Predictors of Bacterial Vaginosis among Pregnant Women Attending Antenatal Clinic at Tertiary Care Hospital in Tanzania: A Cross Sectional Study

Background: Bacterial vaginosis (BV) is one of the most common genital tract infections in pregnancy associated with an increased risk of pregnancy losses, maternal and perinatal morbidity and mortality. Different social behavioural and obstetric factors can contribute to the development of BV. Determining the predictors of BV could be the best way of identifying women at high risk of developing the disease.Methods: This was a cross-sectional study conducted between December 2017 and February 2018 to determine the prevalence and  predictors of BV among pregnant women attending antenatal Clinic (ANC) at Muhimbili National Hospital (MNH), Tanzania. Participants  were recruited using systematic random sampling. For each consented participant, a pretested questionnaire was filled, a pelvic  examination was done and a sample was collected. BV was diagnosed using Nugent’s score. Data was analysed using Statistical Package for Social Scientists (SPSS) version 23.0. Bivariate and multivariate logistic regression analysis was done to determine factors that were independently associated with BV.Results: 178 (26.7%) pregnant women out of 667 were diagnosed positive for BV. In the bivariate analysis (Table 3), age (COR 1.71; 95% CI, 1.16-2.52), level of education (COR 4.08, 95% CI, 2.84-5.84), gravidity (COR, 1.52, 95% CI; 1.04-2.23), parity (COR 1.69, 95% CI; 1.18-2.42), vaginal douching (COR 2.89, 95% CI; 1.96-4.27), HIV status (COR 9.37, 95%CI; 4.12-21.28), history of STI (COR 2.49 95% CI; 1.46-4.25), LTSP (COR 2.76, 95% CI; 1.68-4.54) and age of first coitus (COR 3.19, 95% CI; 2.24-4.56) were significantly associated with BV. After adjusting for confounders in multivariate analysis, the following risk factors remained significantly associated with BV; age of 21- 29 years (AOR, 2.22, 95%CI; 1.45-3.49), primary education level (AOR 3.97, 95% CI; 2.63-5.98), vaginal douching (AOR 3.68, 95% CI; 2.35-5.76), HIV status (AOR 6.44, 95% CI; 2.62-15.88), STI infection (AOR 2.34, 95% CI; 1.25-4.37), more than one LTSP (AOR 2.69, 95% CI; 1.53-4.74) and age of less than 18 years of first coitus (AOR 2.16, 95% CI; 1.42-3.30).Conclusion: The prevalence of BV in pregnant women was found to be high. Age of less than 30 years, primary education level and below, vaginal douching, HIV infection, STI, more than one lifetime sexual partners and early age of sexual debut were found to be significant predictors of BV. The high prevalence of BV in our population should necessitate policy makers to include screening and treatment of BV in the future policy of antenatal care package, as BV is associated with significant maternal and neonatal morbidity and mortality. Women should also be educated on harmful effects of certain behavioural practices such as vaginal douching that predispose to BV. In addition symptoms of BV such as abnormal vaginal discharge during pregnancy are inconsistent, under reported and often overlooked. Therefore, a high-risk approach can be used for screening and treatment of asymptomatic women

Detection of Type 2 Diabetes Mellitus in Serum from Women with Polycystic Ovarian Syndrome

Polycystic ovary syndrome (PCOS) is one of the most common endocrine disorder. To determine the metabolic disorders in women with PCOS, (25) women with PCOS ages (15 - 47) years have been investigated and compared with (20) healthy individuals. All the studied groups were carried out to measure fasting blood sugar, (anti-GAD Ab, anti ?-islet cell Ab by IFAT) and measured insulin level by ELISA. There was significant elevation in the concentration of fasting blood sugar than in control groups (p ? 0.05) and there was negative results for anti-GAD Ab and anti ?-islet cell Ab by IFAT test for serum of women with PCOS, while there was significant differences in the insulin level for women with PCOS compared with control groups (p ? 0.05), these indicated that women with PCOS are at high risk for type -2 Diabetes mellitus and reflecting insulin resistance

Agro-Pastoralists Concerns Over the \u3cem\u3eProsopis\u3c/em\u3e Tree: The Case of the Ilchamus of Baringo District, Kenya

The Prosopis tree was introduced to the arid and semi-arid lands of eastern Africa in the 1970s, through governmental forest development agencies to curb environmental degradation and provide fodder for small stock. A number of other benefits were also then attributed to the tree. However, the Prosopis tree has turned out to be a cause of serious concerns, as it has invaded, dominated and almost totally removed all grass and short vegetation species from pasturelands. In Baringo District of Kenya, Prosopis has been the worst enemy of the local IlChamus agro-pastoralists (Lenachuru, 2003), who have now raised much concern over the species, calling for its complete eradication, and threatening to sue the government for damages caused by the tree. This paper examines the case against Prosopis species, based on the agro-pastoralists\u27 perspectives, and the numerous benefits of the tree that the agro-pastoralists apparently unaware of, or simply refuse to attach value to

The Influence of Dentin Age and the Presence of Cracks in Removal of the Root Filling Material

Introduction: This study evaluated the removal of the filling material during endodontic retreatment considering the presence of cracks and the dentin age. Methods and Materials: A total of 20 freshly extracted single-rooted teeth were categorized into the following two groups according to the age of the patients: Group Young (Y; aged 18-30 years) and Group Old (O; aged ≥60 years). Each tooth specimen was scanned by microcomputed tomography (micro-CT) subsequently after endodontic retreatment with the Reciproc instruments (REC). The images were analyzed for differences in the volume of dentin cracks and the presence of the filling material in the middle and apical thirds of the teeth among the groups, according to the dentin age. Results: The micro-CT images showed that after retreatment, there were more cracks in the old root dentin than those in the young root dentin, although the difference was not statistically significant (P>0.05). The greatest reduction in the filling material was achieved when the old root dentin with cracks was retreated when compared with that of the young root dentin with cracks, but the difference was not statistically significant (P>0.05). Conclusion: The dentinal age and the presence of cracks were not found to be relevant factors for the removal of the filling material.Keywords: Dentin; Microcomputed Tomography; Retreatmen

Antimicrobial resistance among producers and non-producers of extended spectrum beta-lactamases in urinary isolates at a tertiary Hospital in Tanzania

<p>Abstract</p> <p>Background</p> <p>Published data on the existence and magnitude of extended spectrum beta-lactamase (ESBL) production in urinary pathogens in local setting is limited. The aim of the present study was to determine the prevalence of antimicrobial resistance and ESBL production among <it>Escherichia coli </it>and <it>Klebsiella spp </it>from urine samples in a tertiary hospital. This was a cross sectional study conducted at Muhimbili National Hospital in Dar es Salaam, Tanzania.</p> <p>Findings</p> <p>A total of 270 <it>E.coli </it>and <it>Klebsiella spp </it>urinary pathogens from children and adults isolated from January to March 2010 were included in the study. <it>E. coli </it>and <it>Klebsiella spp </it>isolates were tested for antimicrobial susceptibility by the Clinical and Laboratory Standard Institute's disc diffusion method. These isolates were further screened for ESBL phenotype using cefotaxime and ceftazidime discs. Isolates with reduced sensitivity were confirmed using ESBL E-test strips. Of 270 isolates, 138 (51.1%) were <it>E. coli </it>and 132 (48.9%) were <it>Klebsiella spp</it>. ESBL was detected in 122 (45.2%) of all the isolates. ESBL- producing <it>E. coli </it>strains were significantly more resistance to cotrimoxazole (90.7%), ciprofloxacin (46.3%) and nalidixic acid (61.6%) than strains that did not produce ESBL (p < 0.05). Similarly, ESBL- producing <it>Klebsiella spp </it>strains were significantly more resistance to cotrimoxazole (92.6%), ciprofloxacin (25.0%), nalidixic acid (66.2%), and gentamicin (38.2%) than strains that did not produce ESBL (P < 0.05). Multi-drug resistance was found to be significantly (<it>P </it>< 0.05) more in ESBL producing isolates (90.5%) than non ESBL producers (68.9%). The occurrence of ESBL was significantly higher among isolates from inpatients than outpatients [95 (50.5%) vs. 27(32.9%)] (p = 0.008). The occurrence of ESBL was significantly higher among isolates from children than in adults [84 (54.9%) vs. 38(32.5%)] (p < 0.001).</p> <p>Conclusions</p> <p>High prevalence of ESBL-producing <it>E. coli </it>and <it>Klebsiella spp </it>strains was found among inpatients and children. Most of the ESBL- producing isolates were multi-drug resistant making available therapeutic choices limited. We recommend continued antibiotic surveillance as well comprehensive multi-center studies to address the emerging problem of ESBL-associated infections in order to preserve the continued usefulness of most antimicrobial drugs. Further more conducting molecular studies will help to evaluate the various ESBL types.</p

Inhibiting tryptophan metabolism enhances interferon therapy in kidney cancer.

Renal cell carcinoma (RCC) is increasing in incidence, and a complete cure remains elusive. While immune-checkpoint antibodies are promising, interferon-based immunotherapy has been disappointing. Tryptophan metabolism, which produces immunosuppressive metabolites, is enhanced in RCC. Here we show indolamine-2,3-dioxygenase-1 (IDO1) expression, a kynurenine pathway enzyme, is increased not only in tumor cells but also in the microenvironment of human RCC compared to normal kidney tissues. Neither kynurenine metabolites nor IDO inhibitors affected the survival or proliferation of human RCC or murine renal cell adenocarcinoma (RENCA) cells in vitro. However, interferon-gamma (IFNγ) induced high levels of IDO1 in both RCC and RENCA cells, concomitant with enhanced kynurenine levels in conditioned media. Induction of IDO1 by IFNα was weaker than by IFNγ. Neither the IDO1 inhibitor methyl-thiohydantoin-DL-tryptophan (MTH-trp) nor IFNα alone inhibited RENCA tumor growth, however the combination of MTH-trp and IFNα reduced tumor growth compared to IFNα. Thus, the failure of IFNα therapy for human RCC is likely due to its inability to overcome the immunosuppressive environment created by increased IDO1. Based on our data, and given that IDO inhibitors are already in clinical trials for other malignancies, IFNα therapy with an IDO inhibitor should be revisited for RCC

Rapid Identification of Human Adenoviruses and Cytokine Estimation among Patients with Epidemic Keratoconjunctivitis in Babylon Governorate, Iraq

One hundred seventy five conjunctival swabs were collected from patients with keratoconjunctivitis. All swabs were cultured on Blood agar and MacConkey agar , 82 positive bacterial culture isolates were excluded and 93 negative bacterial culture isolates were taken as a study samples. All 93 swabs were subjected to rapid immunochromatography test (IC) test. The results of rapid identification revealed that 79 specimens (84.9%) were found positive for human adenoviruses , whereas 14 specimens (15.1%) were found negative for human adenoviruses. In addition , the results indicated that the positive rate of the IC test for specimens obtained within 1–5 days after of the onset of illness 59 (74.7%) were significantly higher than that for specimens obtained within 6–10 days after of the onset of illness 20 (25.3%) at P-value &lt; 0.05.Tear samples were also collected from both (30) patients and (25) controls to estimate the tear levels of some immune parameters Interleukine-6  (IL-6), Interlukine-8 (IL-8), and tumor necrosis factor alpha (TNF-α) by ELISA (Enzyme linked Immunosorbent Assay) method .The cytokine profile showed that there is a significant increase (P&lt;0.05) in the mean tear concentration of each (IL-6, IL-8 and TNF-α) between EKC patients and control groups , and the result showed that IL-8 was the predominant cytokine released and followed by IL-6 and TNF-α . Keywords: Adenovirus, Keratoconjunctivitis, Immunochromatography test, Cytokin

Reaching expert consensus on training different cadres in delivering early childhood development: technical report

The Sustainable Development Goals (SDGs) signal a greater focus on inter-sectoral, collaborative approaches to ensuring that all human beings can fulfil their potential in dignity and equality. This is reflected in the current global concern with promotion of holistic, community-based programmes to support early childhood development and wellbeing ? widely referred to as ?early childhood development? (ECD). Within this context, the study reported here sought to achieve consensus among 14 global experts on training needs for three groups of personnel (?cadres?) involved in delivery of early childhood development (ECD) programmes. The three cadre groups, identified via a comprehensive review of literature on current issues in the provision of ECD, comprise delivery of education, health and community-based early childhood interventions across a diverse range of low resource settings. The study responds to a gap in knowledge on training needs for ECD cadres, associated with a serious dearth of human resources to support provision of ECD services. Key challenges reported here, based on comprehensive review of available literature, include: 1. A long-running, severe global shortage in availability of cadres to support delivery of ECD programmes. 2. To date, delivery of key health and education interventions principally in siloes, with limited integration and practitioners/professionals/para-professionals widely employed in vertical programmes. 3. Low professional and social status of many ECD cadres, due to a lack of systematic recognition and support. This has resulted in large numbers of cadres with undefined career paths, and high rates of turnover / attrition2. In response, expert consensus points to the following potential strategies for enhancing provision of ECD cadres training and professional development: 1. Development of coherent systems to support ECD training and professional development. a. Findings indicate consensus around commonalities among and distinctions between essential skills and knowledge required for education professionals, health professionals and non-certified para-professional groups. These insights could provide a basis for establishing coherent, joined-up professional pathways and support systems for development of ECD cadres. b. Consensus around the respective roles of these three cadres is reflected in the distinct training needs outlined for each group. There is consensus that, while noncertified para-professionals require programme-specific training to facilitate delivery of particular tasks, certified education and health professionals require training in more advanced skills such as problem-solving and flexibility. Exposure to a range of different programmes and approaches is required for certified professionals, to facilitate informed decision making around programme development and adapting / responding to local contextual needs. These distinctions could provide a basis for establishing clarity in respective roles for ECD cadres with regard to programme delivery. c. Consensus around training needs across cadre groups is indicated, in particular the need for on-going mentoring and supervision. While there is acknowledgment among experts about complexities associated with provision of on-going support, consensus around this component of training was strongest among all aspects surveyed. This reflects widespread concern among participating experts, as well as within the literature, that short-term training for ECD cadres must be followed up with opportunities for continuing professional development and systematic support, to facilitate sustained effective practice. 2. Within systems for ECD cadres training, a strong focus on the importance of contextually grounded programmes, materials / resources and strategies for implementation. a. There is strong consensus that ECD cadres training should be contextually-grounded to ensure responsive, effective provision. Training should be based on and promote careful consideration of a range of factors that shape provision of ECD, including but not restricted to, policy, budgets, available resources, local values, beliefs and practices. 3. Adoption of the concept of nurturing care as an underpinning principle for provision of ECD cadres training. a. Delphi findings indicate consensus around essential dispositions, or attitudes, required to support caring, respectful, responsive and trustful interactions with children, caregivers and communities. They also indicate that all cadres require knowledge and skills in promoting early stimulation; child-centred learning and development; effective communication and collaboration; problem solving, and reflective practice. These strategies are outlined in the proposed framework provided below, which identifies unique roles / training needs for different cadre groups, as well as opportunities for enhancing integration across ECD cadres training systems. 3 Experts suggest that these ?dispositions?, which are essential for effective provision, should be viewed as malleable. Training should work / be designed to promote, model and strengthen these characteristics

Assessing children’s implicit attitudes using the Affect Misattribution Procedure

In the current research we examined whether the Affect Misattribution Procedure (AMP; Payne et al., 2005) could be successfully adapted as an implicit measure of children’s attitudes. We tested this possibility in three studies with 5 to 10 year old children. In Study 1 we found evidence that children misattribute affect elicited by attitudinally positive (e.g., cute animals) and negative (e.g., aggressive animals) primes to neutral stimuli (inkblots). In Study 2, we found that, as expected, children’s responses following flower and insect primes were moderated by gender. Girls (but not boys) were more likely to judge inkblots as pleasant when they followed flower primes. Children in Study 3 showed predicted affect misattribution following happy as compared to sad face primes. In addition, children’s responses on this child-friendly AMP predicted their self-reported empathy; the greater children’s spontaneous misattribution of affect following happy and sad primes, the more children reported feeling the joy and pain of others. These studies provide evidence that the AMP can be adapted as an implicit measure of children’s attitudes and the results of Study 3 offer novel insight into individual differences in children’s affective responses to the emotional expressions of other