Effects of mefloquine and artesunate mefloquine on the emergence, clearance and sex ratio of Plasmodium falciparum gametocytes in malarious children

<p>Abstract</p> <p>Background</p> <p>The gametocyte sex ratio of <it>Plasmodium falciparum</it>, defined as the proportion of gametocytes that are male, may influence transmission but little is known of the effects of mefloquine or artesunate-mefloquine on gametocyte sex ratio and on the sex ratio of first appearing gametocytes.</p> <p>Methods</p> <p>350 children with uncomplicated <it>P. falciparum </it>malaria were enrolled in prospective treatment trial of mefloquine or artesunate-mefloquine between 2007 and 2008. Gametocytaemia was quantified, and gametocytes were sexed by morphological appearance, before and following treatment. The area under curve of gametocyte density <it>versus </it>time (AUC_gm) was calculated by linear trapezoidal method.</p> <p>Results</p> <p>91% and 96% of all gametocytes appeared by day 7 and day 14, respectively following treatment. The overall rate of gametocytaemia with both treatments was 31%, and was significantly higher in mefloquine than in artesunate-mefloquine treated children if no gametocyte was present a day after treatment began (25.3% <it>v </it>12.8%, P = 0.01). Gametocyte clearance was significantly faster with artesunate-mefloquine (1.8 ± 0.22 [sem] <it>v </it>5.6 ± 0.95 d; P = 0.001). AUC_gmwas significantly lower in the artesunate mefloquine group (P = 0.008). The pre-treatment sex ratio was male-biased, but post-treatment sex ratio or the sex ratio of first appearing gametocytes, was significantly lower and female-biased two or three days after beginning of treatment in children given artesunate-mefloquine.</p> <p>Conclusion</p> <p>Addition of artesunate to mefloquine significantly modified the emergence, clearance, and densities of gametocytes and has short-lived, but significant, sex ratio modifying effects in children from this endemic area.</p

Intraperitoneal drain placement and outcomes after elective colorectal surgery: international matched, prospective, cohort study

Despite current guidelines, intraperitoneal drain placement after elective colorectal surgery remains widespread. Drains were not associated with earlier detection of intraperitoneal collections, but were associated with prolonged hospital stay and increased risk of surgical-site infections.Background Many surgeons routinely place intraperitoneal drains after elective colorectal surgery. However, enhanced recovery after surgery guidelines recommend against their routine use owing to a lack of clear clinical benefit. This study aimed to describe international variation in intraperitoneal drain placement and the safety of this practice. Methods COMPASS (COMPlicAted intra-abdominal collectionS after colorectal Surgery) was a prospective, international, cohort study which enrolled consecutive adults undergoing elective colorectal surgery (February to March 2020). The primary outcome was the rate of intraperitoneal drain placement. Secondary outcomes included: rate and time to diagnosis of postoperative intraperitoneal collections; rate of surgical site infections (SSIs); time to discharge; and 30-day major postoperative complications (Clavien-Dindo grade at least III). After propensity score matching, multivariable logistic regression and Cox proportional hazards regression were used to estimate the independent association of the secondary outcomes with drain placement. Results Overall, 1805 patients from 22 countries were included (798 women, 44.2 per cent; median age 67.0 years). The drain insertion rate was 51.9 per cent (937 patients). After matching, drains were not associated with reduced rates (odds ratio (OR) 1.33, 95 per cent c.i. 0.79 to 2.23; P = 0.287) or earlier detection (hazard ratio (HR) 0.87, 0.33 to 2.31; P = 0.780) of collections. Although not associated with worse major postoperative complications (OR 1.09, 0.68 to 1.75; P = 0.709), drains were associated with delayed hospital discharge (HR 0.58, 0.52 to 0.66; P &lt; 0.001) and an increased risk of SSIs (OR 2.47, 1.50 to 4.05; P &lt; 0.001). Conclusion Intraperitoneal drain placement after elective colorectal surgery is not associated with earlier detection of postoperative collections, but prolongs hospital stay and increases SSI risk

Cost and returns on the marketing of charcoal within Ibadan Metropolis, Nigeria

The study on the cost and returns of charcoal marketing was carried out within Ibadan metropolis, Nigeria. The objective of the study was to investigate the returns on the sales of charcoal among randomly selected major charcoal markets. Questionnaire was used as a primary source of data collection. Descriptive statistics, Rate of Return on Investment and Cost and Return analysis was used to analyze the data obtained for thestudy. The results revealed that 92% of the respondents were female, 44% were in the age group 36-45 years old which was the largest group, 41% had primary school education while residues and breakages (70%) constitute a very serious problem faced by the marketers. The result further show that Bodija market had the highest profit of about N59, 665 and rate of return on investment of 48.50% with this it implied thatthere was high demand of charcoal in the market. Alesinloye had the lowest profit of about N23, 610 and the rate of return on investment was 19.04%. This was because it had the largest marketing cost incurred in the business and low revenue generated. It was concluded that to boost the business in the area, the producers should ensure that the pyrolysis or carbonization of wood is done perfectly so as to reduce residues

Mortality and Co-Morbidities Among Hospitalised Hypertensives in Nigeria

Background: There is paucity of data on the burden of morbidities, clinical characteristics and mortality related to systemic hypertension in Nigeria. The present study therefore aimed to systematically assess the co-morbidities and in-hospital outcomes among hypertensives admitted to 3 Teaching Hospitals in Nigeria. Methods Medical records of all subjects admitted to the medical wards of the study centres with an established diagnosis of hypertension in 2013 were reviewed. Admission, discharge and mortality registers of the medical wards were used to identify the cases, those discharged and those who died. The records of the patients were then reviewed and included if the inclusion criteria were satisfied. Results 288 hypertensive patients were consecutively admitted in the medical wards of the 3 centres in 2013, of whom 146 (59.8%) were males. 88.4% of males and 87.8% of females had 1 or more co-morbidities at admission, and the commonest among all patients was heart failure (HF) followed by stroke/transient ischemic attack (TIA), in 76 (31.2%) and 69 (28.3%) patients respectively. The most frequent co-morbidity among males was HF in 34.3% of them, while stroke/TIA was more common among female patients, in 34.7% of them. Non-cardiovascular co-morbidities were uncommon, and the most frequent was community acquired pneumonia in 7.4% of all patients. 7.8% of all patients (13 males and 6 females; p=0.427) died in-hospital. The deceased had higher systolic blood pressure than the survivors, and majority of them (52.6%) were not on any antihypertensive medications at admission, which was the only predictor of mortality in the present study, increasing its odds by 7.5 fold (odds ratio=7.5; 95%confidence interval=2.8-20.0; p<0.001). Conclusions Co-morbidities were found in more than four-fifths of male and female patients, and the most frequent among males was HF while stroke and TIA were most common among female patients. Non-cardiovascular co-morbidities were uncommon. The prevalence of in-hospital mortality was relatively low, and not being on antihypertensive treatment at admission increased its odds by 7.5 fold

Effects of livestock wastewater variety and disinfectants on the performance of constructed wetlands in organic matters and nitrogen removal

Background, aim and scope: Treatment performance of constructed wetlands (CWs) is largely dependent on the characteristics of the wastewater. Although livestock wastewater is readily biodegradable in general, its variety in biodegradability can still be significant in practice. In addition, it is a common practice to periodically use disinfectants in livestock activities for health concerns. Obviously, the residual of the disinfectants in livestock wastewater may have serious inhibitory effect on the microbial activities during wastewater treatment. Thus, the main objective of this study was to examine the variety of livestock wastewater in biodegradability and its effect on the performance of a pilot scale tidal flow CWs (TFCWs) in organic matter and nitrogen removal. Furthermore, investigation of the potential inhibition of the chosen disinfectants on organic matter biodegradation and nitrification was another aim of this study. Materials and methods: The TFCWs system consisted of four-stage downflow reed beds with a hydraulic loading rate of 0.29 m3/m2·per day. Long-term stored livestock wastewater and fresh livestock wastewater were used, respectively, as feed to the system in different periods. Meanwhile, batch aeration tests were carried out to investigate the difference in biodegradation of the two types of wastewaters. Inhibitions of two types of disinfectants, namely UNIPRED and HYPROCLOR ED, on microbial activities were investigated in laboratory batch tests, with dosage of from 0.05% to 0.5%. Results: With fresh livestock wastewater, removal efficiencies of up to 93% and 94% could be achieved with average of 73% and 64% for chemical oxygen demand (COD) and TN, respectively. The performance deteriorated when the system was fed with long-term stored wastewater. In the batch tests, the long-time stored wastewater was characterized as non-biodegradable or at least very slowly biodegradable, while the fresh wastewater was readily biodegradable. UNIPRED showed very strong inhibition on both heterotrophic organisms and nitrifiers. Tested inhibition started from content of 0.05%, which is 1/10 of the recommended usage rate. Inhibitory effect of HYPROCLOR ED on COD degradation started from 0.1% and complete inhibition occurred from content of 0.3%, while significant inhibition on nitrification started from 0.1%. Conclusions: Livestock wastewater could vary significantly in biodegradability and it may turn to be non-biodegradable after a long-term storage. The variety of the livestock wastewater has a decisive influence on the performance of the CWs system, especially in TN elimination. In addition, the application of disinfectants UNIPRED and HYPROCLOR ED may cause serious inhibition on microbial activities and subsequent system failure.Department of Agriculture, Fisheries and Food, Ireland: Research Stimulus Fund (project no. RSF 07-528