Impact of COVID‐19 on access to healthcare in low‐ and middle‐income countries: Current evidence and future recommendations

The COVID‐19 pandemic continues to be a major public health threat globally and low‐ and middle‐income countries (LMICs) are not an exception. The impact of the COVID‐19 pandemic is far‐reaching on many areas including but not limited to global health security, economic and healthcare delivery with a potential impact on access to healthcare in LMICs. We evaluate the impact of the COVID‐19 pandemic on access to healthcare in LMICs, as well as plausible strategies that can be put in place to ensure that the delivery of healthcare is not halted. In order to mitigate the devastating effect of the COVID‐19 pandemic on the already weak health systems in LMICs, it is much necessary to reinforce and scale up interventions and proactive measures that will ensure that access to healthcare is not disrupted even in course of the pandemic.     

A novel in vivo rabbit model that mimics human dosing to determine the distribution of antibiotics in ocular tissues.

PURPOSE: The aim of this study was to establish a novel method to predict the human ocular penetration and distribution of topical antibiotics by using a controlled rabbit model that mimics the human eye with manual blinking and tear flow. METHODS: After anesthetizing the rabbits, a single dose of commercial antibiotic formulations was given with precision directly onto the cornea. This was followed by a 30-min controlled period applying manual blinking (4 blinks/min) and a supplementary tear flow (2 microL/min) that mimics the human eye. Tear samples were collected every 5 min and after euthanasia, conjunctival, aqueous humor, iris-ciliary body, and scleral samples were collected. The corneas were mounted in perfusion chambers to determine the level and continuing rate of release of the antibiotics, the levels of which were all determined using high-performance liquid chromatography analysis. RESULTS: U.S. formulations achieved conjunctival and corneal levels (mug/g) as follows: moxifloxacin, 6.6 +/- 0.3 and 50 +/- 5; tobramycin, 3.1 +/- 1.4 and 20 +/- 5; gentamicin, <2 and <2; levofloxacin, 1.5 +/- 0.3 and 19 +/- 2; gatifloxacin, 0.9 +/- 0.1 and 11 +/- 1; and trimethoprim, <0.1 and 2 +/- 1. Japan formulations achieved conjunctival and corneal levels as follows: levofloxacin 2.1 +/- 0.8 and 12 +/- 2; gatifloxacin, 2.2 +/- 0.9 and 7 +/- 1; ofloxacin, 1.6 +/- 0.5 and 7 +/- 1; and tosufloxacin, 0.7 +/- 0.1 and 1.5 +/- 0.3 (mean +/- standard error, n = 4). CONCLUSIONS: Moxifloxacin achieved the highest levels of antibiotic in ocular tissues. In the conjunctiva and cornea, the moxifloxacin level was 3-30 times the level of other fluoroquinolones, at least twice the level of the aminoglycosides, and 25 times the level of the antibacterial trimethoprim.     

Invasive Aspergillosis of the Hand Caused by <Emphasis Type="Italic">Aspergillus ustus</Emphasis>: a Case Report

This is a case report of a 61-year-old cardiac transplant patient who developed a disseminated infection involving the upper extremity with a rare fungus known as Aspergillus ustus. The patient was successfully treated with aggressive serial debridements, antifungal medications, and reduction of immunosuppression. With these interventions, the patient avoided amputation despite the aggressive nature of this infection.     

Rural communities in Africa should not be forgotten in responses to COVID-19

Rural areas in Africa make up a large proportion of the continent. Since the emergence of COVID-19 on the continent, major attention and responses have been placed on urban areas. Rural areas are typified by certain challenges which may serve as limitations to the provision of resources and tools for COVID-19 responses in these areas. These major challenges include limited access to these areas due to poor road networks which may hamper the possibility of conveying resources and manpower. Shortage of healthcare workforce in these areas, poor health facilities/structures and limited access to COVID-19 diagnostics services may also make containment challenging. It is therefore important that investment should be made in these areas towards providing the necessary tools, resources, and manpower to ensure effective containment of COVID-19 and to alleviate the plight caused by the pandemic in rural Africa. Rural communities in Africa should not be left behind in COVID-19 responses.     

Post-traumatic stress disorder (PTSD) after stigma related events in HIV infected individuals in Nigeria

Background  

One of the most distressing concerns of many people living with HIV in sub-Saharan Africa is the stigma. Intense stigma may be traumatic. This study aimed to investigate the probability and correlates of Posttraumatic stress disorder (PTSD) following intense stigmatizing events and situations in HIV infected individuals in Nigeria.     

The burden of hearing loss in Kaduna, Nigeria: a 4-year study at the National Ear Care Centre

Hearing loss among people in developing countries has been recognized as a major source of disability. Many of its causes are preventable, and others are curable. We reviewed the records of 5,485 patients who had presented during a 4-year period to the National Ear Care Centre in Kaduna, Nigeria. Of these, we identified 1,435 patients-812 males and 623 females, aged 9 months to 90 years (mean: 29.2 yr)-who had been diagnosed with hearing loss (26.2%). In addition to demographic data, we compiled information on each patient's type and degree of hearing loss, the affected side, and the predisposing factors. Sex and age cross-tabulations revealed that the greatest proportion of hearing loss according to sex occurred between the ages of 11 and 20 years for males and 21 and 30 years for females. The most common type of hearing loss was sensorineural, which was seen in 78.9% of patients; conductive hearing loss was seen in 17.7% and mixed in 3.4%. More than three-quarters of hearing losses were either moderate, moderately severe, or severe. Bilateral losses were far more common than unilateral losses; among the latter, the left side was affected slightly more often than the right. Predisposing factors were not documented in the vast majority of cases (87.6%), but when they were, the most common were chronic suppurative otitis media, meningitis, febrile convulsion, measles, and trauma. We present these findings to highlight the burden of hearing loss in our part of the world.