Antimicrobial resistance of Salmonella isolates from swine

We examined the antimicrobial resistance of 1,257 isolates of 30 serovars of Salmonella enterica subsp. enterica isolated from swine. Serovars Typhimurium and Typhimurium var. Copenhagen were widespread and were frequently multidrug resistant, with distinct resistance to ampicillin, kanamycin, streptomycin, sulfamethoxazole, and tetracycline and to ampicillin, chloramphenicol, streptomycin, sulfamethoxazole, and tetracycline, respectively.     

Perception of dental fluorosis amongst Ethiopian children and their mothers

This study was conducted in three Ethiopian Rift Valley villages known for endemic fluorosis. Three-hundred-and-six adolescents (12-15 years) and 233 mothers participated. The aim was to study dental fluorosis in the youngsters and to assess the extent of agreement between clinical and self-rated discoloration and pitting of teeth, and also the level at which dental fluorosis is perceived as a problem both by children and their mothers. The children (154 M and 152 F) gave a simple self-assessment of tooth-color and quality of their teeth, and were subsequently examined for dental fluorosis. Finally, four color photographs of teeth with dental fluorosis (TF-scores 2, 3, 5, and 7) were used as references during a structured oral interview of the children, as well as their mothers. At TF score &#83 2, the prevalence of dental fluorosis on maxillary central incisors was 72% and 37% at TF score &#83 4. The mean TF score was significantly higher among boys than among girls of unemployed fathers compared to children of employed fathers. The likelihood of reporting problems with dental appearance increased with increasing individual TF scores. The child/mother pairs found teeth with TF scores 2 and 3 esthetically acceptable, while teeth with TF scores 5 and 7 were considered unacceptable. Mothers were more critical of severe fluorosis than were their children.     

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.

     

High Risk of New Episode of Symptomatic Vasospasm in Unaffected Arteries in Subarachnoid Hemorrhage Patients Receiving Targeted Endovascular Treatment for Symptomatic Focal Vasospasm

Background

There is controversy whether asymptomatic vasospasm in other arteries should be concurrently treated (global treatment) in patients receiving targeted endovascular treatment [percutaneous-transluminal-angioplasty (PTA) and/or intra-arterial (IA) vasodilators] for focal symptomatic vasospasm.

Objective

To determine the rates of occurrence of new symptomatic vasospasm in previously asymptomatic arterial distributions among patients with aneurysmal subarachnoid hemorrhage (SAH) who underwent targeted endovascular treatment for focal symptomatic vasospasm.

Methods

We identified all patients with SAH who had received targeted endovascular treatment during a 4-year period. We ascertained any new occurrence of symptomatic vasosopasm requiring endovascular treatment in previously unaffected (and untreated) arterial distributions within the same hospitalization. Blinded reviewers quantitatively graded angiographic vasospasm (<25, 26–49, ≥50 %) in all major arteries for each patient at the time of targeted treatment.

Results

Of the 41 patients who received targeted endovascular treatment (PTA in 41 % and vasodilators in 59 %), 11 (27 %) developed new symptomatic vasospasm in previously asymptomatic vascular distributions requiring endovascular treatment. Moderate severity of angiographic vasospasm in asymptomatic arteries at the time of targeted treatment tended to predict the occurrence of new symptomatic vasospasm. The rate of death and disability at discharge [modified Rankin scale (mRS) of 3–6] was 82 % (9/11) among those who developed a new episode of symptomatic vasospasm compared with 70 % (21/30) in those who did not (P = 0.58).

Conclusions

High risk of new occurrence of ischemic symptoms in previously asymptomatic (and untreated) arterial distributions among patients receiving targeted treatment should be recognized. Further studies should evaluate the benefit of performing global endovascular treatment during the initial targeted endovascular treatment session.     

Pattern of microbial translocation in patients living with HIV-1 from Vietnam,Ethiopia and Sweden

Introduction

The role of microbial translocation (MT) in HIV patients living with HIV from low- and middle-income countries (LMICs) is not fully known. The aim of this study is to investigate and compare the patterns of MT in patients from Vietnam, Ethiopia and Sweden.

Methods

Cross-sectional samples were obtained from treatment-naïve patients living with HIV-1 and healthy controls from Vietnam (n=83; n=46), Ethiopia (n=9492; n=50) and Sweden (n=51; n=19). Longitudinal samples were obtained from a subset of the Vietnamese (n=24) in whom antiretroviral therapy (ART) and tuberculostatics were given. Plasma lipopolysaccharide (LPS), sCD14 and anti-flagellin IgG were determined by the endpoint chromogenic Limulus Amebocyte Assay and enzyme-linked immunosorbent assay.

Results

All three biomarkers were significantly increased in patients living with HIV-1 from all countries as compared to controls. No differences were found between males and females. Vietnamese and Ethiopian patients had significantly higher levels of anti-flagellin IgG and LPS, as compared to Swedes. ART reduced these levels for the Vietnamese. Vietnamese patients given tuberculostatics at initiation of ART had significantly lower levels of anti-flagellin IgG and higher sCD14. The biomarkers were lower in Vietnamese who did not develop opportunistic infection.

Conclusions

Higher MT is common in patients living with HIV compared to healthy individuals, and in patients from LMICs compared to patients from a high-income country. Treatment with tuberculostatics decreased MT while higher levels of MT are associated with a poorer clinical outcome.     

Effect of Thalidomide on the Expression of TNF-α m-RNA and Synthesis of TNF-α in Cells from Leprosy Patients with Reversal Reaction

Hypersensitivity reactions called reversal reaction (RR) and erythema nodosum leprosum (ENL) occur in leprosy. They are characterized by an increase in tumor necrosis factor-alpha (TNF-α). Thalidomide is an effective treatment for ENL but not RR. Its effectiveness in ENL is attributed to inhibition of TNF-α, and this does not explain its failure to treat RR. We assessed thalidomide's effect on TNF-α in RR. Mononuclear cells from RR and non-RR patients and healthy individuals were treated with thalidomide and M.leprae (AFB), a cytosol fraction of M. leprae or Dharmendra lepromin. Thalidomide suppressed TNF-α, but when some RR patients' cells were stimulated with AFB, it enhanced TNF-α.     

True hermaphrodite: very unusual type

True hermaphrodite is one of the rare gonadal as well as genital abnormality due to a defect in sexual differentiation. Here, we are reporting the most unusual type of true hermaphrodite diagnosed at the age of 25 years during operation for undescended testis, presenting as a case of infertility and failure to ejaculate during sexual intercourse. The patient was found to have grossly as well as histologically proven left ovary, left fallopian tube and uterus as well as a well descended left testis, with totally absent either right fallopian tube and ovary or testis. Thus, this is unusual finding to ratify the occurrence of true hermaphrodite in the absence of ambiguous external genitalia.     

Perception of dental fluorosis among adolescents living in urban areas of Ethiopia

The objective of the study was to assess the perception of dental fluorosis among adolescents residing in two urban areas in Ethiopia: Addis Ababa (low-fluoride drinking water) and Nazreth (high-fluoride drinking water). Students aged 12-15 years, enrolled in two junior secondary schools in Addis Ababa (n = 161) and two similar schools in Nazreth (n = 177) responded to evaluative statements concerning the appearance of anterior maxillary teeth. Color photographs depicting dental fluorosis (TF score 2, 3, 5 and 7) in maxillary front teeth were used as reference during structured interviews. A majority of the students from Addis Ababa and Nazreth were dissatisfied with the appearance of teeth having TF scores 2 and above. More than 66% of the students from both areas confirmed a need for dental consultation concerning fluorotic teeth with TF > or = [corrected] 2. As compared to their counterparts in Nazreth, children in Addis Ababa felt more embarrassed with TF score 2 and 3 (p < 0.01). TF scores 5 and 7 were found unacceptable both in Addis Ababa and in Nazreth. Students in Addis Ababa, more frequently than their counterparts in Nazreth, believed (erroneously) that dental fluorosis were related to neglect on the part of the child. The present findings confirm that fluorotic teeth constitute a social problem among junior secondary school children residing in low-fluoride as well as in high-fluoride urban areas in Ethiopia and, thereby, corroborate the public concern for safe drinking water.     

Central nervous system toxoplasmosis in adult Ethiopians

OBJECTIVES: Toxoplasmosis is identified as one of the major central nervous system (CNS) opportunistic infections in AIDS patients. Sero-epidemiological surveys done among Ethiopian patients indicated a very high prevalence rate. This study was conducted to describe the clinical course of the disease in Ethiopians with AIDS. PATIENTS AND METHODS: Three hundred and twenty three patients with AIDS and CNS Toxoplasmosis that were consecutively admitted and treated with Sulfadoxine Pyrimethamine (SP) at the Tikur Anbessa Specialized Referral Hospital were reviewed. The diagnosis CNS Toxoplasmosis was made based on clinical features or neuroradiologic findings and response to treatment. In over 80% of the cases the dose of Pyrimethamine used was 100 mgs for two days and then 25 mgs daily PO. RESULTS: The male to female ratio was one to one. The median age was 34 years (range 18 - 75). The most common presenting symptoms were headache 293 (91%), fever 269 (83%), and abnormal level of consciousness in 201 (62%) of the cases. Focal neuralgic deficits were seen in 203 (63%) of the cases. The diagnosis of CNS toxoplasmosis was based on clinical features and response to treatment in 186 (58%) of the cases and on CT scan findings and clinical response in 54 (17%) of the cases. Among the 248 (78%) of the cases that had responded favorably to SP, 53% had improvement on the 7th day, while the rest had improvement on the 14th day of treatment. Major treatment related adverse reactions, which required changing treatment, were seen in 68 (20%) of the cases. Among patients who survived the first episode of toxoplasmosis, the median follow up was for 29 days (range 15-1800). CONCLUSION: Toxoplasmosis had been the most AIDS defining event in the study group and clinical response to empiric treatment was essentially diagnostic. In our study group the outcome seen with SP as compared to the standard recommended treatment yielded comparable results. Tolerance to treatment was better and the adverse effects warranting change in treatment were fewer despite that only few patients received folinic acid supplements. We recommend a well-designed prospective study to establish the efficacy and optimal dose of SP in the treatment of CNS toxoplasmosis.