Evaluation of two rapid tests for the diagnosis ofChlamydia trachomatis genital infections

The performance of two new enzyme immunoassays (EIA) for the detection ofChlamydia trachomatis in a practice setting was compared. A consecutive series of 207 female patients seen at an inner-city sexually transmitted disease clinic were tested by cell culture, the Kodak SureCell (SC) and Abbott TestPack Chlamydia (TP) EIAs. In addition 210 male patients, selected by physicians on the basis of the fact that multiple urethral samples could be obtained, were tested by cell culture and SC. The prevalence of infection was 19 % in the females and 12.5 % in males. The sensitivity, specificity, positive predictive value and negative predictive value for the SC and TP were 88 %, 95 %, 81 %, 97 % and 59 %, 99 %, 95 %, 91 %, respectively, in the female population. The sensitivity of the SC was significantly greater than that of the TP (p 0.002). The performance values of the SC in men (in the same order) were 64 %, 96 %, 71 % and 95 %, respectively. The SC in male patients and the TP in female patients had low sensitivity. The sensitivity of the SC in female patients was significantly higher than that of the TP. However, the SC yielded more false positive results. To determine the utility of these tests in a practice setting further studies are required.     

Breast Nurse Intervention to Improve Adherence to Endocrine Therapy Among Breast Cancer Patients in South Ethiopia

IntroductionMany women in rural Ethiopia do not receive adjuvant therapy following breast cancer surgery despite the majority being diagnosed with estrogen-receptor-positive breast cancer and tamoxifen being available in the country. We aimed to compare a breast nurse intervention to improve adherence to tamoxifen therapy for breast cancer patients.Methods and MaterialsThe 8 hospitals were randomized to intervention and control sites. Between February 2018 and December 2019, patients with breast cancer were recruited after their initial surgery. The primary outcome of the study was adherence to tamoxifen therapy by evaluating 12-month medication-refill data with medication possession ratio (MPR) and using a simplified medication adherence scale (SMAQ) in a subjective assessment.ResultsA total of 162 patients were recruited (87 intervention and 75 control). Trained nurses delivered education and provided literacy material, gave additional empathetic counselling, phone call reminders, and monitoring of medication refill at the intervention hospitals. Adherence according to MPR at 12 months was high in both the intervention (90%) and control sites (79.3%) (P = .302). The SMAQ revealed that adherence at intervention sites was 70% compared with 44.8% in the control sites (P = .036) at 12 months. Persistence to therapy was found to be 91.2% in the intervention and 77.8% in the control sites during the one-year period (P = .010).ConclusionBreast nurses can improve cost-effective endocrine therapy adherence at peripheral hospitals in low-resource settings. We recommend such task sharing to overcome the shortage of oncologists and distances to central cancer centers.     

Nondermal irritating hyperosmotic nanoemulsions reduce treatment times in a contamination model of wound healing

Increased microbial burden within the wound often complicates wound healing and may lead to subsequent infection or delayed healing. Here, we investigate a novel topical for addressing wound contamination that utilizes hyperosmotic saccharides with a cell membrane disrupting emulsion. These hyperosmotic nanoemulsions (HNE) were administered topically in a full‐thickness biopsy model of wound healing. Results show that HNE were well tolerated in noninfected animals with no indications of dermal irritation or acute toxicity. Additionally, HNE was able to reduce bacterial bioburden (Escherichia coli and Enterococcus faecalis) levels by 3 logs within 24 h when wounds were inoculated with 5 × 10⁶ total CFU. These bactericidal values were similar to wounds treated with silver sulfadiazine. Wound closure showed HNE wounds closed in 7.6 ± 0.2 days while SSD and control required 10.2 ± 0.4 and 10.4 ± 0.3 days, respectively. HNE maintained a moist wound environment, were well debrided, and exhibited improved hemostatic response. Further histological examination revealed enhanced granulation tissue as compared to silver sulfadiazine and control cohorts. These results were corroborated with 3D topographical imprints of the wounds at day 14 which qualitatively showed a smoother surface. In contrast, silver sulfadiazine appeared to delay wound closure. Finally, dermal sensitization and irritation studies conducted in guinea pig and rabbits did not reveal any acute dermal side effects from HNE exposure. The cumulative data indicates nonantibiotic‐based HNEs may be a promising topical treatment for the management of contaminated wounds.     

International Variations in Bladder Cancer Incidence and Mortality

Context

Previous studies have reported substantial worldwide regional variations in bladder cancer (BCa) incidence and mortality.

Objective

To describe contemporary international variations in BCa incidence and mortality rates and trends using the most recent data from the International Agency for Research on Cancer (IARC).

Evidence acquisition

Estimated 2008 BCa incidence and mortality rates for each country by sex were obtained from GLOBOCAN. Recent trends in incidence for 43 countries and in mortality for 64 countries were assessed by join-point model using data from the IARC's Cancer Incidence in Five Continents and from the World Health Organisation's mortality database, respectively.

Evidence synthesis

The highest incidence rates for both men and women are found in Europe, the United States, and Egypt, and the lowest rates are found in sub-Saharan Africa, Asia, and South America. Mortality rates are highest in parts of Europe and northern Africa and lowest in Asia, Central America, and middle Africa. Incidence rates among men decreased in 11 of 43 countries (46 registries) (North America, western and northern Europe), remained stable in 20, and increased in 12 countries (southern, central, and eastern Europe). Among women, incidence rates decreased in 10 countries, stabilised in 22 countries, and increased in 12 countries. Mortality rates among men decreased in 32 of 65 countries (throughout all world regions except Central and South America), stabilised in 30 countries, and increased in 3 (Romania, Slovenia, and Cuba). Among women, mortality rates decreased in 24 countries, remained stable in 36 countries, and increased in 5 countries (central and eastern Europe).

Conclusions

Incidence and mortality rates in general decreased in most Western countries but increased in some eastern European and developing countries. These patterns in part may reflect differences in the stage and extent of the tobacco epidemic, changes in coding practices, prevalence of schistosomiasis (Africa), and occupational exposure.     

Prevalence,organ distribution,risk factors,and financial losses of hydatid cysts in sheep and goats slaughtered in restaurants in Jimma,south western Oromia

A cross-sectional study was carried out from November 2010 through April 2011 to determine the prevalence, risk factors, number, size, and fertility of hydatid cysts in infected organs and assess the economic losses due to condemnation of organs in sheep and goats slaughtered in different restaurants in Jimma Town. For this purpose, a total of 804 small ruminants (502 sheep and 302 goats) slaughtered in Jimma Town were examined for presence of hydatid cysts. Hydatid cysts were detected in 149 (29.5 %) sheep and 75 (24.8 %) goats examined. Results of the study showed that statistically significant variation was never observed in the prevalence of hydatid cysts between sheep and goat hosts. In the study, 162 (25.8 %) males and 62 (35.5 %) females were found to harbor hydatid cysts in one or more of their organs. Significantly higher prevalence in females than males was recorded. An overall prevalence of 26.3 % in young and 29.4 % in adult sheep and goats of hydatid cysts was recorded. Our study showed that the liver was the most commonly infected organs of sheep and goats with the prevalence of 50.7 % followed by the lungs (37.5 %) whereas the rest 11.3 % was mixed infection. In sheep, out of the total 508 cysts collected, 38.6 % small, 45.5 % medium, and 21.3 % large were recorded. Similarly, for goats, the corresponding values of 33.8, 43.5, and 22.4 % were detected, respectively. In this study, a total of 168 from sheep and 135 cysts from goats collected from different infected organs were subjected to fertility and viability studies. Results of the study revealed that out of the total 95 (56.5 %) of the fertile cysts in sheep, 81 (85.3 %) were viable; however, the rest 14 (14.7 %) were nonviable. In goats, out of the total 59 (43.7 %) of the fertile cysts, 44 (74.6 %) were viable; however, the rest 15 (25.4 %) were nonviable. Significantly higher numbers of fertile cysts were recorded in the livers than in the lungs in both sheep and goats hosts. The total annual economic loss incurred due to cystic echinococcosis in sheep and goats slaughtered in restaurants in Jimma Town was estimated to be 149,312.8 USD (249,324 ETB). In view of the findings of the current study, there is a need and recommendation for proper disposal of offal, reduction of backyard slaughtering, and control of stray dogs to prevent the economic losses and public health hazard associated with the cystic echinococcosis. The findings of the current study imply that cystic echinococcosis is highly prevalent and incurs huge financial losses through condemnation of infected internal organs in sheep and goats slaughtered in Jimma. Further epidemiological studies on the comparative importance of intermediate host species, definitive hosts, genotype of strains from different host species, and zoonotic and economic significance of cystic echinococcosis are urgently needed in different parts of Ethiopia.