Chlamydia on children and flies after mass antibiotic treatment for trachoma

There are various approaches to control trachoma. These include the elimination of the ocular strains of Chlamydia trachomatis that cause the disease and to decrease the spread of infection by other measures such as fly control. Here, we examined how these two are related (i.e., how treating children with antibiotics affects carriage of Chlamydia by flies). Flies were collected in villages that had received mass oral azithromycin distribution and were compared with flies in untreated villages. Polymerase chain reaction (PCR) was performed to detect chlamydial DNA on the flies. Conjunctival swabs were also taken to assay for chlamydial prevalence in the children. Chlamydia was found on 23% of the flies in the untreated villages but only 0.3% in treated villages. Prevalence of trachoma in children proved to be an excellent predictor of the prevalence on flies (correlation coefficient, 0.89). Thus, treating children with antibiotics may drastically reduce the role of flies as a vector.     

Modified grading system for upper eyelid trachomatous trichiasis

Aim This study was conducted to determine the level of inter-observer agreement in the modified grading scheme for trichiasis of the upper eyelid. Methods A grading system that covers the entire spectrum of trachomatous trichiasis, extending from the simple to the severe forms, was initially developed by the first and second authors and field-tested. The grading scheme recognizes three levels of severity, based on deviation of the lid margin (TT1, TT2 and TT3); and four anatomical locations indicating where the eyelashes touch the globe in TT1 (nasal, central, temporal, or combined). The grading of trichiasis patients was then conducted on the basis of the modified grading scheme. Results The inter-observer agreement between the grades of simple trichiasis (TT1) and entropion (TT2) using Cronbach's alpha was 0.84, and the agreement within each sub-grade was 0.86. The weighted Kappa value was 0.68 (95% CI 0.57–0.79) for the main grades and 0.49 (95% CI 0.23–0.79) for the sub-grades. Conclusions The inter-observer agreement was very reliable and could easily be attained by all levels of ophthalmic professionals. As the grading follows the natural progression of trichiasis from the simple to the severe forms in relation to the anatomical site involved, it helps to determine the degree of correction and how far to extend the surgical incision.     

Advantages of converting incontinent to continent urinary diversion

A modified Mainz pouch with catheterizable stoma was constructed in six patients who had originally undergone incontinent urinary diversion by ureteroileostomy 7 to 22 years previously for bladder exstrophy or neurogenic bladder with total urinary incontinence. The surgical technique differed from the standard as follows: after stomal excision, the preexisting ileal loop was detubularized and combined with additional ileal and colonic segments for pouch construction. In patients in whom the original ureteroileal anastomoses were patent and the contrast medium refluxed freely to the upper urinary tract during loopography, the ureters were not reimplanted but kept intact. In all patients the ileal valve was connected as stoma to the umbilicus. In addition, two patients underwent construction of a standard Mainz pouch. One had had primary ureterosigmoidostomy and the other one ureterostomies, 10 and 3 months previously, respectively. The urodynamic characteristics of the reservoir were normal in all. In six ureteropelvic units dilation improved significantly and in two patients the bilateral loop-ureter reflux diminished. Long-term follow-up (up to 45 months) showed no further impairment of the kidneys.     

Large-scale commodity agriculture exacerbates the climatic impacts of Amazonian deforestation

In the Amazon rainforest, land use following deforestation is diverse and dynamic. Mounting evidence indicates that the climatic impacts of forest loss can also vary considerably, depending on specific features of the affected areas. The size of the deforested patches, for instance, was shown to modulate the characteristics of local climatic impacts. Nonetheless, the influence of different types of land use and management strategies on the magnitude of local climatic changes remains uncertain. Here, we evaluated the impacts of large-scale commodity farming and rural settlements on surface temperature, rainfall patterns, and energy fluxes. Our results reveal that changes in land–atmosphere coupling are induced not only by deforestation size but also, by land use type and management patterns inside the deforested areas. We provide evidence that, in comparison with rural settlements, deforestation caused by large-scale commodity agriculture is more likely to reduce convective rainfall and increase land surface temperature. We demonstrate that these differences are mainly caused by a more intensive management of the land, resulting in significantly lower vegetation cover throughout the year, which reduces latent heat flux. Our findings indicate an urgent need for alternative agricultural practices, as well as forest restoration, for maintaining ecosystem processes and mitigating change in the local climates across the Amazon basin.

During the past 50 y, ∼20% of the Amazon forest has been lost to deforestation (1, 2). These changes in the land surface have affected the functioning of ecosystems and the climate in ways we are only starting to understand. Deforestation size, for instance, is a potential factor defining the magnitude and characteristics of changes in local climate associated with forest loss (3, 4). There is also evidence that the different land uses that follow deforestation can regulate the magnitude of changes in surface energy balance and water cycle (5). Historically, there has been large variation in the characteristics and causes of deforestation (1, 6–9). In the area known as the “arc of deforestation,” two major processes have contributed to forest loss: government-supported rural settlements and expansion of market-focused large-scale agriculture (hereinafter referred to as “commodity agriculture”) (10, 11). Deforestation caused by these two types of farming systems has distinct characteristics, and each can have several variants.Rural settlements are generally associated with government colonization projects, migratory flow incentives, and the construction of new roads (7). In areas dominated by rural settlements, small properties with plots ranging from 25 to 100 ha are predominant (8, 9, 12). However, medium-sized properties ranging from 250 to 1,000 ha and farms larger than 1,000 ha may also occur. Activities inside these areas are characterized by livestock production (extensive pastures), small-scale crop production, and family farming (13). The establishment of small farms along main highways and secondary roads results in the well-known “fish bone” deforestation pattern.Forest areas taken by large-scale commodity agriculture represent a more recent stage of occupation, usually associated with spontaneous and economical migration but also, with changes in land use policies and market conditions (14). Agricultural activities aimed at commodity crop plantation are in general productive and often technologically advanced. The most common commodity crops in the Amazon region are soybean, maize, sorghum, and cotton. Nonetheless, forests are typically not converted directly into croplands, with pastures often used as a transitory land use. Permanent mid- to large-scale cattle ranching also occurs, although many of these areas are being rapidly converted into croplands (6, 14–16). Farm sizes can reach several thousand hectares. Properties are, therefore, bigger and more isolated, in comparison with rural settlements (13).Given the different characteristics of commodity agriculture and rural settlements, the spatiotemporal patterns of land cover biophysical properties can also differ considerably. In general, commodity crops cultivation involves an intensive use of the land, sometimes with two or more harvests per year (17). Hence, rapid changes in the vegetation cover, albedo, and evapotranspiration (ET) can occur (5, 18). On the other hand, in areas where small-scale pastures and agriculture are prevalent, the biophysical properties of the land surface are expected to vary less, given the less intensive use of the land (e.g., associated with family farming and agroforestry). Furthermore, modeling studies suggest that the type of vegetation involved in land cover conversions is important in determining the sign of the land change impacts (19). However, empirical studies are crucially needed to better understand how different land uses across the Amazon region affect the local and regional climate.Tropical deforestation has deep impacts on biophysical processes (1, 20–22), contributing to amplifying diurnal temperature variability (1.95 ± 0.08 °C) as well as increasing mean air temperature (∼1 °C) (23). The causes of increase in temperature are dominated by nonradiative mechanisms, in particular a decrease in latent heat flux (LE) (24). The cooling effects of albedo increase due to deforestation are in most cases outweighed by the warming effects of decreasing ET, leading to net warming (23–25).The impacts of Amazon deforestation on rainfall patterns are not yet fully understood (4). In the initial phases of deforestation, vegetation loss was shown to increase regional cloudiness and precipitation (3). In comparison with deforested areas, the greater humidity over forests leads to more convective available potential energy, which makes the atmospheric boundary layer more unstable (26). Conversely, small deforestation patches showed more active shallow convection, explaining the higher frequency of shallow clouds over deforested areas (26). However, it is unclear how these mechanisms change as deforested areas increase and land cover becomes more uniform. One hypothesis is that convective lifting mechanisms will lose force, and shallow clouds over deforested areas will no longer be favored. Modeling studies indicate that this shift is already happening in some parts of the Amazon, where deforestation has reached a point in which thermally dominated regime has declined, leading to a more dynamically driven hydroclimatic regime (27). A dynamically driven regime becomes dominant when differences in surface roughness between forest and forest clearings start to play a larger role in the atmospheric response, in comparison with the differences in the surface energy partitioning (28).As observational and modeling studies indicate that land use and management can play an important role in the climate system, overlooking these landscape heterogeneities can hinder an adequate response to the threats posed by human activities (29). Clarifying the climatic impacts of different land uses in the Amazon is crucial to foster informed plans for sustainable land management, in particular those aiming at strategies for climate change mitigation, maintenance of ecological functioning, and guarantying provision of essential ecosystem services. Here, we hypothesize that forest conversion to large-scale commodity agriculture is more detrimental to local climate than conversion to rural settlements. To test this hypothesis, we first evaluated whether or not land uses associated with commodity agriculture and rural settlements lead to quantitatively distinguishable land cover spatiotemporal patterns in regions with similar deforestation rates (1985 to 2018) and total deforested area in 2018. Next, we collected empirical evidence on how forest clearing associated with these two causes has affected local rainfall, surface temperature, and LE.     

HIV/AIDS prevention practices among military personnel in Northwest Ethiopia

ABSTRACT

The spread of HIV/AIDS is a major public health problem in military personnel in Africa. However, the epidemiological evidence regarding HIV/AIDS prevention practices among military personnel in Ethiopia remains unclear. The aim of this study was to investigate HIV/AIDS prevention practices among military personnel in Northwest Ethiopia. A cross-sectional study among military personnel (n?=?410) was conducted in Northwest Ethiopia in 2015. Data were collected using a pre-tested questionnaire. Multivariable logistic regression model was fitted to ascertain factors influencing participation in HIV/AIDS prevention programs. About one-fourth (24.6%) of the military personnel had multiple sexual partners, of whom 24.7% failed to use condoms regularly when having sex with non-regular sexual partners. Majority of the sample (n?=?355, 86.6%) participated in HIV/AIDS prevention programs. Military personnel who had multiple sexual partners were 6.3 times more likely to report history of non-participation in HIV/AIDS prevention programs (AOR?=?6.3, CI₉₅?=?3.5–11.54). A considerable proportion of military personnel had multiple sexual partners with lower levels of condom utilization with non-regular sexual partners. The study further demonstrated misconceptions about HIV/AIDS in Ethiopian military personnel, which reduce their likelihood of participation in HIV/AIDS prevention programs. Health authorities need to strengthen and accelerate HIV/AIDS prevention programs focusing towards military personnel.     

Bisoprolol,a once-a-day beta-blocking agent for patients with mild to moderate hypertension

The 24-h blood pressure control of bisoprolol, a new beta₁-selective, beta-blocking agent, was studied in 240 mild to moderate hypertensive patients in this 4-week, randomized, double-blind, placebo-controlled trial. A once-daily dosing schedule was evaluated by comparing bisoprolol's antihypertensive effectiveness and safety at 24 h postdose and 3 h postdose, the latter time intended to correspond to peak effectiveness. Results from this trial demonstrated the antihypertensive effectiveness of once-daily bisoprolol at doses ranging from 5-20 mg. Mean reductions from baseline diastolic blood pressure, measured 24 h postdose, were 6.3,8.8, and 10.1 mmHg for patients receiving bisoprolol 5, 10, and 20 mg, respectively, compared with 1.6 mmHg for placebo-treated patients (p< 0.01); mean reductions from baseline systolic blood pressure for the bisoprolol groups were 8.6, 8.6, and 10.9 mmHg, respectively, versus 3.3 mmHg for placebo (p≤0.01); and mean reductions from baseline heart rate for the bisoprolol groups were 5.1,7.1, and 10.2 beats/min, respectively, compared with a 0.9 beats/min increase in heart rate for the placebo group (p < 0.01). The response rates for bisoprolol-treated patients ranged from 47 to 70% compared with 18% for patients on placebo (p < 0.01). Antihypertensive effects were dose-related and sustained over the 24-h dosing interval. Near maximal antihypertensive effects were achieved within 1 week of initiation of therapy with bisoprolol and were sustained over the course of the trial. The antihypertensive effects of bisoprolol were accompanied by a favorable safety profile. Furthermore, bisoprolol was welltolerated and did not differ significantly from placebo in either the frequency or severity of reported adverse experiences. Withdrawal rates for adverse events were 1.4% for the placebo group versus 1.9% for the composite bisoprolol group. Laboratory changes generally were related to small increases within the normal range and were not clinically relevant. No bisoprolol-treated patient left the study or interrupted treatment for a clinical laboratory abnormality.     

Use of qPCR and Genomic Sequencing to Diagnose Plasmodium ovale wallikeri Malaria in a Returned Soldier in the Setting of a Negative Rapid Diagnostic Assay

Plasmodium ovale is one of several clinically relevant malaria species known to cause disease in humans. However, in contrast to Plasmodium falciparum and Plasmodium vivax, which are responsible for most cases of human malaria, P. ovale has a wide distribution but low prevalence in tropical regions. Here, we report the case of a soldier returning from Liberia with P. ovale wallikeri malaria. This case highlights the limitations of both microscopy and the malaria rapid diagnostic test for diagnosing infection with P. ovale and for distinguishing P. ovale wallikeri from P. ovale curtisi. To our knowledge, this is the first case report in which quantitative real-time polymerase chain reaction amplification using the Cytochrome B gene, coupled with genomic sequencing of the potra locus, was used for definitive diagnosis of P. ovale wallikeri malaria.     

Treatment Patterns,HealthCare Resource Utilization and Costs in Patients with Bipolar Disorder,Newly Treated with Extended Release or Immediate Release Quetiapine Fumarate using US Healthcare Administrative Claims Data

Background

Differences in treatment patterns, health care resource use, and costs are expected among patients newly treated with quetiapine extended release (XR) or quetiapine immediate release (IR).

Objective

To compare treatment patterns, health care resource use, and costs in patients with bipolar disorder newly treated with quetiapine XR or quetiapine IR.

Methods

This was an observational, retrospective cohort study that used HealthCore Integrated Research Database–identified patients (age range, 18-64 years) with an International Classification of Disease, Ninth Revision diagnosis of bipolar disorder and ≥1 pharmacy claim for quetiapine XR or quetiapine IR between October 2, 2008, and July 31, 2010. Outcomes were as follows: patient characteristics at the index date (first claim for quetiapine XR or quetiapine IR); 12-month preindex clinical characteristics, health care resource use, and costs; and 12-month postindex treatment patterns, health care resource use, and costs, assessed using generalized linear models (adjusted for index date and preindex patient demographic characteristics, clinical characteristics, health care resource use, and costs).

Results

In total, 3049 patients with bipolar disorder were analyzed (651 in the quetiapine XR group and 2398 in the quetiapine IR group). Of patients initiating treatment with quetiapine XR, 8.8% had no change in or discontinuation of their index therapy compared with 5.7% of patients treated with quetiapine IR (adjusted odds ratio, 1.44; 95% confidence interval, 1.03-2.00; P = 0.0317). The average daily dose (adjusted mean) of quetiapine XR was higher than quetiapine IR (225 vs 175 mg/d, P < 0.0001). An average daily dose of 300 to 800 mg was reached sooner (15.6 vs 30.8 days, P = 0.0049) and in more patients (44.2% vs 27.2%, P < 0.0001) who were taking quetiapine XR compared with patients taking quetiapine IR. No differences in total health care costs were found between the cohorts; however, patients taking quetiapine XR were less likely to be hospitalized for mental health–related reasons (12.1% vs 18.3%, P = 0.0022) and incurred lower mental health–related costs (US $6686 vs US $7577, P = 0.0063) compared with patients taking quetiapine IR.

Conclusions

Treatment patterns and dosing differ in patients with bipolar disorder treated with quetiapine XR compared with those treated with quetiapine IR. Mental health–related hospitalizations and costs may be reduced in the 12 months after patients initiating treatment with quetiapine XR compared with initiating treatment with quetiapine IR.     

Pattern of admissions to the medical intensive care unit of Addis Ababa University Teaching Hospital

A case-series study of all admissions using patient registers was carried out to analyse patterns of medical admissions into the Medical Intensive Care Unit (MICU) of the Addis Ababa University Teaching Hospital, and evaluate for any changes in that pattern over a study period. All patients admitted to the MICU of a 500-bed Teaching Hospital in Addis Ababa between 1985-2000 were the study subjects. Demographic variables, specific categories of diagnoses and their outcomes were recorded A total of 3548 patients (male to female ratio of 1.4:1, mean age 37.10 +/- 17.29) were admitted from September 1985 to August 2000. Acute infectious and cardiovascular diseases accounted for half of the entire critical care admissions with infectious diseases accounting for 30%. Among specific diagnoses, diabetic ketoacidosis was the leading cause of admission followed by acute myocardial infarction and severe and complicated malaria, each accounting for 10.7, 9.8 and 9.3% of all admissions respectively. Trends of admissions over the sixteen-year period showed steady increase in relative frequency of acute complications of non-communicable diseases consisting of diabetes, acute myocardial infarction and stroke while infectious diseases showed interspersed peaks of admissions coinciding with epidemics. The overall mortality of the MICU was 32%, with proportionally more female deaths, 34.8 versus 29% (P = 0.0002). Severe and complicated malaria was the leading cause of death (10.3%) followed by tetanus (6.4%) and acute myocardial infarction (6.3%). The increase in relative and absolute frequency of acute complications of non-communicable diseases most probably heralds an emerging epidemic of non-communicable diseases related to life style changes in the urban well to do in addition to existing problems of infectious diseases of poverty.