The Colposcopic Atlas of Schistosomiasis in the Lower Female Genital Tract Based on Studies in Malawi, Zimbabwe, Madagascar and South Africa

Background Schistosoma (S.) haematobium is a neglected tropical disease which may affect any part of the genital tract in women. Female genital schistosomiasis (FGS) may cause abnormal vaginal discharge, contact bleeding, genital tumours, ectopic pregnancies and increased susceptibility to HIV. Symptoms may mimic those typical of sexually transmitted infections (STIs) and women with genital schistosomiasis may be incorrectly diagnosed. An expert consensus meeting suggested that the following findings by visual inspection should serve as proxy indicators for the diagnosis of schistosomiasis of the lower genital tract in women from S. haematobium endemic areas: sandy patches appearing as (1) single or clustered grains or (2) sandy patches appearing as homogenous, yellow areas, or (3) rubbery papules. In this atlas we aim to provide an overview of the genital mucosal manifestations of schistosomiasis in women. Methodology/Principal findings Photocolposcopic images were captured from women, between 1994 and 2012 in four different study sites endemic for S. haematobium in Malawi, Zimbabwe, South Africa and Madagascar. Images and specimens were sampled from sexually active women between 15 and 49 years of age. Colposcopic images of other diseases are included for differential diagnostic purposes. Significance This is the first atlas to present the clinical manifestations of schistosomiasis in the lower female genital tract. It will be freely available for online use, downloadable as a presentation and for print. It could be used for training purposes, further research, and in clinical practice

Unexplained chronic liver disease in Ethiopia: a cross-sectional study

BACKGROUND: Hepatitis B virus (HBV) infection is assumed to be the major cause of chronic liver disease (CLD) in sub-Saharan Africa. The contribution of other aetiological causes of CLD is less well documented and hence opportunities to modulate other potential risk factors are being lost. The aims of this study were to explore the aetiological spectrum of CLD in eastern Ethiopia and to identify plausible underlying risk factors for its development. METHODS: A cross-sectional study was undertaken between April 2015 and April 2016 in two public hospitals in Harar, eastern Ethiopia. The study population comprised of consenting adults with clinical and radiological evidence of chronic liver disease. The baseline evaluation included: (i) a semi-structured interview designed to obtain information about the ingestion of alcohol, herbal medicines and local recreational drugs such as khat (Catha edulis); (ii) clinical examination; (iii) extensive laboratory testing; and, (iv) abdominal ultrasonography. RESULTS: One-hundred-and-fifty patients with CLD (men 72.0%; median age 30 [interquartile range 25-40] years) were included. CLD was attributed to chronic HBV infection in 55 (36.7%) individuals; other aetiological agents were identified in a further 12 (8.0%). No aetiological factors were identified in the remaining 83 (55.3%) patients. The overall prevalence of daily khat use was 78.0%, while alcohol abuse, defined as > 20 g/day in women and > 30 g/day in men, was rare (2.0%). Histological features of toxic liver injury were observed in a subset of patients with unexplained liver injury who underwent liver biopsy. CONCLUSION: The aetiology of CLD in eastern Ethiopia is largely unexplained. The widespread use of khat in the region, together with histopathological findings indicating toxic liver injury, suggests an association which warrants further investigation

Using ordinal logistic regression to analyse self-reported usage of, and attitudes towards swearwords

Likert-type data is commonly used in many research fields in humanities: from gaging the usability of different user-interface designs, to determining users’ likeliness to vote for a particular political party, to evaluation of course materials–to name but a few examples. Despite its prevalence, there is still some disagreement within the statistics community on whether Likert-type scales are true ordinal variables, and by implication whether parametric tests are legitimate to be used in such cases (Endresen &Janda 2017).In this paper, we explore one parametric statistical test, viz. cumulative odds ordinal logistic regression (OLR),as an analysis method for self-reported data in the humanities. For illustration purposes, our focus is specifically on data of users’ self-reported usage of, and attitudes towards swearwords, with the aim of identifying demographic attributes that are predictive of their usage and/or attitudes. After a brief description of the data we’re using, including how the data is being collected, we give a layman’s overview of OLR. Since one of our aims is to demonstrate the usability of OLR, we apply our discussion practically to a step-by-step procedure (based on Laerd Statistics 2015) that could be followed easily. We demonstrate the usefulness of the results in reporting on the usage of, and attitude towards two near synonymous Afrikaans swearwords. We show, amongst others, that the odds ratios that are generated as part of the modelling procedure can be used to draw direct conclusions about specific demographic groups

Identification of coherent flood regions across Europe by using the longest streamflow records

This study compiles a new dataset, consisting of the longest available flow series from across Europe, and uses it to study the spatial and temporal clustering of flood events across the continent. Hydrological series at 102 gauging stations were collected from 25 European countries. Five geographically distinct large-scale homogeneous regions are identified: (i) an Atlantic region, (ii) a Continental region, (iii) a Scandinavian region, (iv) an Alpine region, and (v) a Mediterranean region. The months with a higher likelihood of flooding were identified in each region. The analysis of the clustering of annual counts of floods revealed an over-dispersion in the Atlantic and Continental regions, forming flood-rich and flood-poor periods, as well as an under-dispersion in the Scandinavian region that points to a regular pattern of flood occurrences at the inter-annual scale. The detection of trends in flood series is attempted by basing it on the identified regions, interpreting the results at a regional scale and for various time periods: 1900-1999; 1920-1999; 1939-1998 and 1956-1995. The results indicate that a decreasing trend in the magnitude of floods was observed mainly in the Continental region in the period 1920-1999 with 22% of the catchments revealing such a trend, as well as a decreasing trend in the timing of floods in the Alpine region in the period 1900-1999 with 75% of the catchments revealing this trend. A mixed pattern of changes in the frequency of floods over a threshold and few significant changes in the timing of floods were detected

ICON 2019: International Scientific Tendinopathy Symposium Consensus: Clinical Terminology

© Author(s) (or their employer(s)) 2019. No commercial re-use. See rights and permissions. Published by BMJ.Background Persistent tendon pain that impairs function has inconsistent medical terms that can influence choice of treatment.1 When a person is told they have tendinopathy by clinician A or tendinitis by clinician B, they might feel confused or be alarmed at receiving what they might perceive as two different diagnoses. This may lead to loss of confidence in their health professional and likely adds to uncertainty if they were to search for information about their condition. Clear and uniform terminology also assists inter-professional communication. Inconsistency in terminology for painful tendon disorders is a problem at numerous anatomical sites. Historically, the term ‘tendinitis’ was first used to describe tendon pain, thickening and impaired function (online supplementary figure S1). The term ‘tendinosis’ has also been used in a small number of publications, some of which were very influential.2 3 Subsequently, ‘tendinopathy’ emerged as the most common term for persistent tendon pain.4 5 To our knowledge, experts (clinicians and researchers) or patients have never engaged in a formal process to discuss the terminology we use. We believe that health professionals have not yet agreed on the appropriate terminology for painful tendon conditions.Peer reviewedFinal Accepted Versio

Use of Lateral Flow Assays in Forensics

Already for some decades lateral flow assays (LFAs) are ‘common use’ devices in our daily life. Also, for forensic use LFAs are developed, such as for the analysis of illicit drugs and DNA, but also for the detection of explosives and body fluid identification. Despite their advantages, including ease-of-use, LFAs are not yet frequently applied at a crime scene. This review describes (academic) developments of LFAs for forensic applications, focusing on biological and chemical applications, whereby the main advantages and disadvantages of LFAs for the different forensic applications are summarized. Additionally, a critical review is provided, discussing why LFAs are not frequently applied within the forensic field and highlighting the steps that are needed to bring LFAs to the forensic market

Performance of Spectrophotometric and Fluorometric DNA Quantification Methods

Accurate DNA quantification is a highly important method within molecular biology. Methods widely used to quantify DNA are UV spectrometry and fluorometry. In this research, seven different DNA samples and one blank (MilliQ ultrapure water) were quantified by three analysts using one spectrophotometric (i.e., a NanoDrop instrument) and three fluorometric (i.e., the AccuGreen High Sensitivity kit, the AccuClear Ultra High Sensitivity kit, and the Qubit dsDNA HS Assay kit) methods. An analysis of variance (ANOVA) scheme was used to determine the influence of the analyst, the method, and the combination of analyst and method, on DNA quantification. For most samples, the measured DNA concentration was close to or slightly above the concentration of 10 ng/μL as specified by the supplier. Results obtained by the three analysts were equal. However, it was found that, compared to the fluorometric kits, the used spectrophotometric instrument in the case of fish DNA samples tends to overestimate the DNA concentration. Therefore, if sufficient sample volume is available, a combination of a spectrophotometric and a fluorometric method is recommended for obtaining data on the purity and the dsDNA concentration of a sample

A Comparison of Statistical Tests for Likert-Type Data: The Case of Swearwords

There has been a long-standing debate about the applicability of different statistical tests to Likert-type data. This work contributes to this debate by comparing the results of three statistics, Analysis of Variance, Kruskal-Wallis H test, and ordinal logistic regression, in the context of self-reported attitude and usage of swearwords. The aims of this comparison are to determine how similar the results of the different statistics are, which of the statistical test are most appropriate for sociopragmatic linguistic investigations, and how the results influence the interpretation possibilities of the same data. An analysis of the results for the different statistics shows some overlap between the three statistics, but that the parametric ANOVA is substantially more conservative in identifying significant relationships between sociodemographic factors and the usage and attitude toward swearwords, while the H test and ordinal logistic regression models are mostly identical, except where the assumptions of the regression model are violated. Based on our results, we argue that the Kruskal-Wallis H test, with the associated post-hoc test, is the most appropriate test for Likert-type data, with sufficient descriptive power to allow for detailed and informed analysis of this data

Urinary human papillomavirus DNA as an indicator of gynaecological infection in young women in Schistosoma and HIV endemic South Africa

BackgroundGlobally, Africa has the highest HIV, cervical cancer and schistosomiasis prevalence. Female Genital Schistosomiasis (FGS) is hypothesized to be associated with HIV and cervical atypia. Young women aged 15 and above, constituting almost 3 million of the South African population, have limited health care access and are at risk for this triad of diseases. Urinary HPV DNA analysis is a non-invasive sampling method that can assist in evaluating risk among this population. This study compared the analysis of HPV DNA in urine and cervico-vaginal lavage (CVL) samples to cytology Pap smear, Schistosoma microscopy and HIV results.MethodsIn this cross-sectional study, 235 young women aged 16 years and older from rural high schools in KwaZulu-Natal participated. HPV DNA analysis was done in urine and CVL samples. Pap smears were analysed for squamous cell atypia and urine microscopy was used for the identification of Schistosoma ova.ResultsUrinary schistosomiasis was reported in 49 (20.9%) and HIV detected in 49 (20.4%). Urinary and CVL HPV DNA was found in 147 (62.6%) and 177 (75.3%) respectively. Any atypia was detected cytologically among 173 (73.6%). The following associations were found using the Pearson Chi-Square and a Likelihood Ratio test: (a) between HIV positive status and urinary HPV DNA positive cases on both the urine (X2 = 5.007; p-value = 0.025) and (X2 = 4.264; p-value = 0.039) and between HIV positive status and CVL HPV DNA tests respectively (X2 = 5.165; p-value = 0.023) and (X2 = 4.321; p-value = 0.015), and (b) among urine HPV DNA and the CVL HPV DNA tests, where (X2 = 52.966; p-value = 0.001) and (X2 = 50.716; p-value = 0.001). Urine HPV DNA showed a sensitivity of 75.7% and specificity of 77.6% relative to the CVL HPV DNA. There was no statistical association between urinary schistosomiasis and HPV or with any atypia.ConclusionUrine has the potential of being optimized as an alternative and possibly more acceptable sample for HPV detection among young adolescent populations at risk in comparison to CVL samples. An integrated targeted intervention incorporating Schistosoma in addition to HPV and HIV testing needs consideration among young women in this age group from endemic areas