Patient referral alone is not an effective strategy to capture partners of patients with sexually transmitted infections in low-resource settings: a case-control study

Aim

Partner notification (PN) is a key public health intervention aimed at preventing re-infection and controlling the spread of STIs. However, only limited research has been conducted to investigate factors associated with PN in Ethiopia.

Subject and methods

A nested case-control study was undertaken within a cohort of individuals being treated for STIs in public health facilities in Ethiopia. Hierarchical binary logistic regression was used to identify socio-demographic, behavioral and psychosocial factors associated with PN.

Results

A total of 250 patients on STI treatment who notified their partners (cases) were compared with 185 patients who did not notify their partners (controls). STI patients were less likely to notify their partner if they were single [AOR = 0.33, 95% CI: (0.15–0.73)], in a casual partnership [adjusted odds ratio (AOR) = 0.33, 95% CI: (0.15–73)], not knowledgeable about a partner’s sexual behavior [AOR = 0.43, 95% CI: (0.24–0.77)], had poor knowledge of risky sexual behavior [AOR = 0.23, 95% CI: (0.12–0.43)] and had no intention of notifying partners [AOR = 0.19, 95% CI: (0.10–0.36)]. The odds of PN were higher among highly educated respondents [AOR = 5.16; 95% CI: (1.83–14.54)].

Conclusion

Capturing STI cases through patient referral partner notification is less likely to be successful among patients who are single and in a casual relationship.

     

Evaluation of the impact of pharmacist-led medication reconciliation intervention: a single centre pre–post study from Ethiopia

International Journal of Clinical Pharmacy - Background The role of pharmacists in medication reconciliation (MedRec) is highly acknowledged in many developed nations. However, the impact of this...     

Ceftriaxone-induced pseudolithiasis in children treated for perforated appendicitis

Purpose

Ceftriaxone has been associated with development of pseudolithiasis. In our institution, it is used for treatment of perforated appendicitis in children. This study evaluated the occurrence of ceftriaxone-related pseudolithiasis in this population.

Methods

After obtaining IRB approval, we performed a retrospective chart review over 51 months. We included patients undergoing laparoscopic appendectomy for perforated appendicitis. All patients were treated with ceftriaxone post-operatively. Patients without initial or post-treatment gallbladder imaging available for review were excluded.

Results

There were 71 patients who met inclusion criteria with a mean (±SD) age of 10.8 ± 3.8 years. Of these, 14 % (n = 10) developed stones or sludge in the gallbladder. The mean duration of ceftriaxone therapy was 8.7 ± 3.8 days. The average time to post-antibiotic imaging was 11.5 ± 10.3 days from initiation of antibiotics. There was no significant difference in duration of ceftriaxone therapy in the children that developed pseudolithiasis or sludge (10.0 ± 4.9 days) compared to those that did not (8.5 ± 3.6, p = 0.26). One child (10 %) with pseudolithiasis went on to become symptomatic, requiring a laparoscopic cholecystectomy.

Conclusions

In our experience, ceftriaxone use for perforated appendicitis is associated with a significant incidence of biliary pseudolithiasis, and is unrelated to duration of ceftriaxone therapy.     

Radiation exposure from head computed tomography scans in pediatric trauma

Background

We have previously reported that children receive significantly less radiation exposure after abdominal and/or pelvis computed tomography (CT) scanning for acute appendicitis when performed at our children's hospital (CH) rather than at outside hospitals (OH). In this study, we compare the amount of radiation children receive from head CTs for trauma done at OH versus those at our CH.

Methods

A retrospective chart review was performed on all children transferred to our hospital after receiving a head CT for trauma at an OH between July 2012 and December 2012. These children were then blindly case matched based on date, age, and gender to children at our CH.

Results

There were 50 children who underwent head CT scans for trauma at 28 OH. There were 21 females and 29 males in each group. Average age was 7.01 ± 0.5 y at the OH and 7.14 ± 6.07 at our CH (P = 0.92). Average weight was 30.81 ± 4.69 kg at the OH and 32.69 ± 27.21 kg at our CH (P = 0.81). Radiation measures included dose length product (671.21 ± 22.6 mGycm at OH versus 786.28 ± 246.3 mGycm at CH, P = 0.11) and CT dose index (53.4 ± 2.26 mGy at OH versus 49.2 ± 12.94 mGy at CH, P = 0.56).

Conclusions

There is no significant difference between radiation exposure secondary to head CTs for traumatic injuries performed at OH and those at a dedicated CH.     

Andrographolide derivatives inhibit guanine nucleotide exchange and abrogate oncogenic Ras function

Aberrant signaling by oncogenic mutant rat sarcoma (Ras) proteins occurs in ∼15% of all human tumors, yet direct inhibition of Ras by small molecules has remained elusive. Recently, several small-molecule ligands have been discovered that directly bind Ras and inhibit its function by interfering with exchange factor binding. However, it is unclear whether, or how, these ligands could lead to drugs that act against constitutively active oncogenic mutant Ras. Using a dynamics-based pocket identification scheme, ensemble docking, and innovative cell-based assays, here we show that andrographolide (AGP)—a bicyclic diterpenoid lactone isolated from Andrographis paniculata—and its benzylidene derivatives bind to transient pockets on Kirsten-Ras (K-Ras) and inhibit GDP–GTP exchange. As expected for inhibitors of exchange factor binding, AGP derivatives reduced GTP loading of wild-type K-Ras in response to acute EGF stimulation with a concomitant reduction in MAPK activation. Remarkably, however, prolonged treatment with AGP derivatives also reduced GTP loading of, and signal transmission by, oncogenic mutant K-RasG12V. In sum, the combined analysis of our computational and cell biology results show that AGP derivatives directly bind Ras, block GDP–GTP exchange, and inhibit both wild-type and oncogenic K-Ras signaling. Importantly, our findings not only show that nucleotide exchange factors are required for oncogenic Ras signaling but also demonstrate that inhibiting nucleotide exchange is a valid approach to abrogating the function of oncogenic mutant Ras.     

Clinical Activity and Polymerase Chain Reaction Evidence of Chlamydial Infection after Repeated Mass Antibiotic Treatments for Trachoma

It is unclear how the prevalence of clinically active trachoma correlates with the prevalence of ocular chlamydial infection at the community level. In 24 villages from a cluster-randomized clinical trial of mass azithromycin distributions in Ethiopia, the correlation between the prevalence of clinical activity (on examination) and chlamydial infection (by polymerase chain reaction) was moderately strong before mass antibiotic treatments (Pearson''s correlation coefficient r = 0.75, 95% confidence interval [CI] = 0.52–0.87), but decreased at each time point during four biannual treatments (at 24 months, r = 0.15, 95% CI = −0.14–0.41). One year after the final treatment, the correlation coefficient had increased, but not to the pre-treatment level (r = 0.55, 95% CI = 0.30–0.73). In a region with hyperendemic trachoma, conjunctival examination was a useful indicator of the prevalence of chlamydial infection before treatments, less useful during mass treatments, but regained utility by one year after treatments had stopped.     

Management of traumatic arterio-venous fistulas,experience in Armed Forces General Hospital,Addis Ababa

In Armed Forces General Hospital from March to December 1999, 53 patients were operated for Arterio-venous fistula. All were males, their age ranging from 19 to 46 years, average 27 years. The diagnosis of arterio-venous fistulas was established clinically. The pathological distribution of the lesions were: 23(43.4%) Arterio-Venous aneurysm; 11(20.75%) Arterio-Venous fistula, 19(35.85%) Arterial false aneurysms. The anatomical location was: 15 femoral, 10 Tibial, 6 poplitial, 6 brachial, 4 Axilláry, 1 ulnar, 7 external carotid and 1 occipital. The types of surgical procedures performed were: 29 (54.72%) excision of the arterio-venous fistula and aneurismal sac with arterial restoration by end to end anastomosis and/or saphenous vein graft, 16(30.19%) by excision of arteriovenous fistula and quadriple ligation of small vessels, 8(15.09%) excision of the false aneurismal sac and lateral repair of the artery (lateral arterioraphy). During the post operative period the patients were followed for three months, and we had the following results based on the clinical outcome criteria; 37(69.81%) excellent, 15(28.3%) good and 1(1.89%) fair.     

Comparison of computer assisted scan diagnoses and clinical diagnoses of major mental disorders in Butajira, rural Ethiopia

One of the major difficulties in mental health research is finding suitable research instruments. In the last few decades questionnaires that are supposed to work in different languages and cultures have been developed by WHO to solve this problem. One of such instruments is SCAN, an instrument which uses computer algorithm to make a diagnosis. It is meant to be used for semi-structured interview by qualified psychiatrists or clinical psychologists. This and a few other research instruments have been translated and used in clinical and community settings for psychiatric research in Ethiopia over the last few years. In this study computer assisted SCAN Diagnoses and clinical diagnoses made by trainee psychiatrists in Butajira, a rural setting in Ethiopia, were compared Seven hundred twenty nine persons were diagnosed to have schizophrenia and bipolar disorder using both methods. The agreement between the clinical and SCAN derived diagnosis was shown to be 100% for schizophrenia (Kappa = 1.0). However, the agreement between the two methods of diagnosis was shown to be lower when it comes to subtypes of schizophrenia. The agreement for the diagnoses of bipolar disorder was 95.3%, kappa = 0.9, P < 0.0001 and for depression it was 93.0%, kappa = 0.8, p < 0.0001. Taking into account the limited number of psychiatrists and clinical psychologists in the third world countries like Ethiopia we have shown that using trainees in psychiatry for SCAN interview is a feasible and reliable method to identify major categories of mental disorders in community studies.     

Pesky trachoma suspect finally caught

AIM: Face seeking flies have long been thought to transmit Chlamydia trachomatis, the causative agent of trachoma, but this has never been proven. The four criteria proposed by Barnett, previously used to incriminate other arthropods suspected of transmitting disease, were examined. One of these criteria remains unmet: the repeated demonstration of the presence of C trachomatis on flies. The authors used polymerase chain reaction (PCR) to look for the presence of C trachomatis DNA on flies in the Gurage Zone of Ethiopia. METHODS: Using sticky paper, one fly was collected from the face of each of 103 children aged 1-10 years. The piece of fly paper to which the fly was attached was cut out, followed by the collection of an empty piece from an arbitrary area of the fly paper, which served as control. Roche Amplicor PCR kits were used to detect C trachomatis DNA. RESULTS: Evidence of C trachomatis by PCR was found on 15 of 103 flies versus 0 of 103 controls (p = 0.0001). CONCLUSION: These results meet the final criterion needed to incriminate flies as a vector of trachoma. However, interventional studies will be needed to show the importance of fly control.     

Low vision and blindness in adults in Gurage Zone,central Ethiopia

AIM: To determine the magnitude and causes of low vision and blindness in the Gurage zone, central Ethiopia. METHODS: A cross sectional study using a multistage cluster sampling technique was used to identify the study subjects. Visual acuity was recorded for all adults 40 years and older. Subjects who had a visual acuity of <6/18 were examined by an ophthalmologist to determine the cause of low vision or blindness. RESULTS: From the enumerated population, 2693 (90.8%) were examined. The prevalence of blindness (<3/60 better eye presenting vision) was 7.9% (95% CI 6.9 to 8.9) and of low vision (6/24-3/60 better eye presenting vision) was 12.1% (95% CI 10.9 to 13.3). Monocular blindness was recorded in 16.3% of the population. Blindness and low vision increased with age. The odds of low vision and blindness in women were 1.8 times that of the men. The leading causes of blindness were cataract (46.1%), trachoma (22.9%), and glaucoma (7.6%). While the prevalence of vision reducing cataract increased with age, the prevalence of trachoma related vision loss did not increase with age, suggesting that trichiasis related vision loss in this population might not be cumulative. CONCLUSION: The magnitude of low vision and blindness is high in this zone and requires urgent intervention, particularly for women. Further investigation of the pattern of vision loss, particularly as a result of trachomatous trichiasis, is warranted.