Caregiver perspectives for the prevention, diagnosis and treatment of childhood giardiasis in Havana City, Cuba. A qualitative study

Although long considered a non-pathogenic protozoan, Giardia lamblia is now a well recognized cause of abdominal discomfort, diarrhoea and failure-to-thrive in children. The overall prevalence of this infection in Cuban population is about 7.2%; however, higher prevalences have been found among young children attending day-care centres and primary school in the country. Anecdotally, clinical giardiasis is generally considered to place a large burden on both diagnostic and treatment services in Cuba. In order to gain insight into caregivers' perspectives with respect to this infection in children, a qualitative study was carried out in a paediatric hospital in Cuba. Focus group discussions were conducted to gather information about the awareness of the giardiasis, their mode of transmission and symptoms, diagnosis process, treatment seeking behaviour, possible ways of prevention, and barriers for not adopting preventive behaviours, the source and channels of information about this disease. Caregivers have knowledge of giardiasis, although there were myths and misconceptions regarding giardiasis. Manifestations like diarrhoea, abdominal pain and nausea were cited; however, asymptomatic forms of these infections are hardly accepted. Boiling water and washing hands before eating and after defecation and washing vegetables were mentioned among the principal ways of preventing this infection. The most commonly mentioned reasons for not adopting preventive behaviours included lack of time due to outdoor activities and limitation of combustible distribution. Treatment-seeking behaviour when giardiasis suspected mainly included visiting the nearby family doctor. The findings of this study reveal the need for a health education intervention in areas of misperceptions and confusion.     

Bezafibrate, a lipid-lowering pharmaceutical, as a potential endocrine disruptor in male zebrafish (Danio rerio)

Fibrates are pharmaceuticals commonly used to control hypercholesterolemia in humans and they are frequently detected in the freshwater environment. Since cholesterol is the precursor of all steroid hormones, it is suspected that low cholesterol levels will impact steroidogenesis. However, the effect of fibrates on fish reproductive endocrinology is not clear; therefore the aim of the present study was to evaluate the effect of bezafibrate (BZF) on gonadal steroidogenesis and spermatogenesis of zebrafish (Danio rerio). For this purpose, adult males were exposed orally to 1.7, 33 and 70 mg BZF/g food for 21 days. Blood and gonads were collected after 48 h, 7 days and 21 days to evaluate plasma cholesterol and plasma 11-ketotestosterone (11-KT). The expression of gonadal genes involved in the steroidogenesis was quantified to determine a potential mechanism of action, likewise the effect on spermatogenesis was evaluated by examining gonadal histopathology. A time dependent monotonic decrease in the plasma cholesterol concentration was observed in fish exposed to BZF. Plasma 11-KT decreased significantly after 21 days of exposure in fish exposed to the high concentration of BZF. Different gene expression patterns were observed: down-regulation in ppara and pparg mRNA levels was observed in fish exposed to the higher concentrations after 48 h; however, the expression of pparg increased after 21 days. After 21 days an increase in the star and cyp17a1 mRNA expression was observed in fish exposed to 70 mg BZF/g food. Sampling time and bezafibrate concentration explained 52.4% and 20%, respectively, of the gene expression variability. Gonadal histology revealed the presence of germ cell syncytia in the tubular lumen of fish exposed to bezafibrate and also an increased number of cysts containing spermatocytes, which indicate testicular degeneration. The study shows that bezafibrate exerts a hypocholesterolemic effect in adult male zebrafish and its potential as an endocrine disruptor due to its effect on the gonadal steroidogenesis and spermatogenesis.     

High prevalence of respiratory symptoms among workers in the development section of a manually operated coal mine in a developing country: A cross sectional study

Background  

Few studies of miners have been carried out in African countries; most are from South Africa, where the working conditions are assumed to be better than in the rest of Africa. Several studies have focused on respiratory disorders among miners, but development workers responsible for creating underground road ways have not been studied explicitly. This is the first study assessing the associations between exposure to dust and quartz and respiratory symptoms among coal mine workers in a manually operated coal mine in Tanzania, focusing on development workers, as they have the highest exposure to coal dust.     

An Argentinean cohort of patients with rheumatic and immune-mediated diseases vaccinated for SARS-CoV-2: the SAR-CoVAC Registry—protocol and preliminary data

Clinical Rheumatology - To evaluate the efficacy and safety of SARS-CoV-2 vaccine in patients with rheumatic and immune-mediated inflammatory diseases (IMIDs) in Argentina: the SAR-CoVAC registry....     

Ongoing initiatives to improve the use of antibiotics in Botswana: University of Botswana symposium meeting report

Background and objective: There are ongoing initiatives in Botswana to enhance appropriate antibiotic use. The objective of this meeting was to discuss ongoing initiatives in Botswana since February 2016 to improve antibiotic use. Subsequently, use the findings to refine national and local action plans.

Method: Presentation and review of ongoing initiatives.

Results:There was a high rate of antibiotic prescribing among ambulatory care patients in the public sector (42.7%) as well as for patients with upper respiratory tract infections in the private sector (72.9%). Prophylactic antibiotics were given to 73.3% of surgical patients to reduce surgical site infections (SSIs) in a leading tertiary hospital in Botswana; however, SSIs at 9% of patients can be reduced further with better timing of antibiotic prophylaxis. To date, 711 patients have been enrolled into the national point prevalence study. Highlighted concerns included limited ordering and use of sensitivity tests despite functional laboratories, as well as concerns with missed doses of antibiotics across most hospitals.

Conclusion: A number of issues and concerns regarding antibiotic use were highlighted. Activities are ongoing across sectors to address identified concerns.     

Non‐Invasive Intracranial Pressure Monitoring with Transcranial Doppler in a Patient with Progressive Cerebral Venous Sinus Thrombosis

In many intracranial disease states, monitoring of intracranial pressure (ICP) is essential to evaluate response to the therapeutic measures as well as estimation of prognosis. Although, direct estimation of ICP is reliable, it is invasive and not possible in all patients. Transcranial Doppler (TCD) ultrasonography is a bedside and noninvasive technique that provides reliable and real‐time information about cerebral hemodynamics. We present a case of extensive and progressive cerebral venous sinus thrombosis in which TCD served as an excellent tool for monitoring ICP and the serial observations correlated closely with clinical status and ophthalmological findings.     

Epidemiology of chronic back pain among adults and elderly from Southern Brazil: a cross-sectional study

BackgroundChronic back pain (CBP) can negatively affect one’s quality of life and health condition, posing significant social and economic burdens.Objectives(1) To determine the prevalence of CBP and analyze associated factors in adult and elderly individuals in a municipality in southern Brazil; (2) to verify who sought medical attention or missed work because of back pain; and (3) to estimate the impact of CBP on selected health outcomes.MethodsThis was a population-based cross-sectional study conducted with individuals aged 18 years and older. CBP was defined as “pain for three consecutive months in the cervical, thoracic, or lumbar regions in the last year.” Demographic, socioeconomic, behavioral, and physical and mental health information was collected. The impact of CBP was assessed by the etiological fraction method.ResultsThe prevalence of CBP was 20.7% (95% CI: 18.3, 23.0) among the 1300 study participants. The factors associated with CBP were women, elderly, smokers, obesity, and sleeping fewer hours per night, as well as those with higher mental stress levels, history of fracture, arthritis/rheumatism, and work-related musculoskeletal disorder/repetitive strain injury. One-third of those with CBP missed work (31%) and 68% visited the physician over a 12-month period. All health outcomes analyzed (poor or very poor sleep quality, regular or poor health perception, worsened quality of life, depressive symptoms, perceived sadness) were significantly associated with CBP.ConclusionOne in five adults or elderly reported having CBP over the previous 12 months. This condition was associated with poorer health perception, poorer quality of life, and depressive symptoms.     

Predictors of Complementary and Alternative Medicine Use by Breast Cancer Patients in Bandung,Indonesia

Background: The study aimed to assess complementary and alternative medicine (CAM) use and their associated factors with breast cancer patients in Bandung, Indonesia. Materials and Methods: In total, 330 breast cancer patients were administered questionnaires on their CAM use and CAM predictive factors including socio-demographic parameters, clinical data and quality of life, trust in physicians, trust in hospitals, satisfaction and informational needs. Data were analyzed using univariate analysis and multivariate log regreesion analysis. Results: Overall 33.3% of patients reported use of CAM. Lower income, lower education, presence of metastasis, prolonged diagnosis, less trust in physician were found to be highly associated with CAM use. Conclusions: CAM use by breast cancer patients can be interpreted as an attempt to explore all possible options, an expression of an active coping style, or expression of unmet needs in the cancer care continuum. Physicians need to openly discuss the use of CAM with their patients and identify whether they have other unmet supportive needs.