Ureteroscopy Outcome and Its Determinants in a Resource-Limited Setting

BackgroundUreteroscopy is a major diagnostic and therapeutic technique for lesions of the ureter and intrarenal collecting system.MethodsA retrospective chart review was done at St. Paul''s Hospital Millennium Medical College, Ethiopia to determine the outcome of ureteroscopy and factors affecting it. The study period was from January 2018 to April 2018. Multivariate analysis was done to determine factors affecting stone clearance and success rate.ResultOne hundred six patients who underwent semirigid ureteroscopy were included in the study. The male-to-female ratio was 1.8:1. The mean age of the patients was 36.4 years (±12.6). Ninety-six (90.6%) patients were found to have ureteric stones, while 9(8.5%) patients had a ureteric stricture. Ureteroscopy therapeutic interventions for stones were successful in 89 (92.7%) patients. The mean procedure time and postoperative hospital stay were 44 minutes (±23.7) and 2.5 days (±2.5) respectively. Intraoperative complications (ureteric avulsion, hemorrhage, and ureteral perforations) occurred in 6(5.7%) patients. The stone clearance rate was 54.7% (52). The site of obstruction was passed in 93 patients making the success rate of the procedure 87.7%. The absence of intraoperative complications was significantly associated with success rate. Patients with intraoperative complications have low success rate (20%) compared to patients without complications (92.3%), p=0.42.ConclusionsSemirigid ureteroscopy had a good success rate, especially for stones in the distal ureter and if there is no flexible ureteroscope, it is an acceptable alternative.     

Review of Modeling Techniques for Analysis and Assessment of RC Beam–Column Joints Subjected to Seismic Loads

Beam–column connections are the most critical components of reinforced concrete (RC) structures. They serve as a load transfer path and take a significant portion of the overall shear. Joints in RC structures constructed with no seismic provisions have an insufficient capacity and ductility under lateral loading and can cause the progressive failure of the entire structure. The joint may fail in the shear prior to the connecting beam and column elements. Therefore, several modeling techniques have been devised in the past to capture the non-linear response of such joints. Modeling techniques used to capture the non-linear response of reinforced-concrete-beam–column joints range from simplified lumped plasticity models to detailed fiber-based finite element (FE) models. The macro-modeling technique for joint modeling is highly efficient in terms of the computational effort, analysis time, and computer memory requirements, and is one of the most widely used modeling techniques. The non-linear shear response of the joint panel and interface bond–slip mechanism are concentrated in zero-length linear and rotational springs while the connecting elements are modeled through elastic elements. The shear response of joint panels has also been captured through rigid panel boundary elements with rotational springs. The computational efficiency of these models is significantly high compared to continuum models, as each joint act as a separate supe-element. This paper aims to provide an up-to-date review of macro-modeling techniques for the analysis and assessment of RC-beam–column connections subjected to lateral loads. A thorough understanding of existing models is necessary for developing new mechanically adequate and computationally efficient joint models for the analysis and assessment of deficient RC connections. This paper will provide a basis for further research on the topic and will assist in the modification and optimization of existing models. As each model is critically evaluated, and their respective capabilities and limitations are explored, it should help researchers to improve and build on modeling techniques both in terms of accuracy and computational efficiency.     

Sero-prevalence of Hepatitis B virus surface antigen and associated factors among women of reproductive age in Bench Maji Zone,Southwest Ethiopia: community based cross-sectional study

BackgroundHepatitis B virus infection is one of the leading causes of liver diseases which occurs worldwide particularly in developing countries. It is often caused by prenatal transmission from mother to child or household transmission from a close contact during early childhood. It causes different complications like; jaundice, induces premature labor, and prematurity.ObjectiveThe aim of this study was to estimate the sero-prevalence of hepatitis B virus surface antigen and associated factors among women of reproductive age in Bench Maji Zone, South West Ethiopia.MethodsA community-based cross-sectional study was conducted from December 15th, 2016 to February 15th, 2017. Multistage sampling technique was applied to select study participants. Logistic regression analysis was applied and p-values < 0.05 was used to see the significant association between dependent and independent variables.ResultsA total of 330 participants were included in this study yielding 98.8% response rate. The sero-prevalence of HBsAg among women of reproductive age was 28(8.5%). Having multiple sexual partners (AOR = 18.73, 95% CI =3.65, 96.21) history of unprotected sex (AOR = 9.39, 95% CI =1.64, 53.77) were found to be significantly associated with sero-prevalence of HBV.ConclusionsThe sero-prevalence of HBV infection among women of reproductive age was highly endemic. Hence, behavioral education and communication programs focusing on reduction of risky sexual behaviors should be designed to reduce HBV infection.     

Mediators of socioeconomic inequalities in dietary behaviours among youth: A systematic review

Children and adolescents with a lower socioeconomic position have poorer dietary behaviours compared to their counterparts with a higher socioeconomic position. A better understanding of the mechanisms behind such socioeconomic inequalities is vital to identify targets for interventions aimed at tackling these inequalities. This systematic review aimed to summarize existing evidence regarding the mediators of socioeconomic differences in dietary behaviours among youth. A systematic literature search of MEDLINE, Embase, PsycINFO, and Web of Science databases yielded 20 eligible studies. The dietary behaviours included in the reviewed studies were the intake of fruit and vegetables, sugar‐sweetened beverages, unhealthy snacks/fast food and breakfast. The consistent mediators of the effects of socioeconomic position on dietary behaviours among youth were: self‐efficacy, food preferences and knowledge at the intrapersonal level; and availability and accessibility of food items at home, food rules and parental modelling at the interpersonal level. Few studies including mediators at the organisational, community or policy levels were found. Our review found several modifiable factors at the intrapersonal and interpersonal levels that could be targeted in interventions aimed at combating inequalities in dietary behaviours among youth. Rigorous studies exploring organisational, community and policy level mediators are warranted.     

Examining 7 years of implementing quality management systems in medical laboratories in sub-Saharan Africa

Background

Achievement of ISO15189 accreditation demonstrates competency of a laboratory to conduct testing. Three programmes were developed to facilitate achievement of accreditation in low- and middle-income countries: Strengthening Laboratory Management Towards Accreditation (SLMTA), Stepwise Laboratory Improvement Process Towards Accreditation (SLIPTA) and Laboratory Quality Stepwise Implementation (LQSI).

Objective

To determine the level of accreditation and associated barriers and facilitators among medical laboratories in the WHO-AFRO region by 2020.

Methods

A desk review of SLIPTA and SLMTA databases was conducted to identify ISO15189-accredited medical laboratories between January 2013 and December 2020. Data on access to the LQSI tool were extracted from the WHO database. Facility and country characteristics were collected for analysis as possible enablers of accreditation. The chi-square test was used to analyse differences with level of significance set at <0.05.

Results

A total of 668 laboratories achieved accreditation by 2020 representing a 75% increase from the number in 2013. Accredited laboratories were mainly in South Africa (n = 396; 55%) and Kenya (n = 106; 16%), two countries with national accreditation bodies. About 16.9% (n = 113) of the accredited laboratories were registered for the SLIPTA programme and 26.6% (n = 178) for SLMTA. Approximately 58,217 LQSI users were registered by December 2020. Countries with a higher UHC index for access to HIV care and treatment, higher WHO JEE scores for laboratory networks, a larger number of registered LQSI users, with national laboratory policy/strategic plans and PEPFAR-priority countries were more likely to have an accredited laboratory. Of the 475 laboratories engaged in the SLIPTA programme, 154 attained ≥4 SLIPTA stars (ready to apply for accreditation) and 113 achieved ISO 15189 accreditation, with 96 enrolled into the SLMTA programme. Lower-tier laboratories were less likely to achieve accreditation than higher-tier laboratories (7.7% vs. 30%) (p < 0.001). The probability of achieving ISO 15189 accreditation (19%) was highest during the first 24 months after enrolment into the SLIPTA programme.

Conclusion

To sustainably anchor quality improvement initiatives at facility level, national approaches including access to a national accreditation authority, adoption of national quality standards and regulatory frameworks are required.     

Insights into SARS-CoV-2 in Angola during the COVID-19 peak: Molecular epidemiology and genome surveillance

Background

In Angola, COVID-19 cases have been reported in all provinces, resulting in >105,000 cases and >1900 deaths. However, no detailed genomic surveillance into the introduction and spread of the SARS-CoV-2 virus has been conducted in Angola. We aimed to investigate the emergence and epidemic progression during the peak of the COVID-19 pandemic in Angola.

Methods

We generated 1210 whole-genome SARS-CoV-2 sequences, contributing West African data to the global context, that were phylogenetically compared against global strains. Virus movement events were inferred using ancestral state reconstruction.

Results

The epidemic in Angola was marked by four distinct waves of infection, dominated by 12 virus lineages, including VOCs, VOIs, and the VUM C.16, which was unique to South-Western Africa and circulated for an extended period within the region. Virus exchanges occurred between Angola and its neighboring countries, and strong links with Brazil and Portugal reflected the historical and cultural ties shared between these countries. The first case likely originated from southern Africa.

Conclusion

A lack of a robust genome surveillance network and strong dependence on out-of-country sequencing limit real-time data generation to achieve timely disease outbreak responses, which remains of the utmost importance to mitigate future disease outbreaks in Angola.     

Momelotinib treatment‐emergent neuropathy: prevalence,risk factors and outcome in 100 patients with myelofibrosis

Momelotinib (a JAK1 and JAK2 inhibitor) induces both anaemia and spleen responses in myelofibrosis (MF). Momelotinib treatment‐emergent peripheral neuropathy (TE‐PN) was documented in 44 (44%) of 100 MF patients treated at our institution; median time of TE‐PN onset was 32 weeks and duration 11 months. Improvement after drug dose reduction or discontinuation was documented in only two patients. TE‐PN was significantly associated with treatment response (P = 0·02) and longer survival (P = 0·048) but significance was lost during multivariate analysis that included treatment duration. TE‐PN did not correlate with initial or maximum momelotinib dose or previous treatment with JAK inhibitor or thalidomide.     

Increased nicotinamide nucleotide transhydrogenase levels predispose to insulin hypersecretion in a mouse strain susceptible to diabetes

Aims/hypothesis Insulin hypersecretion may be an independent predictor of progression to type 2 diabetes. Identifying genes affecting insulin hypersecretion are important in understanding disease progression. We have previously shown that diabetes-susceptible DBA/2 mice congenitally display high insulin secretion. We studied this model to map and identify the gene(s) responsible for this trait. Methods Intravenous glucose tolerance tests followed by a genome-wide scan were performed on 171 (C57BL/6 × DBA/2) × C57BL/6 backcross mice. Results A quantitative trait locus, designated hyperinsulin production-1 (Hip1), was mapped with a logarithm of odds score of 7.7 to a region on chromosome 13. Production of congenic mice confirmed that Hip1 influenced the insulin hypersecretion trait. By studying appropriate recombinant inbred mouse strains, the Hip1 locus was further localised to a 2 Mb interval, which contained only nine genes. Expression analysis showed that the only gene differentially expressed in islets isolated from the parental strains was Nnt, which encodes the mitochondrial proton pump, nicotinamide nucleotide transhydrogenase (NNT). We also found in five mouse strains a positive correlation (r ²  = 0.90, p < 0.01) between NNT activity and first-phase insulin secretion, emphasising the importance of this enzyme in beta cell function. Furthermore, of these five strains, only those with high NNT activity are known to exhibit severe diabetes after becoming obese. Conclusions/interpretation Insulin hypersecretion is associated with increased Nnt expression. We suggest that NNT must play an important role in beta cell function and that its effect on the high insulin secretory capacity of the DBA/2 mouse may predispose beta cells of these mice to failure. G. Morahan and S. Andrikopoulos contributed equally to this study.     

Therapy-related acute promyelocytic leukemia: observations relating to APL pathogenesis and therapy

Therapy-related acute promyelocytic leukemia (t-APL) is a well-recognized form of APL for which the underlying etiology has been well characterized. The pathogenesis of de novo (dn-APL) remains unknown; but epidemiologic studies have consistently identified increased body mass index (BMI), younger age, and ethnicity as possible risk factors. We analyzed demographics, clinical features, and treatment responses in a contemporary series of 64 patients treated with all-trans-retinoic acid and anthracycline-based therapy to assess for differences in these two etiologically distinct patient groups. Compared with patients with t-APL (n = 11), those with dn-APL (n = 53) had a greater median BMI (31.33 vs. 28.48), incidence of obesity (60.4% vs. 27.3%) (P = 0.04), and history of hyperlipidemia (45.3% vs. 18.2%) (P = 0.01). Fewer t-APL than dn-APL patients achieved complete remission at 63.6% vs. 92.5% respectively (P = 0.008). This was the result of a higher induction mortality rate of 36.4% vs. 7.5% respectively (P = 0.008). No cases of leukemic resistance were seen in either group. Overall survival (OS) was inferior in t-APL compared with dn-APL at 51% vs. 84%, respectively (P < 0.005), primarily as a result of higher induction mortality. Relapse occurred in nine patients (16.1%) overall, but no relapses occurred in the t-APL cohort. Our observations provide further support for the hypothesis that abnormalities in lipid homeostasis may in some way be of pathogenic importance in dn-APL. Therapy-related APL is sensitive to standard therapy with no cases of resistance or relapse seen. The inferior OS of the t-APL was due to induction mortality, possibly reflecting prior therapy.     

Somalia: supporting the child survival agenda when routine health service is broken

Somalia, one of the most unstable countries in the world, has been without a permanent government for nearly 2 decades. With a health system in total disarray, coverage of basic health interventions remains low and, maternal and child mortality is among the highest in the world. Health partners jointly outlined an integrated package of critical child survival interventions to be delivered through a population-based delivery strategy known as Child Health Days (CHDs), to reduce child mortality. Using this strategy, key child survival interventions are delivered to the community with an objective of reaching children <5 years and women of childbearing age in all districts of Somalia every 6 months. Through this strategy, immunization services were reached in remote areas, and coverage disparity between the urban and rural areas was reduced from 17% (42% urban and 25% rural) to 10% (50% urban and 60% rural). In addition, infants were reached with a third dose of diphtheria-pertussis-tetanus vaccine, achieving 51% coverage during 2009 and 66% in 2010. This paper summarizes the challenges of scaling up child interventions in the troubled context of Somalia by reviewing the planning, implementation, and achievements of CHDs as well as reflecting on challenges for the future of child survival in Somalia.