Persistence of onchocerciasis and associated dermatologic and ophthalmic pathologies after 27 years of ivermectin mass drug administration in the middle belt of Ghana

Objectives

There is a pressing need to regularly evaluate the progress of onchocerciasis elimination programmes to timely identify and mitigate potential risks hindering the reaching of the 2030 targets proposed by the World Health Organization (WHO) in its roadmap on neglected tropical diseases (NTDs). We determined the prevalence of onchocerciasis and associated dermatological and ophthalmological manifestations in six endemic communities in the Bono Region of Ghana after 27 years of ivermectin mass treatment.

Methods

In a cross-sectional study, 564 participants aged ≥5 years were enrolled (49.1% females), with a median age of 26 (range: 5–89) years. In 54% and 47%, skin-snip microscopy and Ov16 rapid diagnostic tests were performed, respectively. Skin disease was determined using the WHO Skin NTD App. Visual function assessments included tests of visual acuity.

Results

The overall microfilarial prevalence was 12.5% (38/305) and Ov16 seroprevalence was 24.2% (64/265). Severe itching was recorded in 24.3%, acute papular onchodermatitis in 52.8%, chronic papular onchodermatitis in 12.5%, lichenified onchodermatitis in 0.7%, skin atrophy in 11.3%, depigmentation in 1.7% and palpable nodules in 5.3%. Of the 301 persons in which visual acuity was examined, 17% were visually impaired and 5.3% were blind and 47.3% presented with cataract. Chronic papular onchodermatitis, lichenified onchodermatitis, depigmentation and visual impairment were significantly associated with the presence of skin microfilariae and Ov16 seropositivity.

Conclusions

The persistence of Onchocerca volvulus infection and onchocerciasis-associated dermatological and ophthalmological pathologies after prolonged treatment is of concern. There is a need to include morbidity management in onchocerciasis elimination programmes and understand better patterns of treatment coverage, adherence and actual intake of ivermectin.     

Long-term biological variation in cardiac troponin I

ObjectivesTo determine the long-term biological variation (BV) of cardiac troponin I.Design and methodsThree samples separated by a mean of 8.7 ± 2.8 months from 17 patients seen in an outpatient clinic. Tropoinin I was measured using a high sensitivity assay from Singulex, Inc.ResultsThe long-term analytical, intra-assay and total variation were 15.2%, 27.9%, and 70.9%, respectively. The index of individuality (II) was 0.45, and the reference change value was + 98% and ? 50%, respectively.ConclusionThe BV over 9 months was comparable to previously published results over 2 months using the same testing methodology. The II indicates that reference range values are of less value than serial testing.     

First report of immunohistochemical detection of Peste des petit ruminants,parainfluenza 3 and respiratory syncytial viral antigens in lungs of Nigerian goats

This study determined the of involvement of PPR, PI3, and RS viruses in the pathology of caprine pneumonia across Nigeria. 150 goats were selected randomly. PI3 and RSV monoclonal antibodies and PPR polyclonal antibody were used for the immunolocalization of the antigens. Histologically, 61 of the goats had broncho-interstitial pneumonia, 25 had interstitial pneumonia, 42 had bronchopneumonia, 12 had bronchiolitis, and 10 were normal. PPR, PI3, and RS viral antigens were demonstrated in: intact and desquamated bronchial, bronchiolar epithelial cells, macrophages, leukocytes, pneumocytes, and giant cells. 23% of the caprine lungs had positive immuno-staining to PI3 viral antigen, 10% were positive for RSV antigen while 34% were positive for PPR viral antigen. 8% showed immunostaining for the two and or three respiratory viral antigens in the goats. PI3 and RSV antigens were more in the young goats, red sokoto breed and during the dry season. This is the first report of immunohistochemical detection of PPR, PI3 and RS viral antigens in caprine lungs in Nigeria. These findings underscore the importance of PI3 and RSV viruses in the control of caprine pneumonia in Nigeria.     

Lipid peroxidation in brain tissue following administration of low and high doses of arsenite and L-ascorbate in wistar strain rats

This study aimed at investigating the mechanism by which sodium arsenite induces brain injury and the role of L-ascorbate. Thirty adult (n=5) Wistar rats weighing between 140 and 160 g were used. Group 1 neither received sodium arsenite nor L-ascorbate (control), group 2 was administered low dose of arsenite only, group 3 received high dose of arsenite only, group 4 was administered L-ascorbate only, group 5 was administered low dose of arsenite and L-ascorbate, and group 6 received high dose of arsenite and L-ascorbate. M0 alon dialdehyde, MDA, levels were significantly increased in rats treated with high dose of arsenite when compared with those treated with low dose of arsenite. However, all treated groups except those treated with L-ascorbate only showed significant increase in MDA levels when compared with the control group. Rats treated with high dose of arsenite and L-ascorbate showed a significantly higher MDA level than those treated with low dose of arsenite and L-ascorbate. However, catalase activity, body weight gain, brain weight and mean food consumption were comparable across all groups. Brain tissue total protein was similar in all groups except in both groups treated with high dose of arsenite, where they were significantly reduced when compared with the control group. I0 n conclusion, sodium arsenite treatment induces brain injury via a mechanism associated with lipid peroxidation, but not catalase-dependent. However, L-ascorbate ameliorates arsenite-induced oxidative injury in the brain. L-ascorbate antioxidative potential in alleviating arsenite-induced brain injury is dependent on the concentration of arsenite.     

In vivo trypanocidal activity of Annona senegalensis Pers. leaf extract against Trypanosoma brucei brucei

Chemotherapy of African trypanosomiasis still remains far from being satisfactory. There is the urgent need for therapeutic agents that are effective, affordable and accessible to the rural poor in Africa who bear most of the disease burden. Root preparations of Annona senegalensis Pers. is claimed by traditional medicine practitioners to be effective in the treatment of sleeping sickness. Validation of this claim, evaluation of the therapeutic effects of other parts of the plant, and standardization of the preparations are necessary in order to fully exploit the chemotherapeutic potentials of this plant. We have evaluated the chemotherapeutic effects of extracts of the leaves, whole root, root and stem bark of the plant in experimental trypanosomiasis. Crude and partially purified aqueous extracts of the leaves, at a dose of 200mg/kg body weight per day completely cured experimental Trypanosoma brucei brucei infection in mice. Sub-inoculation of blood and cerebrospinal fluid drawn from the cured mice into healthy mice failed to produce any infection within 60 days of post-inoculation. Pre-treatment of healthy mice with the crude extract before infection did not prevent establishment of infection. Administration of 5000mg/kg body weight of the crude extract did not lead to fatality in mice. Preliminary phytochemical screening showed the presence of tannin, phlobatanin, and saponin.     

Patient acceptance of a foot pump device used for thromboprophylaxis

Our study aimed to find out patients' opinion on a foot pump device used for thromboprophylaxis, as compared to subcutaneous low molecular weight heparin injections. A survey of 43 consecutive patients undergoing hip and knee joint replacement was carried out at our hospital. Patients were assessed for pain and a questionnaire was used to gauge patients' attitudes towards the two thromboprophylactic measures. There was no statistically significant difference in the level of discomfort as assessed on the visual analogue score, between two methods. An equal percentage of patients (74.4%) disagreed that either the foot pump or injection was painful (p = 1). Though a larger percentage of patients (footpumps: 44.2%, injections: 27.9%; p = 0.12) would rather not use the foot pump, still 69.8% would be willing to keep on using these foot pumps at home for 4 weeks after discharge from the hospital. Eighty one percent were agreeable to foot pump use if they have another joint replacement later. Overall, the foot pump was at least as well tolerated as subcutaneous low molecular weight heparin in the group studied. Its use as post discharge prophylaxis is also acceptable to the majority of our patients.     

Mature cystic renal teratoma in a 25-year-old woman with ipsilateral hydronephrosis, urinary tract infection and spontaneous abortion

Benign cystic renal teratomas are uncommon clinical entities in our environment. To the best of our knowledge, it has never been reported here. Renal teratomas are rare and most have been dismissed as retroperitoneal teratomas secondarily invading the kidney. We report a case in which benign cystic renal teratoma was associated with ipsilateral hydronephrosis, urinary tract infection and spontaneous abortion, with histological confirmation in a 25-year-old woman.