Pattern of Pathogens and Their Sensitivity Isolated from Surgical Site Infections at the Aga Khan University Hospital, Nairobi, Kenya

Background: In low income countries, surgical site infections (SSIs) are costly and impose a heavy and potentially preventable burden on both patients and healthcare providers. This study aimed to determine the occurrence of SSI, pathogens associated with SSI, the antibiogram of the causative pathogens and specific risk factors associated with SSI at the hospital. Methods: Two hundred and sixty-eight respondents admitted for general surgical procedures (other than neurological and cardiothoracic surgeries) at the Aga Khan University Hospital were eligible to take part in the study. Post-surgery patients were observed for symptoms of infection. Follow ups were done through the consulting clinics, breast clinic and casualty dressing clinic by a team of surgeons. In cases of infection, pus swabs were collected for culture.Results: SSI incidence rate was 7.0%, pathogens isolated from SSI included gram negative enteric bacilli and S. aureus which was the most prevalent bacterial isolate. Only one isolate of MRSA was found and all staphylococci were susceptible to Vancomycin. Preoperative stay ≥ 2 days and wound class were the risk factors associated with SSI.Conclusions: The SSI incidence rates (7.0%) observed in this study were relatively lower than the ones documented in other studies in Kenya. S. aureus is the most prevalent pathogen associated with SSI. Similar to findings from other studies done in the region; prolonged hospital stay and dirty wounds were the risks associated with postsurgical sepsis at the hospital.Keywords: Surgical sites, Infection, Surveillance, Antibiotic

Mapping local patterns of childhood overweight and wasting in low- and middle-income countries between 2000 and 2017

A double burden of malnutrition occurs when individuals, household members or communities experience both undernutrition and overweight. Here, we show geospatial estimates of overweight and wasting prevalence among children under 5 years of age in 105 low- and middle-income countries (LMICs) from 2000 to 2017 and aggregate these to policy-relevant administrative units. Wasting decreased overall across LMICs between 2000 and 2017, from 8.4% (62.3 (55.1–70.8) million) to 6.4% (58.3 (47.6–70.7) million), but is predicted to remain above the World Health Organization’s Global Nutrition Target of <5% in over half of LMICs by 2025. Prevalence of overweight increased from 5.2% (30 (22.8–38.5) million) in 2000 to 6.0% (55.5 (44.8–67.9) million) children aged under 5 years in 2017. Areas most affected by double burden of malnutrition were located in Indonesia, Thailand, southeastern China, Botswana, Cameroon and central Nigeria. Our estimates provide a new perspective to researchers, policy makers and public health agencies in their efforts to address this global childhood syndemic

Tropical Data: Approach and Methodology as Applied to Trachoma Prevalence Surveys

PURPOSE: Population-based prevalence surveys are essential for decision-making on interventions to achieve trachoma elimination as a public health problem. This paper outlines the methodologies of Tropical Data, which supports work to undertake those surveys. METHODS: Tropical Data is a consortium of partners that supports health ministries worldwide to conduct globally standardised prevalence surveys that conform to World Health Organization recommendations. Founding principles are health ministry ownership, partnership and collaboration, and quality assurance and quality control at every step of the survey process. Support covers survey planning, survey design, training, electronic data collection and fieldwork, and data management, analysis and dissemination. Methods are adapted to meet local context and needs. Customisations, operational research and integration of other diseases into routine trachoma surveys have also been supported. RESULTS: Between 29th February 2016 and 24th April 2023, 3373 trachoma surveys across 50 countries have been supported, resulting in 10,818,502 people being examined for trachoma. CONCLUSION: This health ministry-led, standardised approach, with support from the start to the end of the survey process, has helped all trachoma elimination stakeholders to know where interventions are needed, where interventions can be stopped, and when elimination as a public health problem has been achieved. Flexibility to meet specific country contexts, adaptation to changes in global guidance and adjustments in response to user feedback have facilitated innovation in evidence-based methodologies, and supported health ministries to strive for global disease control targets

Effect of angiotensin-converting enzyme inhibitor and angiotensin receptor blocker initiation on organ support-free days in patients hospitalized with COVID-19

IMPORTANCE Overactivation of the renin-angiotensin system (RAS) may contribute to poor clinical outcomes in patients with COVID-19. Objective To determine whether angiotensin-converting enzyme (ACE) inhibitor or angiotensin receptor blocker (ARB) initiation improves outcomes in patients hospitalized for COVID-19. DESIGN, SETTING, AND PARTICIPANTS In an ongoing, adaptive platform randomized clinical trial, 721 critically ill and 58 non–critically ill hospitalized adults were randomized to receive an RAS inhibitor or control between March 16, 2021, and February 25, 2022, at 69 sites in 7 countries (final follow-up on June 1, 2022). INTERVENTIONS Patients were randomized to receive open-label initiation of an ACE inhibitor (n = 257), ARB (n = 248), ARB in combination with DMX-200 (a chemokine receptor-2 inhibitor; n = 10), or no RAS inhibitor (control; n = 264) for up to 10 days. MAIN OUTCOMES AND MEASURES The primary outcome was organ support–free days, a composite of hospital survival and days alive without cardiovascular or respiratory organ support through 21 days. The primary analysis was a bayesian cumulative logistic model. Odds ratios (ORs) greater than 1 represent improved outcomes. RESULTS On February 25, 2022, enrollment was discontinued due to safety concerns. Among 679 critically ill patients with available primary outcome data, the median age was 56 years and 239 participants (35.2%) were women. Median (IQR) organ support–free days among critically ill patients was 10 (–1 to 16) in the ACE inhibitor group (n = 231), 8 (–1 to 17) in the ARB group (n = 217), and 12 (0 to 17) in the control group (n = 231) (median adjusted odds ratios of 0.77 [95% bayesian credible interval, 0.58-1.06] for improvement for ACE inhibitor and 0.76 [95% credible interval, 0.56-1.05] for ARB compared with control). The posterior probabilities that ACE inhibitors and ARBs worsened organ support–free days compared with control were 94.9% and 95.4%, respectively. Hospital survival occurred in 166 of 231 critically ill participants (71.9%) in the ACE inhibitor group, 152 of 217 (70.0%) in the ARB group, and 182 of 231 (78.8%) in the control group (posterior probabilities that ACE inhibitor and ARB worsened hospital survival compared with control were 95.3% and 98.1%, respectively). CONCLUSIONS AND RELEVANCE In this trial, among critically ill adults with COVID-19, initiation of an ACE inhibitor or ARB did not improve, and likely worsened, clinical outcomes. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT0273570

Design of one-dimensional magnetophotonic crystals operating at visible wavelengths

In this paper, a proposal for designing the one-dimensional magnetophotonic crystals operating at visible wavelengths is presented. To this aim, a binary all-dielectric periodic structure is considered with quarter wavelength optical thicknesses condition. However, the Bi:YIG as a magneto-optical defect layer with two different optical thicknesses of λ0/ 2 and 4λ0 is utilized. Using the 4 × 4 transfer matrix method the defect mode properties of the considered structures are investigated regarding the different period numbers and various magneto-optical defect layer positions. Analyzing the transmittance, Faraday rotation and absorption coefficient of these structures for the 720 nm visible light, the optimum structures are proposed for both cases of magneto-optical defect layer thicknesses. These structures may have potential applications in designing the miniaturized magneto-optical devices such as magneto-optical sensors and isolators and integrated photonic elements

Transmittance Magneto-Optical Responses of One-Dimensional Magnetophotonic Heterostructures

Transmittance magneto-optical responses of one-dimensional magnetophotonic heterostructures are investigated using 4 by 4 transfer matrix method. It is shown that in a simple magnetophotonic heterostructure constituted of two different periodic structures, the enhanced Faraday rotation associated with high transmittance at a desired wavelength can be realized with specifying optimized repetition numbers and adjusting the thicknesses of the substructure layers. However, the unique features of multichanneled enhanced Faraday rotations are obtained for different configurations of a multiple magnetophotonic heterostructure and the most suitable one to simultaneously support the both resonance wavelengths of $1.3 μm$ and $1.55 μm$ are introduced. These wavelengths are currently used in telecommunication systems. Then the obtained results may have potential applications in designing the multi-function single magneto-optical devices such as multiple Faraday rotators and wavelength division multiplexing systems

QAPD: an ontology-based question answering system in the physics domain

The tremendous development in information technology led to an explosion of data and motivated the need for powerful yet efficient strategies for knowledge discovery. Question answering (QA) systems made it possible to ask questions and retrieve answers using natural language queries. In ontology-based QA system, the knowledge-based data, where the answers are sought, have a structured organization. The question-answer retrieval of ontology knowledge base provides a convenient way to obtain knowledge for use. In this paper, QAPD, an ontology-based QA system applied to the physics domain, which integrates natural language processing, ontologies and information retrieval technologies to provide informative information for users, is presented. This system allows users to retrieve information from formal ontologies using input queries formulated in natural language. We proposed inferring schema mapping method, which uses the combination of semantic and syntactic information, and attribute-based inference to transform users’ questions into ontological knowledge base query. In addition, a novel domain ontology for physics domain, called EAEONT, is presented. Relevant standards and regulations have been utilized extensively during the ontology building process. The original characteristic of system is the strategy used to fill the gap between users’ expressiveness and formal knowledge representation. This system has been developed and tested on the English language and using an ontology modeling the physics domain. The performance level achieved enables the use of the system in real environments

Insight into the mechanical properties of 3D printed strut-based lattice structures

The file attached to this record is the author's final peer reviewed version. The Publisher's final version can be found by following the DOI link. This study was funded by the Faculty of Computing, Engineering and Media at De Montfort UniversitySince the development of additive manufacturing (3D printing), there has been a growing interest in the use of 3D printed lattice structures for a range of mechanical and biomedical applications. This study investigates the elastic properties of different types of strut-based lattice structures obtained through a series of compression tests and compares them against numerically calculated properties of intended designs. Two different 3D printing processes are employed for the fabrication of lattice structures, including selective laser sintering (SLS) and digital light processing (DLP). Gibson-Ashby power-law for cellular structures has been initially utilised as a framework for the comparison of numerical and experimental results. The results are normalised, allowing the comparison of elastic properties of lattices made in different polymer materials independent of the bulk material properties. This study suggests that although the mechanical properties of the fabricated parts are heavily dependent on the design of lattice unit-cell, the mechanical properties can be significantly different to those of intended designs depending on the 3D printing process used for the fabrication of lattice structures