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BackgroundFungal lung diseases are global in distribution and require specific tests for diagnosis. We report a survey of diagnostic service provision in Africa.MethodsA written questionnaire was followed by a video conference call with each respondent(s) and external validation. To disseminate the questionnaire, a snowball sample was used.ResultsData were successfully collected from 50 of 51 African countries with populations >1 million. The questionnaire was completed by respondents affiliated with 72 health facilities. Of these 72 respondents, 33 (45.8%) reported data for the whole country while others reported data for a specific region/province within their country. In the public sector, chest X-ray and computed tomography are performed often in 49 countries (98%) and occasionally in 37 countries (74%), and less often in the private sector. Bronchoscopy and spirometry were done often in 28 countries (56%) and occasionally in 18 countries (36%) in the tertiary health facilities of public sector. The most conducted laboratory diagnostic assay was fungal culture (often or occasionally) in 29 countries (58%). In collaboration with the Africa Centre for Disease Control and Prevention, regional webinars and individual country profiles provided further data validation.ConclusionThis survey has found a huge disparity of diagnostic test capability across the African continent. Some good examples of good diagnostic provision and very high-quality care were seen, but this was unusual. The unavailability of essential testing such as spirometry was noted, which has a high impact in the diagnosis of lung diseases. It is important for countries to implement tests based on the World Health Organization Essential Diagnostics List.

Indonesia’s batik industry is growing rapidly, including the segment specializing in natural dyes. However, this has produced concerns regarding sustainability deriving from, for example, the use of environmental pollutants in the field. This research aims to propose a set of preliminary indicators to facilitate the assessment of the sustainability of the natural-dye-based batik industry. We selected Batik Preketek, a company in Pekalongan City, Indonesia, as a case study and received support from representative panellists who were knowledgeable on these issues. We employed a mixed-methods approach, with data collected from field observations, laboratory analyses, structured and semi-structured interviews and secondary sources. The validated indicators were then applied to assess the current sustainability of batik production. The indicators used included five indicators from the environmental dimension, four from the economic dimension and six from the social dimension. Assessment of the company’s sustainability level produced a score of 77.50, indicating that it could be categorized as sustainable. The instrument developed was proved capable of capturing major sustainability issues and delivering prioritized strategies to improve sustainability.

Antibiotic exposure disturbs the developing infant gut microbiota. The capacity of the gut microbiota to recover from this disturbance (resilience) depends on the type of antibiotic. In this study, infant gut microbiota was exposed to a combination of amoxicillin and clavulanate (amoxicillin/clavulanate) in an in vitro colon model (TIM-2) with fecal-derived microbiota from 1-month-old (1-M; a mixed-taxa community type) as well as 3-month-old (3-M; Bifidobacterium dominated community type) breastfed infants. We investigated the effect of two common infant prebiotics, 2′-fucosyllactose (2’-FL) or galacto-oligosaccharides (GOS), on the resilience of infant gut microbiota to amoxicillin/clavulanate-induced changes in microbiota composition and activity. Amoxicillin/clavulanate treatment decreased alpha diversity and induced a temporary shift of microbiota to a community dominated by enterobacteria. Moreover, antibiotic treatment increased succinate and lactate in both 1- and 3-M colon models, while decreasing the production of short-chain (SCFA) and branched-chain fatty acids (BFCA). The prebiotic effect on the microbiota recovery depended on the fermenting capacity of antibiotic-exposed microbiota. In the 1-M colon model, the supplementation of 2’-FL supported the recovery of microbiota and restored the production of propionate and butyrate. In the 3-M colon model, GOS supplementation supported the recovery of microbiota and increased the production of acetate and butyrate.

IntroductionAlthough child morbidity and mortality could be reduced in Sub-Saharan Africa during the last years both remain high. Since neonatal infections play a major role, we conducted a cross-sectional pilot study in the lake region of Western Tanzania in order to analyze not only the prevalence of neonatal infection with its bacterial etiology including antimicrobial resistance pattern but also to detect potential maternal risk factors.MethodsWe screened 156 women for potential risk factors and examined their neonates for clinical signs of an infection including microbiological verification. All women were interviewed for medical history and their socio-economic background. High-vaginal swabs (HVS) of pregnant women and blood cultures of sick infants were investigated for bacterial pathogens using culture followed by matrix-assisted laser desorption ionization time-of-flight mass spectrometry (MALDI-TOF MS) or polymerase-chain-reaction (PCR)-based assays. Antimicrobial resistances were determined using a disk diffusion test and verified by VITEK 2. Maternal malaria, blood glucose, and hemoglobin levels were determined by rapid tests and helminth infections by stool microscopy.Results and discussionOur results showed a prevalence of 22% for neonatal infections. In total, 57% of them had culture-positive bloodstream infections with Gram-negative bacteria being the most prevalent. All these expressed resistance against ampicillin. The prevalence of maternal infection with helminths or Plasmodium was low, indicating that anti-worming strategies and intermittent preventive treatment of malaria for pregnant women (IPTp) are effective. The study identified maternal urinary tract infection (UTI) and an elevated blood glucose level as potential maternal risk factors for early neonatal infection, an elevated blood glucose level, and maternal anemia for a late-onset infection.ConclusionOur study, therefore, indicates that monitoring maternal UTI in the last trimester as well as levels of maternal hemoglobin and blood glucose might be important to predict and eventually manage neonatal infections. As Gram-negative bacteria with resistance to ampicillin were most prevalent in culture-proven neonatal sepsis, WHO recommendations for calculated antibiosis in the sick young infant should be discussed.

MR defecating proctography (MRDP) is a noninvasive examination that can be used for evaluating posterior compartment disorders. MRDP has several advantages over conventional fluoroscopic defecography. These benefits include high-contrast resolution evaluation of the deep pelvic organs, simultaneous multicompartmental assessment that is performed statically and dynamically during defecation, and lack of ionizing radiation. MRDP also provides a highly detailed anatomic evaluation of the pelvic floor supportive structures, including direct assessment of the pelvic floor musculature and indirect assessment of the endopelvic fascia. As the breadth of knowledge regarding anatomic and functional posterior compartment disorders expands, so too does the advancement of noninvasive and surgical treatment options for these conditions. High-quality MRDP examinations, with key anatomic and functional features reported, guide treatment planning. Reporting of MRDP examination findings with use of standardized terminology that emphasizes objective measurements rather than subjective grading aids consistent communication among radiologists, clinicians, and surgeons. Familiarity with commonly encountered posterior compartment pelvic floor pathologic entities that contribute to posterior compartment disorders and awareness of the essential information needed by surgeons are key to providing an optimal multidisciplinary discussion for planning pelvic floor dysfunction treatment. The authors provide an overview of the basic concepts of the MRDP acquisition technique, the anatomic abnormalities of posterior compartment pelvic floor pathologic entities associated with defecatory disorders, and recently developed interdisciplinary MRDP reporting templates and lexicons. In addition, the associated imaging findings that are key for surgical treatment guidance are highlighted.

Rationale: Animal studies of cardiac arrest suggest that shorter epinephrine dosing intervals than currently recommended (every 3–5 min) may be beneficial in select circumstances. Objectives: To ev...

Multiparametric magnetic resonance imaging (mpMRI) plays several valuable roles in preoperative staging of adenocarcinoma of the prostate gland, including detection of clinically significant disease, determination of extraglandular extension, and assessment of nodal disease. The Prostate Imaging Reporting and Data System (PI-RADS) establishes certain acceptable technical standards for mpMRI. These technical parameters allow for consistent image quality, enabling accurate detection and staging of disease; this in turn has significant implications for treatment recommendations. The prostate gland has a characteristic zonal anatomy, with cancers arising from the peripheral zone tending to demonstrate more aggressive histologic features. The acquisition of several sequences as part of mpMRI protocol allows for assessment of locoregional disease as well as regional and distant lymphadenopathy. The local staging of prostate cancer with mpMRI is reviewed in this article.

Objective To evaluate outcomes before and after implementation of a risk-stratified heparin-based obstetric thromboprophylaxis protocol. Methods We performed a retrospective cohort study of all patients who delivered at our tertiary care center from 2013 to 2018. Deliveries were categorized as preprotocol (2013-2015; no standardized heparin-based thromboprophylaxis) and postprotocol (2016-2018). Patients receiving outpatient anticoagulation for active venous thromboembolism (VTE) or high VTE risk were excluded. Coprimary effectiveness and safety outcomes were postpartum VTEs and wound hematomas, respectively, newly diagnosed after delivery and up to 6 weeks postpartum. Secondary outcomes were other wound or bleeding complications, including unplanned surgical procedures (eg, hysterectomies, wound explorations) and blood transfusions. Outcomes were compared between groups, and adjusted odds ratios (aORs) and 95% CIs were calculated using the preprotocol group as reference. Results Of 24,229 deliveries, 11,799 (49%) occurred preprotocol. Although patients were more likely to receive heparin-based prophylaxis postprotocol (15.6% vs 1.2%, P Conclusion Risk-stratified heparin-based thromboprophylaxis in a general obstetric population was associated with increased wound and bleeding complications without a complementary decrease in postpartum VTE. Guidelines recommending this strategy should be reconsidered.

Literature suggests that adolescents may not accurately report sexual activity to their providers, impeding risk-based screening efforts for gonorrhea and chlamydia (GC/CT). We assessed the effect of a clinic-based universal GC/CT screening initiative on GC/CT screening frequency and detection of GC/CT infections among adolescents (boys and girls ≥13 years) and the association between positive GC/CT and documented sexual activity.We conducted a pre-post analysis of a primary care clinic affiliated with an academic institution. The electronic medical record was queried to extract all adolescent well and acute encounters for the 12 months preimplementation and postimplementation of universal GC/CT screening in January 2015.Eight hundred fifty-six encounters from 752 unique adolescents were included. Screening increased postimplementation (23.3% vs 61.4%, P0.001) of universal screening. Although there were similar rates of documented sexual activity preimplementation and postimplementation (14.6% vs 16.0%), a larger proportion of unknown sexual activity was documented (10.5% vs 23.7%, P0.001). Provider-level factors were the most frequent reasons for not screening. The absolute number of GC/CT cases increased, although the proportion of cases out of all eligible adolescents remained similar as more testing was completed (chlamydia, 5 of 752 vs 12 of 752; P = 0.09; gonorrhea, 0 of 752 vs 1 of 752; P = 0.32). Nearly half of positive chlamydia infections postimplementation appeared in adolescents who reported no sexual activity.Universal screening in a primary care clinic increased screening and detection of cases of gonorrhea and chlamydia, including in adolescents who did not report sexual activity.

Background Universal screening is a strategy for addressing the limitations of risk-based screening for gonorrhea and chlamydia (GC/CT). This quality improvement (QI) initiative aimed to improve GC/CT screening by implementing universal annual screening for all adolescents ≥ 13 years old. Methods At an academic pediatric resident continuity clinic, an interdisciplinary team designed and conducted multiple Plan-Do-Study-Act (PDSA) cycles over one year. The primary aim, and process measure, was to increase the percentage of encounters with screening for GC/CT in the 12 months prior to the encounter to 80%. The secondary outcome measure was rate of detection of GC or CT infection. Further, pulse checks of provider/staff knowledge and adherence were conducted. The balancing measure was denied insurance claims. Results The mean screening rate of 29.2% increased during the project implementation to 65.1% with several bundles of PDSA cycles. There were no cases of gonorrhea detected in the baseline period or implementation period. The case rate of chlamydia was similar during both periods (from 9.7 per 1,000 adolescent encounters to 10.8 per 1,000 adolescent encounters, p = 0.74). There was similarly high provider/staff knowledge about (p = 0.35) and adherence to (p = 0.06) the screening protocol at 6 and 12 months of implementation. There was no increase in percentage of denied insurance claims. Conclusion This QI initiative doubled rates of GC/CT screening with no statistically significant increase in number of cases.

OBJECTIVES To analyze factors associated with the initiation of long-acting reversible contraception (LARC) among adolescent patients in inpatient settings in the United States. METHODS This study is a secondary data analysis of the national Kids’ Inpatient Database 2016 data (N = 4200 hospitals). Eligible patients were hospitalized girls 10 to 20 years old. The primary outcome was initiation of LARC (ie, subdermal implant and/or intrauterine device [IUD]) while hospitalized. Covariables included age, race or ethnicity, insurance type, postpregnancy status, geographic region, hospital type (rural or urban), hospital size, and children’s hospital status. Bivariable statistics were calculated by using survey-weighted analysis, and a design-based logistic regression model was used to determine the adjusted odds of LARC initiation and of implant versus IUD initiation. RESULTS LARC initiation occurred in 0.4% (n = 3706) of eligible hospital admissions (n = 874 193). There were differences in LARC initiation by patient age, insurance type, race or ethnicity, postpregnancy status, hospital type, and hospital status (all P < .01). In the adjusted model, older age, public insurance, nonwhite race or ethnicity, postpregnancy status, and urban, teaching or larger hospitals were independently associated with LARC initiation (all P < .01). Smaller hospital size and postpregnancy status increased the odds of implant versus IUD initiation after stratifying by hospital region. CONCLUSIONS LARC initiation occurred in

Tissue expansion is a key reconstructive strategy for certain anatomical areas. However, complications such as infection, skin necrosis and extrusion of expander may halt the expansion process ultimately leading to patient morbidity, stress and associated healthcare costs. We performed a systematic review of the literature following the PRISMA guidelines in order to identify tissue expander (TE) salvage strategies employed. We also present two cases complicated by infection and TE extrusion, in which “True TE Salvage” was achieved. We retrieved 18 articles published between 1989 and 2020. The most common anatomical location for TE reconstruction was the breast and the most common complication was infection. The calculated salvage success rate was 78% (94/120). We classified the TE salvage techniques into True Salvage, Open Salvage, Immediate Exchange Salvage, Delayed Exchange Salvage and TE failure. We present two cases of forehead expansion which were complicated by infection leading to skin necrosis and extrusion of TE. Case 1 was managed by continuous irrigation through a paediatric feeding tube and case 2 with repeat pocket lavage and external scrub. In both cases, with the “True TE Salvage” the infection resolved, the original TEs remained in situ and the expansion process and reconstruction were completed. Various TE salvage techniques and in particular the “True TE Salvage” should be considered an option for select patients. It offers numerous benefits including continuation of the reconstructive process and reduction of patient distress and healthcare costs. Our proposed classification will allow for a more consistent reporting and therefore facilitate future analysis.

Supramolecular polymer gels are a promising class of materials whose polymer components are connected by transient bonds such as metal–ligand interactions, thereby spanning a dynamic network throug...

Vulvovaginal candidiasis (VVC) is a commonly occurring form of mucocutaneous candidiasis in women. The aim of this study was to comprehensively investigate the prevalence, antifungal susceptibility, and etiology of VVC in sub–Saharan Africa (SSA). A search of studies was conducted in seven online databases and the reference lists of selected studies. Observational studies published between January 2000, to July 2021, that met the eligibility criteria were included. Meta-analyses with random and fixed-effects model, and subgroup analyses were performed using STATA 16.0. A total of 41 studies including 15 723 participants were included in the meta-analyses. The pooled prevalence of VVC was 33% (95% Confidence Interval (CI): 28–38%, I2 = 98%, P Lay Summary The overarching aim of this study was to comprehensively investigate the prevalence, antifungal susceptibility, and causative species of vulvovaginal candidiasis (VVC) in sub–Saharan Africa (SSA). A detailed search of studies was conducted to retrieve eligible observational studies published ‘between’ January 1, 2000, to July 31, 2021. From the 41 selected studies including 15 723 participants, VVC was found in 33% of the participants. The chances of diagnosing VVC was 40% higher in symptomatic patients compared to the general study population. In 71.7% of the cases, C. albicans was the causative species of VVC. We conclude that about one-third of women in SSA have VVC, mainly caused by C. albicans.

The dynamic response of critical closing pressure (CrCP) and resistance-area product (RAP) of the cerebral circulation to a step change in mean arterial pressure can shed light on the nonstationary changes induced by paced hyperventilation and the effects of hypocapnia on the autoregulation of cerebral blood flow. Contrary to hypercapnia, where the response is dominated by CrCP, hypocapnia shows an initial depression of cerebral autoregulation, followed by improvements controlled by changes in RAP.

Objetivos: Determinar el efecto citotóxico y genotóxico in vitro del extracto crudo y etanólico del rizoma de Curcuma longa L. Materiales y métodos: El efecto citotóxico fue evaluado utilizando líneas celulares DU-145, HT-29, 3T3 BALB/c. Se hallaron los porcentajes de crecimiento en 48 horas y se determinó la concentración inhibitoria 50 (CI50). El efecto genotóxico en el ADN genómico humano se determinó mediante el método Tomasevich. Resultados: El extracto crudo produjo una CI50 de 12,98 ± 0,21 μg/mL para la línea celular tumoral HT-29, que es inferior a DU-145 con una CI50 de 36,77 ± 9,12 μg/mL; el extracto etanólico presentó una CI50 de 13,24 ± 0,77 y 20,54 ± 2,58 µg/mL para ambas líneas celulares, respectivamente; el compuesto estándar curcumina presentó una CI50 de 3,96 ± 0,60 y 13,94 ± 2,79 μg/mL, respectivamente. El extracto crudo a concentraciones de 50 y 100 mg/mL fragmentó entre el 40% a 95% de ADN genómico humano; mientras que, a 200 mg/mL, la fragmentación fue mayor al 95%. El extracto etanólico a todas las concentraciones no fragmentó el ADN. La curcumina a 200 mg/mL fragmentó menos del 5% de ADN genómico humano. Conclusiones: Los extractos crudo y etanólico de Curcuma longa L. demuestran efecto citotóxico in vitro diferencial para la línea celular tumoral humana DU-145 y HT29 semejante al compuesto estándar curcumina. El extracto crudo de Curcuma longa L. presenta una potente actividad genotóxica in vitro frente al ADN genómico humano, esta actividad está ausente en el extracto etanólico.

In recent years, many local governments in the United States have declared themselves to be sanctuaries, welcoming jurisdictions, safe cities, or cities of refuge for immigrants. At the same time, federal rhetoric and associated national laws—which have legal precedence over local immigration policies—have shifted in anti-immigrant directions. These developments raise questions about whether and how local sanctuary policies affect immigrants’ lives, including their feelings of fear, their access to local services, and their interactions with law enforcement. This article draws on existing studies and new interview data from a pilot study of two sanctuary cities, Boston and Seattle, to evaluate the impacts of municipal sanctuary policies for immigrants, including their potential influences on immigrant and refugee integration. I also explore policy approaches that might enhance these policies’ effectiveness in achieving their supporters’ stated goals.

Objective The aim of the study was to describe a debilitating postmenopausal condition of continuous burning genital pain that remitted with prolonged estrogen focused on the vulvar vestibule. Materials and methods Postmenopausal patients with constant genital pain seen by the author in a specialty vulvar health clinic comprised an institutional review board-approved descriptive case series. Examinations to localize pain used 4% lidocaine topical solution. Each patient received estradiol nightly as vestibule creme or constantly by transdermal route and was followed by serial examinations and follow-up telephone contact. Statistical tests included Student t test, Fisher exact test, and Pearson correlation coefficient. Results Between 2008 and 2016, 16 women presented with constant genital pain that was partly or fully extinguishable with topical vestibular lidocaine, and their pain slowly responded to prolonged vestibule-directed estradiol therapy. The mean age was 66.8 years (± 11.2). The mean pain score was 5 (range = 2-10 on a 0-10 scale). Seven (44%) characterized their pain as debilitating, and 13 (81%) had accompanying urinary symptoms. In 9 patients (56%), ovaries had been removed before natural menopause at ages 27-50 years (mean = 39), followed by minimal or no estrogen therapy. Prolonged estrogen therapy eliminated constant pain in 69% and mitigated it in 31%. Conclusions Information about this severe but remediable condition that is associated with lack of estrogen may guide specialists who are treating complex vulvar pain. The patients' clinical histories and therapeutic courses invite a review of estrogen receptor physiology related to urogenital pain conditions.

Background: Premature rupture of membrane (PROM) contributes to approximately one-third of premature birth and 10% perinatal mortality worldwide. Here, we report the patterns of facultative pathogenic bacteria colonizing the vagina of pregnant women to guide prophylactic antibiotic treatment in the management of PROM.Methods: This comparative cross-sectional study was conducted between August 2015 and March 2016. High vaginal swabs were collected and processed to detect the presence of facultative pathogenic bacteria. Isolate identification and antibiotic susceptibility testing was conducted using MALDI-TOF MS and VITEK-2 system, respectively. Data were analyzed using STATA version 13.Results: A total of 175 pregnant women with PROM and 175 without PROM were investigated. The median age of the pregnant women with PROM was significantly higher than that of pregnant women without PROM: 27 [21-32] vs. 25[21-29], p=0.026. Pregnant women with PROM were significantly more likely to be colonized with facultative pathogenic bacteria 59/175 (33.7%), 95% CI; 26.7-40.7 than pregnant women without PROM; 27/175 (15.4%), 95% CI; 10.1-20.7, P

Investigations describing the ocular and lacrimal gland lesions associated with rabies are sparse. Here we characterize the pathological changes and distribution of rabies viral antigen in the eye, optic nerve, and lacrimal gland of 18 rabies cases from different mammalian species. Histology and immunohistochemistry for rabies virus, CD3, CD20, and Iba1 were performed on tissue sections of eye, optic nerve, and lacrimal gland. Polymerase chain reaction (PCR) for rabies was performed on all cases, including 7 formalin-fixed, paraffin-embedded (FFPE) and 11 frozen tissue samples of eye and lacrimal gland. Pathological changes in the eye consisted of retinal necrosis (12/18 cases) with occasional viral inclusions within ganglion cells (8/12 cases). Immunohistochemically, viral antigen was detected within the nerve fiber layer, ganglion cells, and inner plexiform layer in all 12 cases with retinal lesions and in 2 cases with no retinal lesions, as well as optic nerve (6/18 cases) and lacrimal gland epithelium (3/18 cases). CD3+ T lymphocytes were present in the retina (11/18 cases), optic nerve (2/18 cases), and lacrimal gland (11/18 cases). No CD20+ B lymphocytes or Iba1+ macrophages were detected. PCR for rabies virus was positive in 9 of 11 frozen samples but in only 2 of 7 FFPE samples. Five samples that were negative for rabies by PCR were positive by immunohistochemistry, and 2 samples were negative by both tests. These results provide evidence that rabies virus infection extends to the eye, likely via the ocular nerve, and that the lacrimal gland might be a source of viral infection.

A common symptom of genitourinary syndrome of menopause (GSM) is dyspareunia, attributed to vulvovaginal atrophy. Our objective was to systematically describe the pain characteristics and anatomic locations of tenderness in a cohort with moderate/severe dyspareunia likely due to GSM.This cross-sectional study reports the baseline data of postmenopausal women with dyspareunia screened for an intervention trial of topical estrogen. Postmenopausal women not using hormone therapy who had moderate or severe dyspareunia were eligible if estrogen was not contraindicated. Biopsychosocial assessments were performed using the Vulvar Pain Assessment Questionnaire, and participants underwent a systematic vulvovaginal examination that included a visual assessment and cotton swab testing for tenderness rated using the Numerical Rating Scale (0-10). Vaginal pH and mucosal sensitivity were assessed; pelvic floor muscles and pelvic viscera were palpated for tenderness.Fifty-five eligible women were examined between July 2017 and August 2019. Mean age was 59.5 ± 6.8 years, and duration of dyspareunia was 6.2 ± 4.3 years. The mean intercourse pain score was 7.3 ± 1.8, most often described as "burning" and "raw." Ninety-eight percent had physical findings of vulvovaginal atrophy. Median pain scores from swab touch at the vulvar vestibule (just outside the hymen) were 4 to 5/10, and topical lidocaine extinguished pain. Median vaginal mucosal pain was zero.Participants described their pain as "burning" and "dry." Tenderness was most severe and most consistently located at the vulvar vestibule. Correlating the symptom of dyspareunia with genital examination findings may further our understanding of treatment outcomes for GSM.Video Summary:http://links.lww.com/MENO/A916.

Increasing antimicrobial resistance (AMR) colonizing domesticated animals is a global concern threatening food safety. This study aimed at determining the prevalence of multidrug resistance (MDR) and epidemiological cut-off values (ECVs) of

Background: Over-the-counter antibiotic access is common in low-and-middle-income countries, including Tanzania and Uganda, and this may accelerate antimicrobial resistance. Our study explores critical aspects of the drug seller-client interaction and antibiotic dispensing patterns for simulated COVID-19 symptoms during the pandemic in two study sites in countries with different government responses to the pandemic.Methods: Research assistants posing as clients approached different types of drug sellers such as pharmacies (Pharms), drug shops (DSs), and accredited drug dispensing outlets (ADDOs) in Mwanza, Tanzania (nPharms= 415, nADDOs= 116) and Mbarara, Uganda (nPharms= 440, nDSs= 67), from June 10-July 30, 2021. The mystery clients (who held no prescription) sought advice for simulated COVID-19 symptoms from the drug sellers, documented the quality of their interaction with sellers and the type of drugs dispensed.Results: Adherence to COVID-19 preventive measures and vigilance to COVID-19 symptoms was low in both sites but significantly higher in Uganda than in Tanzania. A higher percentage of drug sellers in Mbarara (Pharms= 36%, DSs= 35%, p-value= 0.947) compared to Mwanza (Pharms= 9%, ADDOs= 4%, p-value= 0.112) identified the client’s symptoms as possibly COVID-19. More than three-quarters of drug sellers in both Mbarara (Pharms= 86%, DSs= 89%) and Mwanza (Pharms= 93%, ADDOs= 97%) sold prescription-only medicines without asking for a prescription. A relatively high percentage of drug sellers that sold prescription-only medicines in Mwanza (Pharms= 51%, ADDOs= 67%) compared to Mbarara (Pharms= 31%, DSs= 42%) sold a partial course without any objection. Among the drug sellers who sold antibiotics, more drug sellers in Mbarara (Pharms= 73%, DSs= 78%, p-value= 0.580) compared to Mwanza (Pharms= 40% ADDOs= 46%, p-value= 0.537) sold antibiotics relevant for treating secondary bacterial infections in COVID-19 patients.Conclusion: Our study highlights low levels of awareness of and vigilance towards COVID-19 symptoms and widespread propensity to dispense prescription-only antibiotics without a prescription and to dispense partial doses of antibiotics. The implications of these for antimicrobial resistance are further discussed. Our study also highlights the need for more efforts to improve antibiotic stewardship among drug sellers in response to the current pandemic and to prepare them for future health emergencies.

Introduction: Irrational antifungals prescription results in inappropriate use of antifungals, leading to emergence of antifungal resistance. Aim: To determine the prescription patterns of antifungal agents in gynaecology and oncology departments of the tertiary hospital in Tanzania. Materials and Methods: This was a retrospective hospital-based study involving files of patients who attended gynaecology and oncology department of Bugando Medical Centre between January 2017 and December 2017. All files of patients with fungal infections were analysed. Checklist was used to collect information such as clinical diagnosis, age, name of antifungal, number of antifungals, dosage form and dose frequency. Descriptive analysis was done using STATA version 13.0. Results: A total of 1,070 files of patients who attended gynaecology and oncology departments in the year 2017 were retrieved, of which 860 (80.4%) were from patients who attended gynaecology department. A total of 156 (14.6%) files out of 1,070 were of patients with fungal infections. Of the patients from gynaecology 116 (n=860, 13.48%) had fungal infection. While of the patients from oncology 40 (n=210, 19.1%) had fungal infection. The most common fungal infection diagnosed were vaginal candidiasis 112 (96.6%) and oral candidiasis 33 (82.5%) from gynaecology and oncology department, respectively. Common antifungal prescribed were azoles (clotrimazole 56.9% in gynaecology and fluconazole 37.5% in oncology). The prevalence of irrational antifungal prescription in gynaecology and oncology departments was 22.4% (26/116) and 20% (8/40), respectively. Conclusion: About one in five antifungal prescriptions for vaginal candidiasis in gynaecology and oral candidiasis in oncology are irrational as evidenced in standard treatment guideline. Clinicians should adhere to the national standard treatment guidelines in order to reduce irrational prescriptions of antifungal agents.

Additional file 1.

Funding: This study is part of the Holistic Approach to Unravel Antibacterial Resistance in East Africa (HATUA) project funded by the National Institute for Health Research, Medical Research Council and the Department of Health and Social Care, Award (MR/S004785/1). Background: There is a growing body of evidence on the potential involvement of coagulase-negative Staphylococci (CoNS) in causing urinary tract infections (UTIs). The aim of this study was to delineate virulence potential, antimicrobial resistance genes, and sequence types of CoNS isolated from patients with UTI symptoms and pyuria in Tanzania. Methods: CoNS from patients with UTI symptoms and more than 125 leucocytes/μL were retrieved, subcultured, and whole-genome sequenced. Results: Out of 65 CoNS isolates, 8 species of CoNS were identified; Staphylococcus haemolyticus, n = 27 (41.5%), and Staphylococcus epidermidis, n = 24 (36.9%), were predominant. The majority of S. haemolyticus were sequence type (ST) 30, with 8 new ST138-145 reported, while the majority of S. epidermidis were typed as ST490 with 7 new ST1184-1190 reported. Sixty isolates (92.3%) had either one or multiple antimicrobial resistance genes. The most frequently detected resistance genes were 53 (21%) dfrG, 32 (12.9%) blaZ, and 26 (10.5%) mecA genes conferring resistance to trimethoprim, penicillin, and methicillin, respectively. Out of 65 isolates, 59 (90.8%) had virulence genes associated with UTI, with a predominance of the icaC 47 (46.5%) and icaA 14 (13.9%) genes. Conclusion: S. haemolyticus and S. epidermidis harboring icaC, dfrG, blaZ, and mecA genes were the predominant CoNS causing UTI in Tanzania. Laboratories should carefully interpret the significant bacteriuria due to CoNS in relation to UTI symptoms and pyuria before labeling them as contaminants. Follow-up studies to document the outcome of the treated patients is needed to add more evidence that CoNS are UTI pathogens. Publisher PDF

Las Unidades de Pasteurización (UP) permiten evaluar la calidad del proceso de pasteurización de la cerveza. Cuando esta se envasa en botellas de vidrio, al pasar por el interior de un pasteurizador de túnel, todo el tiempo correspondiente a las etapas de calentamiento, prepasteurización y pasteurización se toma en cuenta para el cálculo de las UP. Este estudio tiene como objetivo analizar, mediante la simulación del proceso utilizando la Dinámica de Fluidos Computacional a través del software COMSOL, la variación que existe en las UP cuando se considera el tiempo para el calentamiento de la botella. Los resultados arrojan una diferencia que debe tenerse en cuenta para no incurrir en errores que desmeriten la calidad del producto pasteurizado. Palabras claves: cerveza, pasteurización, unidades de pasteurización, botellas de vidrio

El control del proceso de trasiego de los diferentes combustibles ha sido siempre de interés en las comercializadoras que son parte de la cadena de suministro. El presente trabajo muestra la eficacia del control de la calidad de dicho proceso, tomando como ejemplo la Base depósito de Gas Licuado del Petróleo, de la provincia de Camagüey, con el objetivo de evaluar la calidad de la operación de trasiego y almacenaje del GLP y su influencia en el balance operativo. El diagrama causa-efecto elaborado demuestra que los principales factores que llevan al problema son: el uso de instrumentos inadecuados como el Rotogage para medir el volumen, influencia de las condiciones ambientales y el no cumplimiento de los procedimientos de trabajo, lo que fue confirmado con el análisis de Pareto. Se construyen cartas de control que permitan identificar los principales elementos que provocan la inestabilidad estadística. Se detecta que existen variaciones en la medición debido a que todas las variables tuvieron puntos fuera de los límites estadísticos en la variable o en el rango. ese resultado afecta el resto del proceso, provocando resultados ilógicos en la determinación del índice de pérdidas, por lo que se recomienda la consideración de la incertidumbre en las mediciones realizadas para estimar un nuevo valor del mismo. Palabras claves: Gas Licuado de Petróleo, calidad, Rotogage, índice de pérdidas

El control del proceso de trasiego de los diferentes combustibles ha sido siempre de inter��s en las comercializadoras que son parte de la cadena de suministro. El presente trabajo muestra la eficacia del control de la calidad de dicho proceso, tomando como ejemplo la Base dep��sito de Gas Licuado del Petr��leo, de la provincia de Camag��ey, con el objetivo de evaluar la calidad de la operaci��n de trasiego y almacenaje del GLP y su influencia en el balance operativo. El diagrama causa-efecto elaborado demuestra que los principales factores que llevan al problema son: el uso de instrumentos inadecuados como el Rotogage para medir el volumen, influencia de las condiciones ambientales y el no cumplimiento de los procedimientos de trabajo, lo que fue confirmado con el an��lisis de Pareto. Se construyen cartas de control que permitan identificar los principales elementos que provocan la inestabilidad estad��stica. Se detecta que existen variaciones en la medici��n debido a que todas las variables tuvieron puntos fuera de los l��mites estad��sticos en la variable o en el rango. ese resultado afecta el resto del proceso, provocando resultados il��gicos en la determinaci��n del ��ndice de p��rdidas, por lo que se recomienda la consideraci��n de la incertidumbre en las mediciones realizadas para estimar un nuevo valor del mismo. Palabras claves: Gas Licuado de Petr��leo, calidad, Rotogage, ��ndice de p��rdidas

En varios estudios donde se utiliza la modelaci��n matem��tica para el an��lisis de la etapa de pasteurizaci��n de la cerveza se ha observado que se emplean, sin criterio alguno, las propiedades termof��sicas del agua. En este trabajo se realizan pruebas de hip��tesis para medias con el objetivo de validar ese razonamiento, comparando los modelos de la densidad, viscosidad, conductividad t��rmica y la capacidad calor��fica para el agua, con otros que se reportan en la literatura. Los resultados obtenidos, para el intervalo de temperatura de trabajo de un pasteurizador de t��nel, arrojaron en todos los casos un valor de la probabilidad (p), mayor que 0,05 por lo que, al no rechazarse la hip��tesis nula (Ho), se concluye que pueden ser utilizados satisfactoriamente los modelos del agua para la cerveza. Palabras claves: cerveza, propiedades termof��sicas, pasteurizaci��n, pruebas de hip��tesis

Las Unidades de Pasteurizaci��n (UP) permiten evaluar la calidad del proceso de pasteurizaci��n de la cerveza. Cuando esta se envasa en botellas de vidrio, al pasar por el interior de un pasteurizador de t��nel, todo el tiempo correspondiente a las etapas de calentamiento, prepasteurizaci��n y pasteurizaci��n se toma en cuenta para el c��lculo de las UP. Este estudio tiene como objetivo analizar, mediante la simulaci��n del proceso utilizando la Din��mica de Fluidos Computacional a trav��s del software COMSOL, la variaci��n que existe en las UP cuando se considera el tiempo para el calentamiento de la botella. Los resultados arrojan una diferencia que debe tenerse en cuenta para no incurrir en errores que desmeriten la calidad del producto pasteurizado. Palabras claves: cerveza, pasteurizaci��n, unidades de pasteurizaci��n, botellas de vidrio

En varios estudios donde se utiliza la modelación matemática para el análisis de la etapa de pasteurización de la cerveza se ha observado que se emplean, sin criterio alguno, las propiedades termofísicas del agua. En este trabajo se realizan pruebas de hipótesis para medias con el objetivo de validar ese razonamiento, comparando los modelos de la densidad, viscosidad, conductividad térmica y la capacidad calorífica para el agua, con otros que se reportan en la literatura. Los resultados obtenidos, para el intervalo de temperatura de trabajo de un pasteurizador de túnel, arrojaron en todos los casos un valor de la probabilidad (p), mayor que 0,05 por lo que, al no rechazarse la hipótesis nula (Ho), se concluye que pueden ser utilizados satisfactoriamente los modelos del agua para la cerveza. Palabras claves: cerveza, propiedades termofísicas, pasteurización, pruebas de hipótesis

Background and Objectives: Candida colonization in neonates with low birth weight is reported to be the first step for invasive candidiasis. This study was designed to describe the patterns of Candida spp. colonizing neonates with low birth weight in Mwanza, Tanzania to provide baseline information for future studies in this field. Methodology: The hospital based cross sectional study was conducted between January 2019 and April 2019 among neonates with low birth weight. Clinical and social demographic data were collected using interview guide questionnaire. Oral and umbilical rectal swabs were collected on the first and seventh day of life to assess Candida spp. colonization status. Data were analyzed using STATA version 13 following the study objectives. Results: A total of 320 neonates with median body weight of 1600 [IQR 1000 - 2000] grams were enrolled. Prevalence of Candida spp. colonization on either oral, umbilical or rectum was 16.2% (52/320). A total of 34 (10.6%) and 41 (12.8%) neonates were colonized by Candida spp. on the first day and seventh day of life, respectively. Of 34 neonates colonized on the first day of life, 23 (67.7%) were still being colonized on the seventh day. Candida albicans 38 (73.1%), was the predominant species detected followed by Candida glabrata 10 (19.2%). Conclusion: The prevalence of Candida spp. colonization among neonates with low birth weight is within the reported range and is mainly due to Candida albicans. Future studies are highly needed to explore the role of colonization and subsequent Candida spp. infections.

OBJECTIVE The aim of the study was to document treatment-seeking experiences of women with chronic vulvar pain, comfort communicating about pain, and test the clinical utility of the screening version of the Vulvar Pain Assessment Questionnaire, screening version (VPAQscreen). MATERIALS AND METHODS Patients scheduled for an appointment with the Program in Vulvar Health at Oregon Health and Science University were invited to complete the VPAQscreen and answer descriptive questions about previous treatment-seeking experiences and communication with health care providers. Clinicians provided provisional diagnoses based on VPAQscreen summaries, final diagnoses based on gynecological examination, and commented on alignment with clinical observations. Patients gave feedback on the accuracy and helpfulness of the VPAQscreen summary, characteristics of the questions asked, and whether their comfort communicating increased. RESULTS Participants reported previously seeing approximately 5 medical doctors and 2 other health care providers and perceived them as lacking knowledge of vulvar pain syndromes. Providers indicated that VPAQscreen summaries aligned with clinical presentations and suggested provisional diagnoses with more than 80% accuracy. Participants reported that VPAQscreen summaries were helpful and accurate in summarizing symptoms. Most reported that the number, range, and readability of VPAQscreen questions were good or excellent. More than half reported that completing the VPAQscreen increased comfort when speaking with their Oregon Health and Science University physician. CONCLUSIONS Patients with vulvar pain often endure a lengthy process of consulting multiple clinicians before securing care. The VPAQscreen was more than 80% accurate in predicting diagnosis at this specialty clinic and was useful in assisting patients with expressing symptoms. The applicability of the VPAQscreen in general practice is unknown, although it shows promise.