Mould Contamination of ready-to-eat cereal-based foods retailed in lesotho with special reference to toxigenicAspergillus flavus

Samples belonging to four different brands (Instant Morvite™, E-Papa™, Ace Instant Porridge™ and Roasted Morvite™) of ready-to-eat fortified cereal-based foodstuffs imported from the Republic of South Africa were bought from different retail outlets in the Roma valley, Lesotho and examined for contamination with moulds. All (100%) of Roasted Morvite™ and E-Papa™ examined were contaminated with fungi. The greatest average fungal load (1.33 × 105) was recorded on Roasted Morvite™samples. Although all the E-papa™ samples were contaminated, the upper limit average mould load (1.0 × 104) was the lowest compared to other brands that were analysed. A total of 226 isolates belonging to five different genera (Aspergillus, Penicillium, Cladosporium, Wallemia and unidentified genus) were recovered. For each of the brands assessed, average mould counts for some samples were above maximum permissible limits (103 CFU/g) established by World Food Programmeguidelines for fortified blended foods. Aspergillus and Penicillium isolates exhibited greatest fungal population densities, 52.7%, 36.3%, respectively. Wallemia was the least frequently isolated genus in this study; only four isolates (1.8%) recovered from all the samples investigated belonged to this genus. Of the Aspergillus speciesisolated, A. niger had the greatest relative density (39.5%) followed by A. flavus (37.8%), while Aspergillus amstelodami and unidentified Aspergillus species had the lowest. Of the 22 A. flavus isolates tested for sclerotia production potential, 18 produced large sclerotia with average diameter > 400.02±82.61 on Czapek solution, agar. Ten (56%) of these isolates were toxigenic as evidenced by formation of a blue fluorescence on the reverse of the plates when observed under UV (365 nm). It was concluded that the detection of above -permissible limits levels of moulds and aflatoxigenic fungi in some samples analysed presents a risk to consumers’ health. Itis, therefore, suggested that a statutory, independent and science-based body dedicated to protecting public health and consumer interest in the area of food safety and hygiene be established. The main function of such a body would be to take all reasonable steps to ensure that food produced, distributed or marketed in Lesotho meets the highest standards of food safety and hygiene available

A Participatory Evaluation of the Outcome of Actions Taken Toward the Prevention of Maternal Mortality in a Rural Community in Nigeria

While there has been worldwide focus on improving maternal mortality, in sub-Saharan Africa this is a challenge because of limited healthcare resources, inadequate health literacy and traditional beliefs. National and international policies emphasise better emergency maternal care, skilled birth attendants, better health education and community mobilization to ameliorate the situation. Evidence demonstrates the effect of skilled attendants, better education and emergency services but little about the impact of empowering local communities to take action to prevent maternal mortality. This concluding phase of a participatory action research project aimed to evaluate the actions of a rural community in southern Nigeria following mobilization towards prevention of maternal mortality. Twelve volunteers from the community directly or indirectly involved with pregnancy and childbirth were recruited through purposive and snowball sampling as co-researchers. They undertook participatory data collection from 8 focus groups and 12 individual interviews to evaluate actions previously undertaken by them to raise awareness about maternal mortality and its prevention. Data were thematically analysed. Findings presented in themes included: reported revised understandings of causes of maternal mortality rather than previous beliefs of attributing maternal complications/deaths to evil spirits; more appropriate behaviour to prevent maternal mortality such as preference of skilled birth attendants to traditional birth attendants. Conclusion is that through action research, the community appeared to have been mobilized by showing signs of empowerment to take action in collaboration with skilled birth attendants towards reduction of maternal mortality. Therefore, community members should be involved in actions that help to prevent maternal deaths

Microbiological studies of cockroaches from three localities in Gaborone, Botswana

Cockroaches have become the most common pests in a majority of households in Gaborone, the capital city of Botswana Their presence has always raised safety concerns, especially as carriers of food-borne pathogens and food-spoilage organisms. To address the safety issues, bacteriological investigations were carried out on cockroaches trapped from the kitchens and toilets of three localities in Gaborone, households in Botswana. The bacterial, total spore forming, Bacillus cereus, coliforms and E. coli counts from the surfaces of cockroaches were estimated using bacteriological media. Aerobic and facultatively anaerobic bacteria from the fecal pellets were isolated and characterized. Specialized mediawere used for culturing pathogens. 67 %, 22.2 % and 28.6 % of the cockroaches trapped in the kitchen from Central/Broadhurst, Old Naledi and Tlokweng, respectively, had aerobic plate counts of > 106 CFU/cockroach. The cockroaches trapped from the toilets had higher counts than kitchens. Sporeformers were present in most samples though in lower numbers. However, Bacillus cereus was only found in some of the cockroaches at much lower numbers. As much as 70– 98.3% of the cockroaches had coliforms; but, E. coli was only found in 5–6.5% of the cockroaches at > 103 CFU/cockroach. 70 species of bacteria representing 37 genera were isolated from the surface and fecal pellets. Even though the majority of the bacteria that were isolated from the surfaces were Gram negative thosefrom the pellets were mostly Gram positive. The most common and abundant species belonged to Pseudomonas and Serratia, with members of the Enterobacteriaceae following. In the pellets, species of Bacillus were predominant, but, there were some members of Enterobacteriaceae. Pathogens like Salmonella, Shigella and B. cereus were isolated. Opportunistic pathogens like species of Pseudomonas, Klebsiella and Vibrio and food spoilage bacteria such as species of Enterobacter, Citrobacter, Escherichia, Erwinia, and Pseudomonas were also found. Proper care in disposal of food remnants and overall cleanliness at the householdsprevents cockroaches from foraging in the kitchen and toilet

Unsweetened Natural Cocoa Powder: A Potent Nutraceutical in Perspective

Unsweetened natural cocoa powder is a pulverized high-grade powder of compressed solid blocks which remains after extraction and removal of the cocoa butter. The authors determined the elementary composition of UNCP, investigated its effect on nitric oxide levels, toxicity, and its protective effect on the heart, kidney, and liver during simultaneous administration with high dose (HD) artemether/lumefantrine (A/L). Macro- and microelements in UNCP were analyzed with energy dispersive x-ray fluorescence spectroscopy (EDXRF). Adult male guinea pigs were administered various doses of UNCP alone and also simultaneously with A/L. Phytochemical analysis of UNCP showed the presence of saponins, flavonoids, tannins, cardiac glycosides, and 38 macro- and microelements. Histopathological analysis showed no toxic effect on the heart, liver, kidney, lungs, testis, and spleen. Administration of various doses of UNCP increased white blood cell counts and lymphocyte count (p > 0.05) compared with the controls. Additionally, UNCP and A/L combination caused an increase in nitric oxide levels when compared with the control group and restores some hematological disorders induced by the 3-day HD A/L administration. Even though UNCP appears to be relatively safe, care should be taken due to the high content of copper element to avoid the possibility of intestinal lining erosion

Systematic review of patient-specific predictors of pain improvement to endometriosis surgery

BACKGROUND: Up to 28% of endometriosis patients do not get pain relief from therapeutic laparoscopy but this subgroup is not defined. OBJECTIVES: To identify any prognostic patient-specific factors (such as but not limited to patients’ type or location of endometriosis, sociodemographics and lifestyle) associated with a clinically meaningful reduction in post-surgical pain response to operative laparoscopic surgery for endometriosis. SEARCH STRATEGY: PubMed, Cochrane and Embase databases were searched from inception to 19th May 2020 without language restrictions. Backward and forward citation tracking was used. SELECTION CRITERIA, DATA COLLECTION AND ANALYSIS: Cohort studies reporting prognostic factors, along with scores for domains of pain associated with endometriosis before and after surgery, were included. Studies that compared surgeries, or laboratory tests, or outcomes without stratification were excluded. Results were synthesised but variation in study designs and inconsistency of outcome reporting precluded us from doing a meta-analysis. MAIN RESULTS: Five studies were included. Quality assessment using the Newcastle Ottawa Scale graded three studies as high, one as moderate and one as having a low risk of bias. Four of five included studies separately reported that a relationship exists between more severe endometriosis and stronger pain relief from laparoscopic surgery CONCLUSION: Currently there are few studies of appropriate quality to answer the research question. We recommend future studies report core outcome sets to enable meta-analysis. FUNDING: NIHR PB-PG-0317-20018 PROSPERO: CRD4201810860

Externally validated prediction models for pre‐eclampsia:systematic review and meta‐analysis

Objective: This systematic review and meta‐analysis aimed to evaluate the performance of existing externally validated prediction models for pre‐eclampsia (PE) (specifically, any‐onset, early‐onset, late‐onset and preterm PE). Methods: A systematic search was conducted in five databases (MEDLINE, EMBASE, Emcare, CINAHL and Maternity & Infant Care Database) and using Google Scholar/reference search to identify studies based on the Population, Index prediction model, Comparator, Outcome, Timing and Setting (PICOTS) approach until 20 May 2023. We extracted data using the CHARMS checklist and appraised the risk of bias using the PROBAST tool. A meta‐analysis of discrimination and calibration performance was conducted when appropriate. Results: Twenty‐three studies reported 52 externally validated prediction models for PE (one preterm, 20 any‐onset, 17 early‐onset and 14 late‐onset PE models). No model had the same set of predictors. Fifteen any‐onset PE models were validated externally once, two were validated twice and three were validated three times, while the Fetal Medicine Foundation (FMF) competing‐risks model for preterm PE prediction was validated widely in 16 different settings. The most common predictors were maternal characteristics (prepregnancy body mass index, prior PE, family history of PE, chronic medical conditions and ethnicity) and biomarkers (uterine artery pulsatility index and pregnancy‐associated plasma protein‐A). The FMF model for preterm PE (triple test plus maternal factors) had the best performance, with a pooled area under the receiver‐operating‐characteristics curve (AUC) of 0.90 (95% prediction interval (PI), 0.76–0.96), and was well calibrated. The other models generally had poor‐to‐good discrimination performance (median AUC, 0.66 (range, 0.53–0.77)) and were overfitted on external validation. Apart from the FMF model, only two models that were validated multiple times for any‐onset PE prediction, which were based on maternal characteristics only, produced reasonable pooled AUCs of 0.71 (95% PI, 0.66–0.76) and 0.73 (95% PI, 0.55–0.86). Conclusions: Existing externally validated prediction models for any‐, early‐ and late‐onset PE have limited discrimination and calibration performance, and include inconsistent input variables. The triple‐test FMF model had outstanding discrimination performance in predicting preterm PE in numerous settings, but the inclusion of specialized biomarkers may limit feasibility and implementation outside of high‐resource settings. © 2023 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology

Social research on neglected diseases of poverty: Continuing and emerging themes

Copyright: © 2009 Manderson et al.Neglected tropical diseases (NTDs) exist and persist for social and economic reasons that enable the vectors and pathogens to take advantage of changes in the behavioral and physical environment. Persistent poverty at household, community, and national levels, and inequalities within and between sectors, contribute to the perpetuation and re-emergence of NTDs. Changes in production and habitat affect the physical environment, so that agricultural development, mining and forestry, rapid industrialization, and urbanization all result in changes in human uses of the environment, exposure to vectors, and vulnerability to infection. Concurrently, political instability and lack of resources limit the capacity of governments to manage environments, control disease transmission, and ensure an effective health system. Social, cultural, economic, and political factors interact and influence government capacity and individual willingness to reduce the risks of infection and transmission, and to recognize and treat disease. Understanding the dynamic interaction of diverse factors in varying contexts is a complex task, yet critical for successful health promotion, disease prevention, and disease control. Many of the research techniques and tools needed for this purpose are available in the applied social sciences. In this article we use this term broadly, and so include behavioral, population and economic social sciences, social and cultural epidemiology, and the multiple disciplines of public health, health services, and health policy and planning. These latter fields, informed by foundational social science theory and methods, include health promotion, health communication, and heath education

Virtual reality for acute pain in outpatient hysteroscopy: a randomised controlled trial

Objective: To evaluate the effectiveness of virtual reality as a distraction technique in the management of acute pain and anxiety during outpatient hysteroscopy. Design: Parallel group, prospective randomised controlled trial. Setting: UK University Hospital. Methods: Forty consenting, eligible women were randomised to virtual reality intervention (immersive video content as a distraction method) or standard care during outpatient hysteroscopy from August to October 2018. Main outcome measures: Pain and anxiety outcomes were measured as a numeric rating score (scale 0–10). Results: Compared with standard care, women with virtual reality intervention experienced less average pain (score 6.0 versus 3.7, mean difference 2.3, 95% CI 0.61–3.99, P = 0.009) and anxiety (score 5.45 versus 3.3, mean difference 2.15, 95% CI 0.38–3.92, P = 0.02). Conclusion: Virtual reality was effective in reducing pain and anxiety during outpatient hysteroscopy in a mixed‐methods randomised control trial. Its wide potential role in ambulatory gynaecological procedures needs further evaluation. Tweetable abstract: Virtual reality can be used as a part of a multimodal strategy to reduce acute pain and anxiety in patients undergoing outpatient hysteroscopy

Prediction of complications in early-onset pre-eclampsia (PREP): development and external multinational validation of prognostic models.

BACKGROUND: Unexpected clinical deterioration before 34 weeks gestation is an undesired course in early-onset pre-eclampsia. To safely prolong preterm gestation, accurate and timely prediction of complications is required. METHOD: Women with confirmed early onset pre-eclampsia were recruited from 53 maternity units in the UK to a large prospective cohort study (PREP-946) for development of prognostic models for the overall risk of experiencing a complication using logistic regression (PREP-L), and for predicting the time to adverse maternal outcome using a survival model (PREP-S). External validation of the models were carried out in a multinational cohort (PIERS-634) and another cohort from the Netherlands (PETRA-216). Main outcome measures were C-statistics to summarise discrimination of the models and calibration plots and calibration slopes. RESULTS: A total of 169 mothers (18%) in the PREP dataset had adverse outcomes by 48 hours, and 633 (67%) by discharge. The C-statistics of the models for predicting complications by 48 hours and by discharge were 0.84 (95% CI, 0.81-0.87; PREP-S) and 0.82 (0.80-0.84; PREP-L), respectively. The PREP-S model included maternal age, gestation, medical history, systolic blood pressure, deep tendon reflexes, urine protein creatinine ratio, platelets, serum alanine amino transaminase, urea, creatinine, oxygen saturation and treatment with antihypertensives or magnesium sulfate. The PREP-L model included the above except deep tendon reflexes, serum alanine amino transaminase and creatinine. On validation in the external PIERS dataset, the reduced PREP-S model showed reasonable calibration (slope 0.80) and discrimination (C-statistic 0.75) for predicting adverse outcome by 48 hours. Reduced PREP-L model showed excellent calibration (slope: 0.93 PIERS, 0.90 PETRA) and discrimination (0.81 PIERS, 0.75 PETRA) for predicting risk by discharge in the two external datasets. CONCLUSIONS: PREP models can be used to obtain predictions of adverse maternal outcome risk, including early preterm delivery, by 48 hours (PREP-S) and by discharge (PREP-L), in women with early onset pre-eclampsia in the context of current care. They have a potential role in triaging high-risk mothers who may need transfer to tertiary units for intensive maternal and neonatal care. TRIAL REGISTRATION: ISRCTN40384046 , retrospectively registered