Barriers to Adherence to Diet and Exercise Recommendation amongst Type 2 Diabetes Mellitus Patients

Diet modification and exercise require commitment to long term established behavioural change and are often very difficult. The study aimed at assessing the barriers to adherence to diet and exercise recommendations among Type 2 Diabetes Mellitus (DM) patients seeking healthcare at Agogo Presbyterian Hospital, Ghana. A sample size of 212 respondents aged ≥30 years who have been diagnosed of Type 2 DM for at least one year were sampled using stratified and simple random sampling techniques. The data collected was analyzed using Statistical Package for Social Sciences (SPSS) version 20.0. The study revealed that rates of non-adherence were 34.9% and 19.3% for diet and exercise respectively. Reasons for exercise  non-adherence included inadequate understanding about exercise (66.0%), perception that exercise could potentially exacerbate their illness (46.4%), being far away from home (16.5%) and busy schedule (15.5%), while the main reasons for non-adherence to diet were inadequate understanding about dietary recommendations (52.3%), eating outside home (32.4%), poor self-control (17.6%), financial constraints (14.9) and situation at home (12.1%). The study also found a strong positive correlation (r=0.984*, p<0.05) between respondents’ age and adherence to exercise recommendation. It is recommended that education on the type of exercise, time and duration of the exercise and the different food combinations for the Type 2 DM should be intensified in diabetic clinics. Keywords: Aerobic, Barriers, Diabetes, Diet and Exercise, Adherence

Tuning Phage for Cartilage Regeneration

The ever-broadening scope of phage research has left behind the simplistic view of studying phages as just model systems in phage biology to a much broader application ranging from ecological management to immunity. Improved throughput technology in crystallography and structural studies has helped our understanding of these systems as supramolecular machines that possess the capacity of self-assembly. The idea of phages as self-assembling supramolecular nano-machines that are bioactive biomaterials in characteristics, tunable and easily producible have lent its utility to recent fields such as regenerative medicine and tissue engineering. Due to low metabolic activity and slow nutrient diffusion within cartilage, damage to this tissue often inevitably consist of slow and delayed regeneration and healing, the restriction of blood from reaching most part of this tissue and the resultant limitations in the availability of oxygen and other essential amino acids dictates a very slow systemic metabolic response also since transports system in this tissue have to employ less speedy forms. Cartilage regeneration therefore is a huge challenge. This chapter takes a look at the application of the phage display technology in cartilage tissue regeneration

Utilising cumulative antibiogram data to enhance antibiotic stewardship capacity in the Cape Coast Teaching Hospital, Ghana

Background: Antimicrobial resistance (AMR) is a major public health challenge with its impact felt disproportionately in Western Sub-Saharan Africa. Routine microbiology investigations serve as a rich source of AMR monitoring and surveillance data. Geographical variations in susceptibility patterns necessitate regional and institutional tracking of resistance patterns to aid in tailored Antimicrobial Stewardship (AMS) interventions to improve antibiotic use in such settings. This study focused on developing a cumulative antibiogram of bacterial isolates from clinical samples at the Cape Coast Teaching Hospital (CCTH). This was ultimately to improve AMS by guiding empiric therapy. Methods: A hospital-based longitudinal study involving standard microbiological procedures was conducted from 1st January to 31st December 2020. Isolates from routine diagnostic aerobic cultures were identified by colony morphology, Gram staining, and conventional biochemical tests. Isolates were subjected to antibiotic susceptibility testing using Kirby-Bauer disc diffusion. Inhibitory zone diameters were interpreted per the Clinical and Laboratory Standards Institute guidelines and were entered and analysed on the WHONET software using the “first isolate only” principle. Results: Overall, low to moderate susceptibility was observed in most pathogen-antibiotic combinations analysed in the study. Amikacin showed the highest susceptibility (86%, n = 537/626) against all Gram-negatives with ampicillin exhibiting the lowest (6%, n = 27/480). Among the Gram-positives, the highest susceptibilities were exhibited by gentamicin (78%, n = 124/159), with clindamycin having the lowest susceptibility (27%, n = 41/154). Among the Gram-negatives, 66% (n = 426/648) of the isolates were identified phenotypically as potential extended-spectrum beta-lactamase producers. Multiple multidrug-resistant isolates were also identified among both Gram-positive and Gram-negative isolates. Low to moderate susceptibility was found against first- and second-line antibiotics recommended in the National standard treatment guidelines (NSTG). Laboratory quality management deficiencies and a turnaround time of 3.4 days were the major AMS barriers identified. Conclusions: Low to moderate susceptibilities coupled with high rates of phenotypic resistance warrant tailoring NSTGs to fit local contexts within CCTH even after considering the biases in these results. The cumulative antibiogram proved a key AMS programme component after its communication to clinicians and subsequent monitoring of its influence on prescribing indicators. This should be adopted to enhance such programmes across the country

The progressive stages of development of BU in mouse injected in the right footpad with <i>M</i>. <i>ulcerans</i>-infected <i>A</i>. <i>polyphaga</i>.

<p>Panel A shows footpad 1 dpi. Panel B shows footpad with erythema 3 dpi. Panel C shows footpad with edema 7 dpi. Panel D shows swollen footpad and thigh 25 dpi. The photographs are typically representatives of each group (n = 3).</p

Detection of strong RFP signals of <i>M</i>. <i>ulcerans</i> 1615::RFP inside trophozoites and cyst of <i>A</i>. <i>polyphaga</i>.

<p>RFP signals were detected in trophozoites (3 days coculture) and also cyst (42 days coculture). Scale bar = 20μm.</p

Experimental demonstration of the possible role of <i>Acanthamoeba polyphaga</i> in the infection and disease progression in Buruli Ulcer (BU) using ICR mice

<div><p>The transmission of Buruli ulcer (BU), caused by <i>Mycobacterium ulcerans</i> (<i>MU</i>), remains puzzling although a number of hypothesis including through bites of infected aquatic insects have been proposed. We report the results of experiments using ICR mice that give credence to our hypothesis that <i>Acanthamoeba</i> species may play a role in BU transmission. We cocultured <i>MU</i> N2 and <i>MU</i> 1615 which expresses red fluorescent protein (RFP) and <i>Acanthamoeba polyphaga</i> (<i>AP</i>), and confirmed infected <i>AP</i> by Ziehl-Neelsen (ZN) staining. We tested for viability of <i>MU</i> inside <i>AP</i> and observed strong RFP signals inside both trophozoites and cysts after 3 and 42 days of coculturing respectively. ICR mice were topically treated, either on shaved intact or shaved pinpricked rumps, with one of the following; <i>MU</i> N2 only (2.25 x 10⁶ colony forming units [CFU] / ml), <i>MU</i> N2:<i>AP</i> coculture (2.96 x 10⁴ CFU: 1.6 x 10⁶ cells/ml), <i>AP</i> only (1.6 x 10⁶ cells/ml), PYG medium and sterile distilled water. Both <i>MU</i> N2 only and <i>MU</i> N2:<i>AP</i> elicited reddening on day (D) 31; edema on D 45 and D 44 respectively, and ulcers on D 49 at pinpricked sites only. To ascertain infectivity and pathogenicity of <i>MU</i> N2 only and <i>MU</i> N2:<i>AP</i>, and compare their virulence, the standard mouse footpad inoculation method was used. <i>MU</i> N2:<i>AP</i> elicited reddening in footpads by D 3 compared to D 14 with <i>MU</i> N2 only of the same dose of <i>MU</i> N2 (2.96 x 10⁴ CFU). ZN-stained <i>MU</i> were observed in both thin sectioned and homogenized lesions, and aspirates from infected sites. Viable <i>MU</i> N2 were recovered from cultures of the homogenates and aspirates. This study demonstrates in ICR mice <i>MU</i> transmission via passive infection, and shows that punctures in the skin are prerequisite for infection, and that coculturing of <i>MU</i> with <i>AP</i> enhances pathogenesis.</p></div

Demonstration of viable <i>M</i>. <i>ulcerans</i> in lesions.

<p>Panel A shows a ZN stain of tissue homogenate from footpad of mouse injected with <i>M</i>. <i>ulcerans</i>-infected <i>A</i>. <i>polyphaga</i>. Profuse acid-fast particles (reddish pink) were seen in tissue homogenate. Panel B shows LJ slant (green) with colonies of <i>M</i>. <i>ulcerans</i> (yellowish) recovered from tissue homogenate of the footpad of mouse injected with <i>M</i>. <i>ulcerans</i>-infected <i>A</i>. <i>polyphaga</i>.</p

The progression of BU signs in the various treatment groups post-inoculation.

<p>The progression of BU signs in the various treatment groups post-inoculation.</p

The progressive development of BU in mouse topically treated with <i>M</i>. <i>ulcerans</i>-infected <i>A</i>. <i>polyphaga</i> at the punctured skin of the rump (lower back).

<p>Panel A shows site of inoculation 1 day post-inoculation (dpi). Panel B shows inflammation (erythema) at site of inoculation 31 dpi. Panel C shows an edema at site of inoculation 44 dpi. Panel D shows ulcer at the site of inoculation 49 dpi. Photograph is representative of group (n = 3).</p