Bacterial diversity and functional profile of microbial populations on surfaces in public hospital environments in South Africa: A high throughput metagenomic analysis.

With the introduction of the One Health approach to global health advocated by the World Health Organization, the role of the environment as a reservoir and transmission route for diverse microorganisms is increasingly being recognised globally. This study investigated the diversity and functional profiles of bacterial communities using high-throughput metagenomics of the 16S rRNA gene in samples collected from environmental surfaces in different levels of healthcare in South Africa. A total of 150 samples were collected in three public hospitals [District (A), Regional (C) and Central (B)] from intensive care and paediatric wards. Military hospitals were excluded. Swabs were taken from mattresses, drip stands, ward telephones, patient files and sinks. A total of 7,996,346 reads were found, of which 7,319,569 were quality-filtered reads. Unique (and shared) microbial community structures were identified within the different hospital levels, locations and sample source. A total of 11 phyla, 29 classes, 50 orders, 105 families, 190 genera and 288 known species were identified. The primary phyla identified were Proteobacteria, Firmicutes and Actinobacteria. The dominant class identified was Gamma-proteobacteria, followed by Bacilli and Actinobacteria. Acinetobacter (16.08%), Citrobacter (13.64%), Staphylococcus (9.65%) and Corynebacterium (6.15%) were predominant genera. Although the functional profile analysis identified citrate cycle (TCA), signal transduction mechanisms, bisphenol degradation, tyrosine metabolism and transcription-factors as the dominant pathways, human disease functional classes, including involvement in antibiotic resistance, were significantly identified. The drip stands, patient files and ward telephones in all the wards of Hospitals A and C contained a higher number of human diseases functional classes. These findings highlight the potential of different hospital environments to serve as reservoirs and possible sources of bacterial pathogens; thus, the need for better monitoring and hygienic practices within the hospital environment.

Apendicite aguda: estudo da escala de alvarado e suas correlações em hospital universitário / Acute apendicitis: alvarado scale study and correlations in teaching hospital

A apendicite aguda exige um diagnóstico precoce e preciso. Alvarado desenvolveu escala clínico- -laboratorial para auxiliar o diagnóstico. O objetivo deste estudo foi avaliar as correlações entre Escore de Alvarado e a história clínica em pacientes com diagnóstico presuntivo de apendicite aguda e submetidos a apendicectomia em Hospital Universitário. Foram avaliados prospectivamente 82 pacientes no período compreendido entre maio e agosto de 2016. A partir de protocolo de coleta realizou-se análise descritiva da prevalência segundo: idade, gênero, Escore de Alvarado, período de evolução, período de internamento hospitalar, sinais e sintomas, leucocitose e grau de inflamação apendicular. Os participantes foram divididos em grupos de acordo com o escore obtido: 0 a 4 (baixo), 5 a 6 (médio) e 7 a 10 (alto). O Escore de Alvarado médio foi 4,9 pontos com predomínio da faixa 0 a 4 (50%). O grau I de inflamação foi o mais frequente (45,6%), seguido pelo grau II (34,2%), grau III (11,4%) e grau IV (8,9%). A apendicite aguda complicada foi observada em 16 (20,3%) casos, enquanto a não complicada em 63 (79,7%). Demonstrou-se significância estatística entre Escore de Alvarado e as variáveis: período de internamento (p=0,02), grau de inflamação apendicular (p=0,08) e complicação apendicular (p=0,04), parâmetros fundamentais na clínica da afecção apendicular.

Acute appendicitis requires an early and accurate diagnosis. Alvarado developed a clinical-laboratory scale to aid diagnosis. The objective of this study was to evaluate the correlations between Alvarado score and clinical history in patients with a presumptive diagnosis of acute appendicitis and submitted to appendectomy at a teaching hospital. A total of 82 patients were prospectively evaluated in the period between May and August 2016. From the collection protocol, a descriptive analysis of the prevalence according to: age, gender, Alvarado score, evolution period, hospitalization period, signs and symptoms , leukocytosis and degree of appendix inflammation. Participants were divided into groups according to the obtained score: 0 to 4 (low), 5 to 6 (medium) and 7 to 10 (high). The average Alvarado score was 4.9 points with a predominance of the range 0 to 4 (50%). Grade I inflammation was the most frequent (45.6%), followed by grade II (34.2%), grade III (11.4%) and grade IV (8.9%). Complicated Acute Appendicitis was observed in 16 cases (20.3%), while uncomplicated in 63 cases (79.7%). Statistical significance was found between Alvarado's score and the variables: period of hospitalization (p = 0.02), degree of appendicular inflammation (p = 0.08), and appendiceal complication (p = 0.04) of the appendicular affection

Lived experiences of HIV community workers participating in a community empowerment programme.

BACKGROUND: Both non-governmental organisations and governmental organisations are very involved in the development and implementation of community empowerment programmes (CEPs). Because of various health issues within the community, 10 CEPs were launched in Ladysmith with a focus on addressing the particular needs of HIV-affected and -infected members. Of the 10 programmes, however, only four were deemed sustainable after five years. OBJECTIVES: The researcher explored the lived experiences of HIV community workers participating in two CEPs in Ladysmith, KwaZulu-Natal in order to develop recommendations for CEPs. METHOD: Data were explored using a qualitative hermeneutic phenomenological approach. Ten participants who had been involved in HIV CEPs for more than six months were identified and individual interviews were held. RESULTS: Three themes emerged, namely, giving of yourself, maintaining sustainability and assisting the CEPs and community workers. Each of these themes also contained a number of subthemes. Exploring the lived experience of the community workers revealed that there are a number of ways in which to promote the sustainability of CEPs. CONCLUSION: The community should be involved in all aspects of the CEP and community workers must respect the community and their knowledge, experience and value systems.