Secondary bacterial infections of buruli ulcer lesions before and after chemotherapy with streptomycin and rifampicin

Buruli ulcer (BU), caused by Mycobacterium ulcerans is a chronic necrotizing skin disease. It usually starts with a subcutaneous nodule or plaque containing large clusters of extracellular acid-fast bacilli. Surrounding tissue is destroyed by the cytotoxic macrolide toxin mycolactone produced by microcolonies of M. ulcerans. Skin covering the destroyed subcutaneous fat and soft tissue may eventually break down leading to the formation of large ulcers that progress, if untreated, over months and years. Here we have analyzed the bacterial flora of BU lesions of three different groups of patients before, during and after daily treatment with streptomycin and rifampicin for eight weeks (SR8) and determined drug resistance of the bacteria isolated from the lesions. Before SR8 treatment, more than 60% of the examined BU lesions were infected with other bacteria, with Staphylococcus aureus and Pseudomonas aeruginosa being the most prominent ones. During treatment, 65% of all lesions were still infected, mainly with P. aeruginosa. After completion of SR8 treatment, still more than 75% of lesions clinically suspected to be infected were microbiologically confirmed as infected, mainly with P. aeruginosa or Proteus miriabilis. Drug susceptibility tests revealed especially for S. aureus a high frequency of resistance to the first line drugs used in Ghana. Our results show that secondary infection of BU lesions is common. This could lead to delayed healing and should therefore be further investigated

Progress and Recent Trends in the Application of Nanoparticles as Low Carbon Fuel Additives—A State of the Art Review

The first part of the current review highlights the evolutionary nuances and research hotspots in the field of nanoparticles in low carbon fuels. Our findings reveal that contribution to the field is largely driven by researchers from Asia, mainly India. Of the three biofuels under review, biodiesel seems to be well studied and developed, whereas studies regarding vegetable oils and alcohols remain relatively scarce. The second part also reviews the application of nanoparticles in biodiesel/vegetable oil/alcohol-based fuels holistically, emphasizing fuel properties and engine characteristics. The current review reveals that the overall characteristics of the low carbon fuel–diesel blends improve under the influence of nanoparticles during combustion in diesel engines. The most important aspect of nanoparticles is that they act as an oxygen buffer that provides additional oxygen molecules in the combustion chamber, promoting complete combustion and lowering unburnt emissions. Moreover, the nanoparticles used for these purposes exhibit excellent catalytic behaviour as a result of their high surface area-to-volume ratio—this leads to a reduction in exhaust pollutants and ensures an efficient and complete combustion. Beyond energy-based indicators, the exergy, economic, environmental, and sustainability aspects of the blends in diesel engines are discussed. It is observed that the performance of the diesel engine fuelled with low carbon fuels according to the second law of efficiency improves under the influence of the nano-additives. Our final part shows that despite the benefits of nanoparticles, humans and animals are under serious threats from the highly toxic nature of nanoparticles. © 2022 by the authors. Licensee MDPI, Basel, Switzerland.20JCJQJC00160; Cardiff University; Universiti Tenaga Nasional: IC6-BOLDREFRESH2025This research was funded by Tianjin Science Fund for Distinguished Young Scholars, grant number 20JCJQJC00160, and the Universiti Tenaga Nasional grant no. IC6-BOLDREFRESH2025 (HCR) under the BOLD2025 Program. The APC was funded by Cardiff University

Integrated AHP-TOPSIS under a Fuzzy Environment for the Selection of Waste-To-Energy Technologies in Ghana: A Performance Analysis and Socio-Enviro-Economic Feasibility Study

Energy recovery from waste presents a promising alternative for several countries, including Ghana, which has struggled with unsustainable waste treatment methods and an inadequate power supply for several decades. The current study adopts a comprehensive multi-criteria decision-making approach for the selection of an optimal waste-to-energy (WtE) technology for implementation in Ghana. Four WtE technologies are evaluated against twelve selection criteria. An integrated AHP-fuzzy TOPSIS method is applied to estimate the criteria’s weights and rank the WtE alternatives. From the AHP results, technical criteria obtained the highest priority weight, while social criteria emerged as the least important in the selection process. The overall ranking order of WtE technologies obtained by fuzzy TOPSIS is as follows: anaerobic digestion > gasification > pyrolysis > plasma gasification. The sensitivity analysis indicates highly consistent and sturdy results regarding the optimal selection. This study recommends adopting a hybrid system of anaerobic digestion and gasification technologies, as this offers a well-balanced system under all of the evaluation criteria compared to the standalone systems. The results of the current study may help the government of Ghana and other prospective investors select a suitable WtE technology, and could serve as an index system for future WtE research in Ghana. © 2022 by the authors.Cardiff University; School of Psychology, Cardiff University; School of Chemistry, Cardiff Universit

Sero-Epidemiology as a Tool to Screen Populations for Exposure to Mycobacterium ulcerans

Sero-epidemiological analyses revealed that a higher proportion of sera from individuals living in the Buruli ulcer (BU) endemic Densu River Valley of Ghana contain Mycobacterium ulcerans 18 kDa small heat shock protein (shsp)-specific IgG than sera from inhabitants of the Volta Region, which was regarded so far as BU non-endemic. However, follow-up studies in the Volta Region showed that the individual with the highest anti-18 kDa shsp-specific serum IgG titer of all participants from the Volta Region had a BU lesion. Identification of more BU patients in the Volta Region by subsequent active case search demonstrated that sero-epidemiology can help identify low endemicity areas. Endemic and non-endemic communities along the Densu River Valley differed neither in sero-prevalence nor in positivity of environmental samples in PCR targeting M. ulcerans genomic and plasmid DNA sequences. A lower risk of developing M. ulcerans disease in the non-endemic communities may either be related to host factors or a lower virulence of local M. ulcerans strains

Laboratory diagnosis of Buruli ulcer : challenges and future perspectives

Current options to control Buruli ulcer (BU) are limited, as no effective vaccine is available and knowledge on transmission mechanisms of the causative agent, Mycobacterium ulcerans, is incomplete. Early case detection and rapid initiation of treatment are key elements to prevent the development of large, disfiguring ulcers often associated with permanent physical disability and stigma. BU has been reported from 34 countries, with the greatest disease burden in West Africa and steadily increasing case numbers in south-eastern Australia. The disease can present in a variety of clinical manifestations, including relatively unspecific, painless nodules, plaques, and edema, which may eventually progress to chronic, ulcerative lesions. The clinical diagnosis of BU is therefore complicated by a broad differential diagnosis, particularly in tropical areas, where the prevalence of other skin conditions with a similar appearance is high. With the introduction of combination antibiotic therapy, replacing excision surgery as the standard treatment for BU, pre-treatment confirmation of the clinical diagnosis has further gained in importance to avoid the redundant use of anti-mycobacterial drugs. At present, available confirmatory diagnostic tests either lack sufficient sensitivity/specificity or are centralized and thus often not accessible to patients living in remote, rural areas of Africa. In recognition of this disparity, WHO and other stakeholders have called for new diagnostic tools for BU that can be applied at district hospitals or primary healthcare facilities. This chapter highlights challenges, advances and future prospects for the necessary decentralization of the diagnosis of BU

Measuring biofouling potential in swro plants with a flow-cytometry-based bacterial growth potential method

Measuring the bacterial growth potential of seawater reverse osmosis (SWRO) feed water is an issue that is receiving growing attention. This study developed and demonstrated the applicability of the flow-cytometry (FCM)-based bacterial growth potential (BGP) method to assess the biofouling potential in SWRO systems using natural microbial consortium. This method is relatively fast (2–3 days) compared to conventional bioassays. The effect of the potential introduction of nutrients during measurement has been studied thoroughly to achieve the lowest measure value of about 45,000 cells/mL, which is equivalent to about (10 µg-C glucose/L). The BGP method was applied in two full-scale SWRO plants that included (i) dissolved air flotation (DAF) and ultra-filtration (UF); (ii) dual-media filtration (DMF) and cartridge filter (CF), which were compared with the cleaning frequency of the plants. A significant reduction (54%) in BGP was observed through DAF–UF as pre-treatment (with 0.5 mg Fe3+/L), while there was a 40% reduction by DMF–CF (with 0.8 mg Fe3+/L). In terms of the absolute number, the SWRO feed water after DAF–UF supports 1.5 × 106 cells/mL, which is 1.25 times higher than after DMF–CF. This corresponds to the higher cleaning-in-place (CIP) frequency of SWRO with DAF–UF compared to DMF–CF as pre-treatment, indicating that the BGP method has an added value in monitoring the biofouling potential in SWRO systems

Association between trace elements in the environment and stroke risk: The reasons for geographic and racial differences in stroke (REGARDS) study

The disparities in stroke mortality between blacks and whites, as well as the increased stroke mortality in the "stroke belt" have long been noted. The reasons for these disparities have yet to be fully explained. The association between trace element status and cardiovascular diseases, including stroke, has been suggested as a possible contributor to the disparities in stroke mortality but has not been fully explored. The purpose of this study is to investigate distributions of four trace elements (arsenic, mercury, magnesium, and selenium) in the environment in relation to stroke risk. The study population (N=27,770) is drawn from the Reasons for Geographic and Racial Disparities in Stroke (REGARDS) cohort. Environmental distribution of each trace element was determined using data from the United States Geological Survey (USGS) and was categorized in quartiles. A proportional hazards model, adjusted for demographic data and stroke risk factors, was used to examine the association of interest. The results showed that higher selenium levels in the environment were associated with increased stroke risk, and the hazard ratio for the 4th quartile compared to the 1st quartile was 1.33 (95% CI: 1.09, 1.62). However, there was no statistically significant relationship between environmental arsenic, mercury or magnesium and the risk of stroke. Because of dietary and non-dietary exposure as well as bioavailability, further research using biomarkers is warranted to examine the association between these trace elements and the risk of stroke

Incidence of postoperative seizures in neonates following cardiac surgery with regional cerebral perfusion and deep hypothermic circulatory arrestCentral MessagePerspective

Objectives: Historically, our center has primarily used deep hypothermic circulatory arrest, but in recent years some surgeons have selectively used regional cerebral perfusion as an alternative. We aimed to compare the incidence of postoperative electroencephalographic seizure incidence in neonates undergoing surgery with regional cerebral perfusion and deep hypothermic circulatory arrest. Methods: A retrospective analysis was performed in neonates who underwent surgery between 2012 and 2022 with either deep hypothermic circulatory arrest or regional cerebral perfusion with routine postoperative continuous electroencephalography monitoring for 48 hours. Propensity matching was performed to compare postoperative seizure risk between the 2 groups. Results: Among 1136 neonates undergoing cardiac surgery with cardiopulmonary bypass, regional cerebral perfusion was performed in 99 (8.7%) and deep hypothermic circulatory arrest in 604 (53%). The median duration of regional cerebral perfusion was 49 minutes (interquartile range, 38-68) and deep hypothermic circulatory arrest was 41 minutes (interquartile range, 31-49). The regional cerebral perfusion group had significantly longer total support, cardiopulmonary bypass, and aortic crossclamp times. Overall seizure incidence was 11% (N = 76) and 13% (N = 35) in the most recent era (2019-2022). The unadjusted seizure incidence was similar in neonates undergoing regional cerebral perfusion (N = 12, 12%) and deep hypothermic circulatory arrest (N = 64, 11%). After propensity matching, the seizure incidence was similar in neonates undergoing regional cerebral perfusion (N = 12, 12%) and deep hypothermic circulatory arrest (N = 37, 12%) (odds ratio, 0.97; 95% CI, 0.55-1.71; P = .92). Conclusions: In this contemporary single-center experience, the incorporation of regional cerebral perfusion did not result in a change in seizure incidence in comparison with deep hypothermic circulatory arrest. However, unmeasured confounders may have impacted these findings. Further studies are needed to determine the impact, if any, of regional cerebral perfusion on postoperative seizure incidence