Antimicrobial Resistance in Typhoidal Salmonella: Surveillance for Enteric Fever in Asia Project, 2016-2019

Background: Clinicians have limited therapeutic options for enteric as a result of increasing antimicrobial resistance, and therefore typhoid vaccination is recommended as a preventive measure. As a part of the Surveillance for Enteric Fever in Asia Project (SEAP), we investigated the extent measured the burden of antimicrobial resistance (AMR) among confirmed enteric fever cases in Bangladesh, Nepal, and Pakistan. Methods: From September 2016-September 2019, SEAP recruited study participants of all age groups from its outpatient, inpatient, hospital laboratory, laboratory network, and surgical sites who had a diagnosis of febrile illness that was either suspected or blood culture confirmed for enteric fever. Antimicrobial resistance of isolates was determined by disc diffusion using Clinical and Laboratory Standard Institute cut-off points. We reported the frequency of multidrug resistance (MDR)(resistance to ampicillin, cotrimoxazole, and chloramphenicol), extensive drug resistance (XDR) (MDR plus non-susceptible to fluoroquinolone and any 3rd generation cephalosporins), and fluoroquinolone (FQ) and azithromycin non-susceptibility. Results: We enrolled 8,705 blood culture confirmed enteric fever cases: 4,873 (56%) from Bangladesh, 1,602 (18%) from Nepal and 2,230 (26%) from Pakistan. Of these, 7,591 (87%) were Salmonella Typhi and 1114 (13%) were S. Paratyphi. MDR S. Typhi was identified in 17% (701/4065) of isolates in Bangladesh, and 1% (19/1342) in Nepal. In Pakistan, 16 % (331/2084) of S. Typhi isolates were MDR, and 64% (1319/2074) were XDR. FQ nonsusceptibility among S. Typhi isolates was 98% in Bangladesh, 87% in Nepal, and 95% in Pakistan. Azithromycin non-susceptibility was detected in 77 (2%) in Bangladesh, 9 (.67%) in Nepal and 9 (.59%) isolates in Pakistan. In Pakistan, three (2%) S. Paratyphi isolates were MDR; no MDR S. Paratyphi was reported from Bangladesh or Nepal. Conclusions: Although AMR against S. Paratyphi was low across the three countries, there was widespread drug resistance among S. Typhi, including FQ non-susceptibility and the emergence of XDR S. Typhi in Pakistan, limiting treatment options. As typhoid conjugate vaccine (TCV) is rolled out, surveillance should continue to monitor changes in AMR to inform policies and to monitor drug resistance in S. Paratyphi, for which there is no vaccine

Bullying of medical students in Pakistan: a cross-sectional questionnaire survey.

Background: Several studies from other countries have shown that bullying, harassment, abuse or belittlement are a regular phenomenon faced not only by medical students, but also junior doctors, doctors undertaking research and other healthcare professionals. While research has been carried out on bullying experienced by psychiatrists and psychiatry trainees in Pakistan no such research has been conducted on medical students in this country. Methodology/Principal Findings: We conducted a cross-sectional questionnaire survey on final year medical students in six medical colleges of Pakistan. The response rate was 63%. Fifty-two percent of respondents reported that they had faced bullying or harassment during their medical education, about 28% of them experiencing it once a month or even more frequently. The overwhelming form of bullying had been verbal abuse (57%), while consultants were the most frequent (46%) perpetrators. Students who were slightly older, males, those who reported that their medical college did not have a policy on bullying or harassment, and those who felt that adequate support was not in place at their medical college for bullied individuals, were significantly more likely to have experienced bullying. Conclusion: Bullying or harassment is faced by quite a large proportion of medical students in Pakistan. The most frequent perpetrators of this bullying are consultants. Adoption of a policy against bullying and harassment by medical colleges, and providing avenues of support for students who have been bullied may help reduce this phenomenon, as the presence of these two was associated with decreased likelihood of students reporting having being bullied

The fields of HIV and disability: past, present and future

This article provides an historic overview of the fields of disability and HIV. We describe this area of concern in terms of "fields" versus "a single field" because of the two related but distinct trends that have evolved over time. The first field involves people living with HIV and their experiences of disability, disablement and rehabilitation brought on by the disease and its treatments. The second involves people with disabilities and their experiences of vulnerability to and life with HIV. These two fields have evolved relatively independently over time. However, in the final section of this article, we argue that the divide between these fields is collapsing, and that this collapse is beginning to produce a new understanding about shared concerns, cross-field learning and the mutual benefits that might be realized from integrating policy and programmatic responses. We close by identifying directions that we expect these merging fields to take in the coming years

Growth, sensory and chemical characterization of Mediterranean yellowtail (Seriola dumerili) fed diets with partial replacement of fish meal by other protein sources

[EN] An 84-day trial was performed to assess the use of alternative protein sources in Seriola dumerili. Three diets were used, FM100 diet, as a control diet without fishmeal substitution, and FM66 and FM33 diets with a fishmeal replacement of 330 g/kg and 660 g/kg, respectively. At the end of experiment, fish fed the FM66 diet showed the no differences in growth, nutritional parameters and fatty acid composition. Heavy metals present some differences but are always lower than risk levels. In sensory analysis, differences between diets appeared in pH and color, and also in some texture parameters between FM33 and the other two diets. No differences appeared between diets related to flavor. In summary, long periods of feeding with high fish meal substitution diets, affects Seriola dumerili growth; despite this the quality of the fillet was not affected even with a 66 % of substitution.This project was financed by "Generalitat Valenciana. Ayudas para grupos de investigacion consolidables."Monge-Ortiz, R.; Martínez-Llorens, S.; Lemos-Neto, M.; Falco, S.; Pagán Moreno, MJ.; Godoy-Olmos, S.; Jover Cerda, M.... (2020). Growth, sensory and chemical characterization of Mediterranean yellowtail (Seriola dumerili) fed diets with partial replacement of fish meal by other protein sources. Aquaculture Reports. 18:1-10. https://doi.org/10.1016/j.aqrep.2020.100466S11018Abbas, K. A., Mohamed, A., Jamilah, B., & Ebrahimian, M. (2008). A Review on Correlations between Fish Freshness and pH during Cold Storage. American Journal of Biochemistry and Biotechnology, 4(4), 416-421. doi:10.3844/ajbbsp.2008.416.421Álvarez, A., García García, B., Garrido, M. D., & Hernández, M. D. (2008). The influence of starvation time prior to slaughter on the quality of commercial-sized gilthead seabream (Sparus aurata) during ice storage. Aquaculture, 284(1-4), 106-114. doi:10.1016/j.aquaculture.2008.07.025AMIARD, J., AMIARDTRIQUET, C., BARKA, S., PELLERIN, J., & RAINBOW, P. (2006). Metallothioneins in aquatic invertebrates: Their role in metal detoxification and their use as biomarkers. Aquatic Toxicology, 76(2), 160-202. doi:10.1016/j.aquatox.2005.08.015Baeverfjord, G., Refstie, S., Krogedal, P., & Åsgård, T. (2006). Low feed pellet water stability and fluctuating water salinity cause separation and accumulation of dietary oil in the stomach of rainbow trout (Oncorhynchus mykiss). Aquaculture, 261(4), 1335-1345. doi:10.1016/j.aquaculture.2006.08.033Baeza-Ariño, R., Martínez-Llorens, S., Nogales-Mérida, S., Jover-Cerda, M., & Tomás-Vidal, A. (2014). Study of liver and gut alterations in sea bream,Sparus aurataL., fed a mixture of vegetable protein concentrates. Aquaculture Research, 47(2), 460-471. doi:10.1111/are.12507Bell, J. G., McEvoy, J., Tocher, D. R., McGhee, F., Campbell, P. J., & Sargent, J. R. (2001). Replacement of Fish Oil with Rapeseed Oil in Diets of Atlantic Salmon (Salmo salar) Affects Tissue Lipid Compositions and Hepatocyte Fatty Acid Metabolism. The Journal of Nutrition, 131(5), 1535-1543. doi:10.1093/jn/131.5.1535Benedito-Palos, L., Navarro, J. C., Sitjà-Bobadilla, A., Gordon Bell, J., Kaushik, S., & Pérez-Sánchez, J. (2008). High levels of vegetable oils in plant protein-rich diets fed to gilthead sea bream (Sparus aurataL.): growth performance, muscle fatty acid profiles and histological alterations of target tissues. British Journal of Nutrition, 100(5), 992-1003. doi:10.1017/s0007114508966071Bjerkeng, B., Refstie, S., Fjalestad, K. T., Storebakken, T., Rødbotten, M., & Roem, A. J. (1997). Quality parameters of the flesh of Atlantic salmon (Salmo salar) as affected by dietary fat content and full-fat soybean meal as a partial substitute for fish meal in the diet. Aquaculture, 157(3-4), 297-309. doi:10.1016/s0044-8486(97)00162-2De Francesco, M., Parisi, G., Médale, F., Lupi, P., Kaushik, S. J., & Poli, B. M. (2004). Effect of long-term feeding with a plant protein mixture based diet on growth and body/fillet quality traits of large rainbow trout (Oncorhynchus mykiss). Aquaculture, 236(1-4), 413-429. doi:10.1016/j.aquaculture.2004.01.006DE FRANCESCO, M., PARISI, G., PÉREZ-SÁNCHEZ, J., GÓMEZ-RéQUENI, P., MÉDALE, F., KAUSHIK, S. J., … POLI, B. M. (2007). Effect of high-level fish meal replacement by plant proteins in gilthead sea bream (Sparus aurata) on growth and body/fillet quality traits. Aquaculture Nutrition, 13(5), 361-372. doi:10.1111/j.1365-2095.2007.00485.xEstruch, G., Collado, M. C., Peñaranda, D. S., Tomás Vidal, A., Jover Cerdá, M., Pérez Martínez, G., & Martinez-Llorens, S. (2015). 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Partial replacement of fish oil by flaxseed oil in Atlantic halibut (Hippoglossus hippoglossus L.) diets: effects on growth, nutritional and sensory quality. Aquaculture Nutrition, 17(6), 671-684. doi:10.1111/j.1365-2095.2011.00869.xMatallanas, J., Casadevall, M., Carrasson, M., Bolx, J., & Fernandez, V. (1995). The Food of Seriola Dumerili (Pisces: Carangidae) in the Catalan Sea (Western Mediterranean). Journal of the Marine Biological Association of the United Kingdom, 75(1), 257-260. doi:10.1017/s0025315400015356Monge-Ortiz, R., Tomás-Vidal, A., Gallardo-Álvarez, F. J., Estruch, G., Godoy-Olmos, S., Jover-Cerdá, M., & Martínez-Llorens, S. (2018). Partial and total replacement of fishmeal by a blend of animal and plant proteins in diets for Seriola dumerili : Effects on performance and nutrient efficiency. Aquaculture Nutrition, 24(4), 1163-1174. doi:10.1111/anu.12655Monge-Ortiz, R., Tomás-Vidal, A., Rodriguez-Barreto, D., Martínez-Llorens, S., Pérez, J. 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Muscle lipid storage pattern, composition, and adipocyte distribution in different parts of Atlantic salmon (Salmo salar) fed fish oil and vegetable oil. Aquaculture, 265(1-4), 230-243. doi:10.1016/j.aquaculture.2006.03.053O’Fallon, J. V., Busboom, J. R., Nelson, M. L., & Gaskins, C. T. (2007). A direct method for fatty acid methyl ester synthesis: Application to wet meat tissues, oils, and feedstuffs. Journal of Animal Science, 85(6), 1511-1521. doi:10.2527/jas.2006-491Olsen, R. L., & Toppe, J. (2017). Fish silage hydrolysates: Not only a feed nutrient, but also a useful feed additive. Trends in Food Science & Technology, 66, 93-97. doi:10.1016/j.tifs.2017.06.003De Paiva, E. L., Alves, J. C., Milani, R. F., Boer, B. S., Quintaes, K. D., & Morgano, M. A. (2016). Sushi commercialized in Brazil: Organic Hg levels and exposure intake evaluation. Food Control, 69, 115-123. doi:10.1016/j.foodcont.2016.04.029Panserat, S., Hortopan, G. A., Plagnes-Juan, E., Kolditz, C., Lansard, M., Skiba-Cassy, S., … Corraze, G. (2009). Differential gene expression after total replacement of dietary fish meal and fish oil by plant products in rainbow trout (Oncorhynchus mykiss) liver. Aquaculture, 294(1-2), 123-131. doi:10.1016/j.aquaculture.2009.05.013Piazzon, M. C., Calduch-Giner, J. A., Fouz, B., Estensoro, I., Simó-Mirabet, P., Puyalto, M., … Pérez-Sánchez, J. (2017). Under control: how a dietary additive can restore the gut microbiome and proteomic profile, and improve disease resilience in a marine teleostean fish fed vegetable diets. Microbiome, 5(1). doi:10.1186/s40168-017-0390-3Regost, C., Arzel, J., Robin, J., Rosenlund, G., & Kaushik, S. . (2003). Total replacement of fish oil by soybean or linseed oil with a return to fish oil in turbot (Psetta maxima). Aquaculture, 217(1-4), 465-482. doi:10.1016/s0044-8486(02)00259-4Robaina, L., Izquierdo, M. ., Moyano, F. ., Socorro, J., Vergara, J. ., & Montero, D. (1998). Increase of the dietary n−3/n−6 fatty acid ratio and addition of phosphorus improves liver histological alterations induced by feeding diets containing soybean meal to gilthead seabream, Sparus aurata. Aquaculture, 161(1-4), 281-293. doi:10.1016/s0044-8486(97)00276-7Serradell, A., Torrecillas, S., Makol, A., Valdenegro, V., Fernández-Montero, A., Acosta, F., … Montero, D. (2020). Prebiotics and phytogenics functional additives in low fish meal and fish oil based diets for European sea bass (Dicentrarchus labrax): Effects on stress and immune responses. Fish & Shellfish Immunology, 100, 219-229. doi:10.1016/j.fsi.2020.03.016Shimeno, S., Masumoto, T., Hujita, T., Mima, T., & Ueno, S. (1993). Protein Source for Fish Feed-V. Alternative Protein Sources for Fish Meal in Diets of Young Yellowtail. NIPPON SUISAN GAKKAISHI, 59(1), 137-143. doi:10.2331/suisan.59.137Sitjà-Bobadilla, A., Peña-Llopis, S., Gómez-Requeni, P., Médale, F., Kaushik, S., & Pérez-Sánchez, J. (2005). Effect of fish meal replacement by plant protein sources on non-specific defence mechanisms and oxidative stress in gilthead sea bream (Sparus aurata). Aquaculture, 249(1-4), 387-400. doi:10.1016/j.aquaculture.2005.03.031SLOTH, J. J., JULSHAMN, K., & LUNDEBYE, A.-K. (2005). Total arsenic and inorganic arsenic content in Norwegian fish feed products. Aquaculture Nutrition, 11(1), 61-66. doi:10.1111/j.1365-2095.2004.00334.xStergiou, K. I., & Karpouzi, V. S. (2001). Reviews in Fish Biology and Fisheries, 11(3), 217-254. doi:10.1023/a:1020556722822Thakur, D. P., Morioka, K., Itoh, N., Wada, M., & Itoh, Y. (2009). Muscle biochemical constituents of cultured amberjack Seriola dumerili and their influence on raw meat texture. Fisheries Science, 75(6), 1489-1498. doi:10.1007/s12562-009-0173-2TOMAS, A., DE LA GANDARA, F., GARCIA-GOMEZ, A., PEREZ, L., & JOVER, M. (2005). Utilization of soybean meal as an alternative protein source in the Mediterranean yellowtail, Seriola dumerili. Aquaculture Nutrition, 11(5), 333-340. doi:10.1111/j.1365-2095.2005.00365.xTomás‐Vidal, A., Monge‐Ortiz, R., Jover‐Cerdá, M., & Martínez‐Llorens, S. (2019). Apparent digestibility and protein quality evaluation of selected feed ingredients in Seriola dumerili. Journal of the World Aquaculture Society, 50(4), 842-855. doi:10.1111/jwas.12597Torstensen, B. E., Bell, J. G., Rosenlund, G., Henderson, R. J., Graff, I. E., Tocher, D. R., … Sargent, J. R. (2005). Tailoring of Atlantic Salmon (Salmo salar L.) Flesh Lipid Composition and Sensory Quality by Replacing Fish Oil with a Vegetable Oil Blend. Journal of Agricultural and Food Chemistry, 53(26), 10166-10178. doi:10.1021/jf051308iTurchini, G. M., Moretti, V. M., Mentasti, T., Orban, E., & Valfrè, F. (2007). Effects of dietary lipid source on fillet chemical composition, flavour volatile compounds and sensory characteristics in the freshwater fish tench (Tinca tinca L.). 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Improving early childhood care and development, HIV testing, treatment and support, and nutrition in Mokhotlong, Lesotho: study protocol for a cluster randomized controlled trial

Background Since 1990, the lives of 48 million children under the age of 5 have been saved because of increased investments in reducing child mortality. However, despite these unprecedented gains, more than 200 million children in low and middle income countries (LMIC) cannot meet their developmental potential due to poverty, poor health and nutrition, and lack of necessary stimulation and care. Lesotho has high levels of poverty, HIV and malnutrition, all of which affect child development outcomes. There is a unique opportunity to address these complex issues through the widespread network of informal preschools in rural villages in the country, which provide a setting for inclusive, integrated Early Childhood Care and Development (ECCD), HIV and nutrition interventions. Methods We are conducting a cluster randomised controlled trial in Mokhotlong district, Lesotho, to evaluate a newly developed community-based intervention programme to integrate HIV testing and treatment services, ECCD, and nutrition education for caregivers with children aged 1-5 years living in rural villages. Caregivers and their children are randomly assigned by village to intervention or control condition. We select, train, and supervise community health workers recruited to implement the intervention, which consists of nine group-based sessions with caregivers and children over 12 weeks (eight weekly sessions, and a ninth top up session one month later), followed by a locally hosted community health outreach day event. Group-based sessions focus on using early dialogic booksharing to promote cognitive development and caregiver-child interaction, health-related messages, including motivation for HIV-testing and treatment uptake for young children, and locally appropriate nutrition education. All children aged 1-5 years and their primary caregivers living in study villages are eligible for participation. Caregivers and their children will be interviewed and assessed at baseline, immediately after completion of the intervention, and 12 months post intervention. Discussion This study provides a unique opportunity to assess the potential of an integrated early childhood development intervention to prevent or mitigate developmental delays in children living in a context of extreme poverty and high HIV rates in rural Lesotho. This paper presents the intervention content and research protocol for the study