high-risk contacts of incidend patients should be an operationally feasible approach for routine control programs. In addition, classification of high-risk household contacts will allow control program resources to be more focused. Is this prospective study, we examined the ability of serology used for the detection of antibodies to phenolic glycolipid I of Mycobacterium leprae to identify those household contacts of multibacillary leprosy patients who had the highest risk of developing leprosy. After the start of multidrug therapy for the index case, a new case of leprosy developed in one in seven of the 178 households studied. In households where new cases appeared, the seropositivity rates were significantly higher (P<0.001) than those in households without new cases. Seropositive household contacts had a significantly higher risk of developing leprosy (relative hazard adjusted for age and sex [aRH], 7.2), notably multibacillary leprosy (aRH=24), than seronegative contacts

Malignant T-cell lymphoma mimicking lepromatous leprosy.

We describe a 16-year-old Filipino boy who presented with skin lesions highly suggestive of lepromatous leprosy, but further assessment established a diagnosis of malignant T-cell lymphoma. This case emphasizes the extensive differential diagnosis of leprosy, as well as the importance of obtaining skin biopsies for diagnostic confirmation.

Detection of phenolic glycolipid I of Mycobacterium leprae in sera from leprosy patients before and after start of multidrug therapy.

A total of 100 untreated new leprosy patients were recruited prospectively and examined for the presence of phenolic glycolipid I (PGL-I) antigen in their serum specimens by dot enzyme-linked immunosorbent assay (ELISA) using rabbit anti-PGL-I antiserum. The presence of circulating PGL-I antigen was closely related to the bacterial indices (BI) of the patients. The PGL-I antigen was detectable in 27 (93.1%) of 29 patients with a BI of 4.0 or above and in 15 (68.2%) of 22 patients with a BI of 3.0 to 3.9. However, none of the 37 patients with a BI of less than 1.9 had detectable PGL-I antigen by the methods used in this study. The level of PGL-I in serum declined rapidly by about 90% 1 month after the start of multidrug therapy. This study showed clearly that anti-PGL-I IgM antibodies and circulating PGL-I antigen levels reflect the bacterial loads in untreated leprosy patients. The serological parameters based on the PGL-I antigen may therefore be useful in the assessment of leprosy patients at the time of diagnosis and possibly in monitoring patients following chemotherapy.

Improvement in psoriasis after intradermal administration of heat-killed Mycobacterium vaccae.

BACKGROUND: New treatments for psoriasis are being developed, but many are associated with limited efficacy, side-effects, or rapid recurrence after discontinuation. Thus, the aim of new agents is to induce longer term remissions with fewer side-effects. Preliminary studies have shown that Mycobacterium vaccae, a nonpathogenic organism prepared as a heat-killed suspension, may induce periods of remission in some psoriasis patients when administered intradermally. METHODS: To further assess the efficacy and tolerability of M. vaccae in patients with moderate to severe psoriasis (psoriasis area and severity index (PASI) of 12-35), we conducted an open label study whereby 24 patients received two intradermal inoculations of M. vaccae in lesion-free deltoid skin, separated by a period of 3 weeks. RESULTS: Twelve weeks after starting treatment, 14 of 24 patients (58%) showed marked improvement in the PASI score (greater than 50% reduction), two had moderate improvement (25-50% reduction), six were unchanged (< 25% reduction), and two had worsened (> 5% increase). By 24 weeks, 11 of 22 patients continued to show greater than 50% improvement. Five patients had complete clearance of skin lesions that lasted for at least 6 months. CONCLUSIONS: Intradermal administration of heat-killed M. vaccae suspension was well tolerated and induced clinically significant improvement in a majority of psoriasis patients in this cohort. Placebo-controlled testing to further define the efficacy of this treatment is warranted.

Cutaneous delayed-type hypersensitivity responsiveness in lepromatous and borderline lepromatous leprosy patients as determined by MULTITEST CMI.

To assess cell mediated immune (CMI) function in patients with lepromatous and borderline lepromatous leprosy (LL and BL), 35 patients were examined with the MULTITEST CMI system to evaluate cutaneous delayed-type hypersensitivity (DTH) responsiveness to 7 recall antigens. Reactions were assessed quantitatively and qualitatively. In addition, patients were classified as "responsive" (> or = 2 positive reactions), "hypo-responsive" (1 positive reaction), or anergic. Only hyporesponsive and anergic patients were re-tested. In 23 patients tested before treatment started (Group 1), 9 were responsive, 4 hypo-responsive, and 10 anergic. Upon re-testing, 10 of the 14 hyporesponsive-anergic subjects showed improvement. In 12 patients assessed after therapy initiation (Group 2), 9 were responsive and 3 others became responsive upon re-testing. Quantitative assessment indicated variable deficiencies in cutaneous DTH reactivity that, in many cases, improved with therapy. Correlations between reactivity and disease severity (LL versus BL) or duration of disease were not observed. The MULTITEST CMI system provided a convenient, safe, and reproducible method to assess cutaneous DTH responsiveness in LL and BL patients. Our findings indicated that most LL and BL patients are able to generate detectable but generally fewer and less robust cutaneous DTH responses to recall antigens, many improving with therapy. However, a semi-quantitative classification whereby patients that reacted to 2 or more antigens were considered "responsive" showed little difference between patients and controls. Overall, the data support the contention that deficits in cutaneous DTH responsiveness probably neither predispose nor necessarily accompany lepromatous disease, a practical consideration as efforts to develop a leprosy vaccine continue.

Avances en el estudio de la toxicidad específica de la vacuna pertussis elaborada por el INH "RR" / Advances in the study of specific toxicity of the pertussis vaccine elaborated by the INH \"RR\"

La vacuna Pertussis, normalmente administrada bajo la forma de vacuna triple o DPT (Difteria, Tétanos y Pertussis), es conocida como una de las vacunas más reactogénicas, causante de la mayoría de las reacciones secundarias presentadas después de la administración de la vacuna triple. Su aprobación es una relación de compromiso entre su toxicidad y un nivel de potencia adecuado para garantizar su capacidad inmunogénica con el menor grado posible de reacciones secundarias. A nivel de control de calidad, para determinar la toxicidad específica de la vacuna pertussis tradicionalmente se ha empleado la prueba de ganancia de peso en el ratón, sin embargo, la variable biológica involucrada, así como todos los factores que pueden incidir sobre la respuesta del animal pueden conllevar a la obtención de resultados contradictorios. Por otra parte, considerando la diversidad de agentes potencialmente tóxicos que posee esta vacuna, es primordial la aplicación de diversas metodologías que permitan la amplia evaluación de su toxicidad específica. Razón por la cual se diseñó este Trabajo de Investigación, con miras a estudiar por una parte la toxicidad específica de la vacuna pertussis elaborada por el Instituto Nacional de Higiene Rafael Rangel INH "RR", tanto en su forma individual como integrando la vacuna triple, (Difteria, Pertussis y Tétanos) y por la otra, evaluar conjuntamente estos resultados con los obtenidos en la prueba de ganancia de peso, con el objeto de realizar una mejor evaluación de la toxicidad específica y así permitir tomar una decisión de aprobación o rechazo sobre bases más sólidas y seguras

Multiple lesions of sporotrichoid leishmaniasis in a Filipino expatriate.

Sporotrichoid cutaneous leishmaniasis (CL) was diagnosed in a Filipino man who had worked in Saudi Arabia for 2 years. Two primary lesions-one on the forearm and one on the abdomen-were characterized by "satellite" papules and subcutaneous nodules extending proximally in a sporotrichoid pattern. Leishmania organisms were found in both primary lesions and a subcutaneous nodule. There was no evidence of systemic involvement. Recognition that Old World CL may disseminate through lymphatic channels has diagnostic and therapeutic importance.

Recombinant interleukin-2 in lepromatous leprosy lesions: immunological and microbiological consequences.

Seven patients with lepromatous leprosy (LL) were inoculated with recombinant interleukin-2 (rIL-2) at 5 lesional sites on the back, four sites receiving one dose of 10 micrograms and biopsy specimens being obtained on 4 consecutive days after the injection. At the 5th site, rIL-2 was instead administered over several days, three patients receiving a total dose of 40 micrograms and 4 patients 150 micrograms, while biopsy specimens from this site were obtained 7, 14 and 21 days after the first injection. Most injection sites developed features of a delayed-type hypersensitivity reaction, namely erythema and induration at the injection site, infiltrates rich in T helper cells, monocytes, and Langerhans cells, and at sites receiving higher doses, multinucleated Langhans giant cells and epithelioid granulomas. In some patients, there were favourable shifts in histological classification or small changes in bacterial load. Low doses of rIL-2 injected into LL lesions rapidly enhance cellular immunity and may alter the histological classification or bacterial load at the injection site.