Institutional Responses to Drought in a High HIV Prevalence Setting in Rural South Africa.

In 2015, South Africa experienced one of the worst (El Niño-induced) droughts in 35 years. This affected economic activities, individual and community livelihoods and wellbeing especially in rural communities in northern KwaZulu-Natal. Drought's direct and indirect impacts on public health require urgent institutional responses, especially in South Africa's stride to eliminate HIV as a public health threat by 2030 in line with the UNAIDS goals. This paper draws on qualitative data from interviews and policy documents to discuss how the devastating effect of the 2015 drought experience in the rural Hlabisa sub-district of uMkhanyakude, a high HIV prevalence area, imposes an imperative for more proactive institutional responses to drought and other climate-related events capable of derailing progress made in South Africa's HIV/AIDS response. We found that drought had a negative impact on individual and community livelihoods and made it more difficult for people living with HIV to consistently engage with care due to economic losses from deaths of livestock, crop failure, food insecurity, time spent in search of appropriate water sources and forced relocations. It also affected government institutions and their interventions. Interviewed participants' reflections on drought-related challenges, especially those related to institutional and coordination challenges, showed that although current policy frameworks are robust, their implementation has been stalled due to complex reporting systems, and inadequate interdepartmental collaboration and information sharing. We thus argue that to address the gaps in the institutional responses, there is a need for more inclusive systems of drought-relief implementation, in which government departments, especially at the provincial and district levels, work with national institutions to better share data/information about drought-risks in order to improve preparedness and implementation of effective mitigation measures.

Age of consent: A case for harmonizing laws and policies to advance, promote and protect adolescents' sexual and reproductive health rights.

The article assesses the legal and policy frameworks that have an impact on adolescents' sexual and reproductive health rights (ASRHR) in East and Southern Africa (ESA), confirming the interconnectedness of the ages of consent to sexual activity, marriage, and services and its influence on adolescents' human rights. It reviews international, continental and national legal instruments used to identify relevant provisions on ASRHR in the ESA region. The region demonstrates substantial disparities between realities of sexual debut among adolescents, national (statutory and customary) laws and policies on ages of consent to sex, marriage and medical services, and international standards around these SRHR issues. These disparities constitute negative consequences: criminalising adolescents, entrenching child marriage, and excluding adolescents from accessing medical services required to secure and promote ASRHR. While some ESA countries lack clear laws and policies on the three issues, cases of internal contradictions and disharmony with international standards abound. This impacts on the full realization of sexual and reproductive health rights of adolescents and young people in the region.

Small bowel obstruction complicating an Ascaris lumbricoides infestation in a 4-year-old male: a case report.

BACKGROUND: Ascariasis is the leading helminthic infection worldwide, with its peak prevalence noted in children aged 2-10 years. Although mainly asymptomatic, chronic and heavy infestation could lead to severe complications such as malnutrition, poor physical and cognitive development, as well as intestinal obstruction. We report the case of a 4-year-old boy with intestinal obstruction due to Ascaris lumbricoides infestation and discuss its public health significance. CASE PRESENTATION: A 4-year-old Black African boy from the Menchum Division in the Northwest Region of Cameroon, with no history of deworming since birth, presented with a 3-day history of generalized abdominal pains, vomiting and obstipation, and abdominal distention evolving over a period of 6 months. Clinical and paraclinical findings were in favor of a subacute intestinal occlusion associated with an electrolyte imbalance. An exploratory laparotomy was done after correction of the electrolyte imbalance. Perioperative findings revealed a dilated small bowel obstructed by bundles of live worms. An enterotomy of 2 cm in length was done, and the bundles of Ascaris lumbricoides worms extracted manually and by milking through the stoma. His postoperative period was unremarkable, and he was discharged on postoperative day 7. He and his entire household were dewormed with a single dose of mebendazole 500 mg administered orally. A follow-up visit 1 week after discharge revealed a healed abdominal wound and normal bowel functions. CONCLUSION: Despite considerable progress made on the control of soil-transmitted helminthiasis in Cameroon, the program faces a number of bottlenecks. Funding is inadequate, making data acquisition and hence remapping of high-risk zones difficult. Accessibility to enclaved zones where most high-risk children live is difficult, while community sensitization on soil-transmitted helminthiasis and proper education on the right environmental hygienic practices are lacking. All these challenges once addressed could go a long way to help achieve recently set sustainable development goals.

Helicobacter pylori infection among patients presenting with dyspepsia at a primary care setting in Cameroon: seroprevalence, five-year trend and predictors.

BACKGROUND: Almost half the world's population is infected with Helicobacter pylori (H. pylori) with the highest reported prevalence from Africa. This infection is associated with several morbid gastrointestinal conditions. Understanding the trends in seroprevalence and the factors associated with H. pylori seropositivity in dyspeptic persons can provide a guide for public health policies. METHODS: This was a retrospective study, carried out with outpatient records of Wum District Hospital (WDH) from January 2012 to December 2016. We reviewed records of all patients for whom a H. pylori serology test was requested. The Cochran-Armitage trend test and multiple regression models were used to explore seroprevalence trends and predictors of seropositivity respectively. RESULTS: We included 451 records, 63.6% (n = 287) were female. The mean age of the study population was 40.7 years, and the overall H. pylori seroprevalence was 51.5% (95% CI: 47-56%). The use of recommended eradication regimen appears to be low and declining. On average, H. pylori seroprevalence declined by 6.8% annually (p < 0.0001). Occupational status independently predicted seropositivity, with students having lower odds of being seropositive than employed persons (aOR = 0.09, 95% CI: 0.02-0.49, p = 0.016). CONCLUSION: Despite decreasing trends, the seroprevalence of Helicobacter pylori infection is high in dyspeptic patients attending this primary care setting. Improving living standards and establishing national guidelines for eradication can possibly aid the control of this infection.

Effect of Holder pasteurization on macronutrients and immunoglobulin profile of pooled donor human milk.

Objective: The objective of this study was to study the effect of Holder pasteurization on macronutrients and immunoglobulin profile of pooled donor human milk. Methods: This descriptive study was conducted in a Human Milk Bank of a tertiary care teaching institute in south India. Thirty random paired pooled donor human milk samples (before and after pasteurization) were analyzed for macronutrients (protein, fat, carbohydrates) using infrared spectroscopy. Similarly, immunoglobulin profile (IgA and IgG) before and after pasteurization was quantified using ELISA. Results: The mean values of protein, fat, and carbohydrates in pooled donor milk pre-pasteurization were 1.6, 3.6, and 6.1 g/dl compared with post-pasteurization values 1.4, 2.7, and 5.9 g/dl, respectively. Pasteurization reduced protein, fat, and energy content of pooled donor milk by 12.5%, 25%, and 16%, respectively. However, carbohydrates were not significantly reduced. Pasteurization decreased IgA by 30% and IgG by 60%. Conclusion: Holder pasteurization of pooled donor human milk decreases protein, fat, and energy content and also reduces the levels of IgA and IgG.

Role of MicroRNAs in the development and function of innate immune cells.

MicroRNAs act as crucial post-transcriptional regulators of various biological processes. Their role in regulating the differentiation and development of the various immune cells of the body is of paramount importance. The development of immune cells from the hematopoietic progenitors involves the complex interplay of transcription factors, cell signaling proteins and growth factors. MicroRNAs govern and sometimes work in a common axis alongside these factors to regulate the differentiation of immune cells. MicroRNAs are also involved in regulating the functions of innate immune cells such as phagocytosis, antigen presentation, endotoxin tolerance and natural killer cell cytotoxicity. Several microRNAs have shown to be activated during the inflammatory response and they limit the excessive immune response. The dysregulation of several microRNAs have shown to cause uncontrolled production of inflammatory cytokines resulting in various diseases. Overall, microRNAs are found to be crucial regulators of the development and function of innate immune cells and maintenance of immune homeostasis.

Role of microRNAs in sepsis.

INTRODUCTION: MicroRNAs have been found to be of high significance in the regulation of various genes and processes in the body. Sepsis is a serious clinical problem which arises due to the excessive host inflammatory response to infection. The non-specific clinical features and delayed diagnosis of sepsis has been a matter of concern for long time. FINDINGS: MicroRNAs could enable better diagnosis of sepsis and help in the identification of the various stages of sepsis. Improved diagnosis may enable quicker and more effective treatment measures. The initial acute and transient phase of sepsis involves excessive secretion of pro-inflammatory cytokines which causes severe damage. MicroRNAs negatively regulate the toll-like receptor signaling pathway and regulate the production of inflammatory cytokines during sepsis. Likewise, microRNAs have shown to regulate the vascular barrier and endothelial function in sepsis. They are also involved in the regulation of the apoptosis, immunosuppression, and organ dysfunction in later stages of sepsis. Their importance at various levels of the pathophysiology of sepsis has been discussed along with the challenges and future perspectives. CONCLUSION: MicroRNAs could be key players in the diagnosis and staging of sepsis. Their regulation at various stages of sepsis suggests that they may have an important role in altering the outcome associated with sepsis.

Management of adult pancreatic injuries: a practice management guideline from the Eastern Association for the Surgery of Trauma

BACKGROUND: Traumatic injury to the pancreas is rare but is associated with significant morbidity and mortality, including fistula, sepsis, and death. There are currently no practice management guidelines for the medical and surgical management of traumatic pancreatic injuries. The overall objective of this article is to provide evidence-based recommendations for the physician who is presented with traumatic injury to the pancreas. METHODS: The MEDLINE database using PubMed was searched to identify English language articles published from January 1965 to December 2014 regarding adult patients with pancreatic injuries. A systematic review of the literature was performed, and the Grading of Recommendations Assessment, Development and Evaluation framework was used to formulate evidence-based recommendations. RESULTS: Three hundred nineteen articles were identified. Of these, 52 articles underwent full text review, and 37 were selected for guideline construction. CONCLUSION: Patients with grade I/II injuries tend to have fewer complications; for these, we conditionally recommend nonoperative or nonresectional management. For grade III/IV injuries identified on computed tomography or at operation, we conditionally recommend pancreatic resection. We conditionally recommend against the routine use of octreotide for postoperative pancreatic fistula prophylaxis. No recommendations could be made regarding the following two topics: optimal surgical management of grade V injuries, and the need for routine splenectomy with distal pancreatectomy.

Differential Paradigms in Animal Models of Sepsis.

Sepsis is a serious clinical problem involving complex mechanisms which requires better understanding and insight. Animal models of sepsis have played a major role in providing insight into the complex pathophysiology of sepsis. There have been various animal models of sepsis with different paradigms. Endotoxin, bacterial infusion, cecal ligation and puncture, and colon ascendens stent peritonitis models are the commonly practiced methods at present. Each of these models has their own advantages and also confounding factors. We have discussed the underlying mechanisms regulating each of these models along with possible reasons why each model failed to translate into the clinic. In animal models, the timing of development of the hemodynamic phases and the varied cytokine patterns could not accurately resemble the progression of clinical sepsis. More often, the exuberant and transient pro-inflammatory cytokine response is only focused in most models. Immunosuppression and apoptosis in the later phase of sepsis have been found to cause more damage than the initial acute phase of sepsis. Likewise, better understanding of the existing models of sepsis could help us create a more relevant model which could provide solution to the currently failed clinical trials in sepsis.

Could stem cells be the future therapy for sepsis?

The severity and threat of sepsis is well known, and despite several decades of research, the mortality continues to be high. Stem cells have great potential to be used in various clinical disorders. The innate ability of stem cells such as pluripotency, self-renewal makes them potential agents for therapeutic intervention. The pathophysiology of sepsis is a plethora of complex mechanisms which include the initial microbial infection, followed by "cytokine storm," endothelial dysfunction, coagulation cascade, and the late phase of apoptosis and immune paralysis which ultimately results in multiple organ dysfunction. Stem cells could potentially alter each step of this complex pathophysiology of sepsis. Multiple organ dysfunction associated with sepsis most often leads to death and stem cells have shown their ability to prevent the organ damage and improve the organ function. The possible mechanisms of therapeutic potential of stem cells in sepsis have been discussed in detail. The route of administration, dose level, and timing also play vital role in the overall effect of stem cells in sepsis.

Design and performance of an ultra-high vacuum scanning tunneling microscope operating at dilution refrigerator temperatures and high magnetic fields.

We describe the construction and performance of a scanning tunneling microscope capable of taking maps of the tunneling density of states with sub-atomic spatial resolution at dilution refrigerator temperatures and high (14 T) magnetic fields. The fully ultra-high vacuum system features visual access to a two-sample microscope stage at the end of a bottom-loading dilution refrigerator, which facilitates the transfer of in situ prepared tips and samples. The two-sample stage enables location of the best area of the sample under study and extends the experiment lifetime. The successful thermal anchoring of the microscope, described in detail, is confirmed through a base temperature reading of 20 mK, along with a measured electron temperature of 250 mK. Atomically resolved images, along with complementary vibration measurements, are presented to confirm the effectiveness of the vibration isolation scheme in this instrument. Finally, we demonstrate that the microscope is capable of the same level of performance as typical machines with more modest refrigeration by measuring spectroscopic maps at base temperature both at zero field and in an applied magnetic field.

First Report of OXA-4, an ESBL Isolated from Pseudomonas aeruginosa a South Indian Strain.

The OXA-type ß-lactamases are so named because of their oxacillin-hydrolyzing abilities. In this study we characterize an extended spectrum ß-lactamase, designated OXA-4, produced by a clinical isolate of Pseudomonas aeruginosa. ESBL production was detected by double disk synergy test. The P. aeruginosa isolate was obtained from endotracheal suction tip of 84 years old male patient diagnosed with CVA and hypertension. ESBL producing OXA ß-lactamases was detected by PCR with primers specific to the conserved regions of the coding genes. Iso electric focusing was done to confirm the significance, sequencing the amplified product was also done. In the phenotypic identification, the strain was highly resistant to third generation cephalosporins and also to imipenem. The PCR amplified product for OXA ß-lactamase was viewed at 919 bp. The pI point for the same was identified at 7.2. With the help of sequencing the amplified OXA ß-lactamase was identified as OXA-4 gene. Here we report P. aeruginosa producing OXA-4 ESBL for the first time in the Indian subcontinent.

Synergistic effect of calcium stearate and photo treatment on the rate of biodegradation of low density polyethylene spent saline vials.

The biodegradation of spent saline bottles, a low density polyethylene product (LDPE) by two selected Arthrobacter sp. under in vitro conditions is reported. Chemical and UV pretreatment play a vital role in enhancing the rate of biodegradation. Treated LDPE film exhibits a higher weight loss and density when compared to untreated films. Arthrobacter oxydans and Arthrobacter globiformis grew better in medium containing pretreated film than in medium containing untreated film. The decrease in density and weight loss of LDPE was also more for pretreated film when compared to untreated film indicating the affect of abiotic treatment on mechanical properties of LDPE. The decrease in the absorbance corresponding to carbonyl groups and double bonds that were generated during pretreatment suggest that some of the double bonds were cut by Arthrobacter species. Since Arthrobacter sp. are capable of degrading urea, splitting of urea group were also seen in FTIR spectrum indicating the evidence of biodegradation after microbial incubation. The results indicated that biodegradation rate could be enhanced by exposing LDPE to calcium stearate (a pro-oxidant) which acts as an initiator for the oxidation of the polymers leading to a decrease of molecular weight and formation of hydrophilic group. Therefore, the initial step for biodegradation of many inert polymers depends on a photo-oxidation of those polymers. The application in sufficient details with improved procedures utilizing recombinant microorganism with polymer degradation capacity can lead to a better plastic waste management in biomedical field. The present plastic disposal trend of waste accumulation can be minimized with this promising eco-friendly technique.

Antimicrobial Activity of Few Medicinal Plants against Clinically Isolated Human Cariogenic Pathogens-An In Vitro Study.

Hexane, ethyl acetate, ethanol and methanol extracts of Psidium guajava, Terminalia chebula, Mimusops elengi and Achyranthes aspera were tested against the dental caries causing bacteria Streptococcus mutans and fungus Candida albicans isolated from caries infected patients. All the four extracts of P. guajava showed activity against both S. mutans and C. albicans. Maximum zone of inhibition was observed in ethyl acetate of P. guajava. The four extracts of T. chebula and M. elengi showed antibacterial activity against S. mutans. M. elengi extracts and ethanol extract of T. chebula did not show any antifungal activity against C. albicans. Except for the hexane extract of A. aspera, the other three extracts showed activity against the tested microbes. The ethyl acetate P. guajava leaf extract showed the minimum inhibitory concentration (MIC) against S. mutans to be <0.076 mg/mL in both MHB and BHI. The P. guajava ethyl acetate extract was subjected to GC-MS.

Bioefficacy of Aristolochia tagala Cham. against Spodoptera litura Fab. (Lepidoptera: Noctuidae).

Bioefficacy of leaf and root extracts of Aristolochia tagala Cham. at different concentrations was evaluated at room temperature against Spodoptera litura Fab. Effects on feeding, larvicidal and pupicidal activities and larval-pupal duration were studied. Higher antifeedant activity (56.06%), lethal concentration for feeding inhibition (3.69%), larvicidal (40.66%), pupicidal (28%), total mortality (68.66%) and prolonged larval-pupal duration (12.04-13.08 days) were observed in ethyl acetate leaf extract at 5.0% concentration. Dose dependant effect of test extracts was observed. This plant could be used to isolate active principles and to develop a new botanical formulation in pest management programmes.

Disability prevention and management in leprosy: a field experience.

Bombay Leprosy Project has conducted operational research into cost effective ways of using therapeutic management for prevention of disabilities (POD). The goal of achieving this are broadly divided as 1) prevention of impairments and disabilities [POID] and 2) prevention of worsening of disabilities [POWD]. About 33-56% of newly registered leprosy patients already have clinically detectable nerve function impairment [NFI], often no longer amenable to MDT. An analysis of 892 leprosy cases treated with WHO-MDT stresses the need to focus attention on leprosy patients having > 5 skin lesions and multiple nerve thickening. Assessment of 454 disabled leprosy patients after 4 years indicated that the compliance for the services offered was good and it helped to improve the disability status in more than 50% of patients. In terms of effectiveness of the services, it was found to be effective in preventing worsening of deformities in hands and healing of trophic ulcers in feet. The methodology adopted has also helped us to develop an operational research model about the necessity to systematize the assistance and support to be given if the services can be routed through a public health facility. Because of the large numbers of leprosy patients with disability living in this region and the limited resources available, the services have to be targeted towards those who are most in need. The major advantage of such community based program is an attempt to eliminate the social stigma in the patients' families and the education of the community.

Disability prevention and management in leprosy: a field experience

Bombay leprosy project has conducted operational research into cost effective ways of using therapeutic management for prevention of disabilities (POD). The goal of achieving this are broadly divided as 1)prevention of impairments and disabilities(POID) and 2)prevention of worsening of disabilities (POWD). About 33-56% of newly registered leprosy patients already have clinically detectable nerve function impairment (NFI), often no longer amenable to MDT. An analysis of 892 leprosy cases treated with WHO-MD stresses the need to focus attention on leprosy patients...

Creating the climate for diversity and race equality in health care.

In 1997 the Department of Health funded eight projects to demonstrate 'mainstreaming' responses to minority ethnic health in the NHS. 'Mainstreaming' is understood to require cultural, organisation and practice change; sustaining such change is a major challenge. Evaluation of the projects identified that leadership was a critical factor in encouraging change that was lasting. Other important issues were maintaining the desire changes in a turbulent organisational context and linking changes in practice with other priorities and initiatives. The agenda for the New NHS presents an opportunity for learning from this programme to be put into practice across the Department of Health and the NHS.

Tethered pyrazolyl phosphinate: pyrazolyl-N- and phosphoryl-O-metal coordination in Ph(2)P(O)[OCH(2)CH(2)(3,5-Me(2)Pz)].

Phosphorus pyrazolides, P(O)(3,5-Me(2)Pz)(3) or RP(E)(3,5-Me(2)Pz)(2) [E = S or O, R = Me or Ph], are hydrolytically sensitive particularly upon interaction with transition metal ions. In this paper, we report a new tethered pyrazolyl phosphinate, Ph(2)P(O)[OCH(2)CH(2)(3,5-Me(2)Pz)] DPEP (1), where the pyrazolyl group is separated from the phosphorus by means of an ethyleneoxy spacer. 1 has two potential coordination sites in the form of a phosphoryl oxygen atom and a pyrazolyl nitrogen atom. 1 forms hydrolytically stable complexes, (DPEP-CoCl(2))(n)(2), (DPEP)(2)-CuCl(2) (3), (DPEP-ZnCl(2))(n )(4), and (DPEP)(2)-PdCl(2) (5). The cobalt(II) and the zinc(II) complexes 2 and 4 show a zigzag polymeric structure in the solid state with a tetrahedral coordination geometry around the metal ion; the ligand DPEP coordinates through its phosphoryl oxygen and the pyrazolyl nitrogen to two neighboring metal ions and functions as a bridging ligand to form the polymeric structure. In contrast to 2 and 4, the copper(II) and the palladium(II) complexes 3 and 5 show a square-planar geometry around the metal ion. Exclusive coordination through the pyrazolyl nitrogens of the ligand 1 is observed. An extensive supramolecular sheetlike two-dimensional polymeric network is observed in the solid-state structures of 3 and 5 as a result of two weak interactions: (a) an intermolecular C-H- - -O interaction involving the phosphoryl oxygen and an aromatic C-H and (b) a pi-pi face-to-face stacking interaction between the phenyl groups of two adjacent molecules.