Prospective evaluation of artemether-lumefantrine for the treatment of non-falciparum and mixed-species malaria in Gabon

Background: The recommendation of artemisinin combination therapy (ACT) as first-line treatment for uncomplicated falciparum malaria is supported by a plethora of high quality clinical trials. However, their recommendation for the treatment of mixed-species malaria and the large-scale use for the treatment of non-falciparum malaria in endemic regions is based on anecdotal rather than systematic clinical evidence. Methods: This study prospectively observed the efficacy of artemether-lumefantrine for the treatment of uncomplicated non-falciparum or mixed-species malaria in two routine district hospitals in the Central African country of Gabon. Results: Forty patients suffering from uncomplicated Plasmodium malariae, Plasmodium ovale or mixed-species malaria (including Plasmodium falciparum) presenting at the hospital received artemether-lumefantrine treatment and were followed up. All evaluable patients (n = 38) showed an adequate clinical and parasitological response on Day 28 after oral treatment with artemether-lumefantrine (95% confidence interval: 0.91,1). All adverse events were of mild to moderate intensity and completely resolved by the end of study. Conclusions: This first systematic assessment of artemether-lumefantrine treatment for P. malariae, P. ovale and mixed-species malaria demonstrated a high cure rate of 100% and a favourable tolerability profile, and thus lends support to the practice of treating non-falciparum or mixed-species malaria, or all cases of malaria without definite species differentiation, with artemether-lumefantrine in Gabon. Trial Registration: ClinicalTrials.gov Identifier: NCT0072577

Loa loa Infection in Pregnant Women, Gabon

Loa loa, the African eye worm, is a filarial pathogen of Central African rainforest regions. As of 2013, it had affected an estimated 2–3 million persons in Central Africa (1,2). Adult worm migrations in humans may intermittently cause Calabar swelling, and microfilariae are commonly found in blood and body fluids. Loiasis is a chronic infection persisting for many years; a considerable proportion of women in loiasis-endemic regions are infected during gestation. To date, the epidemiology of loiasis in pregnant women has not been investigated, and the effects of loiasis on maternal and fetal health outcomes are unknown. We investigated the epidemiology of loiasis in a cohort of pregnant women participating in a drug trial for preventing malaria during pregnancy

Implementation of a national anti-tuberculosis drug resistance survey in Tanzania

A drug resistance survey is an essential public health management tool for evaluating and improving the erformance of National Tuberculosis control programmes. The current manuscript describes the implementation of the first national drug resistance survey in Tanzania. Description of the implementation process of a national anti-tuberculosis drug esistance survey in Tanzania, in relation to the study protocol and Standard Operating Procedures. Factors contributing positively to the implementation of the survey were a continuous commitment of the key stakeholders, the existence of a well organized National Tuberculosis Programme, and a detailed design of cluster-specific arrangements for rapid sputum transportation. Factors contributing negatively to the implementation were a long delay between training and actual survey activities, limited monitoring of activities, and an unclear design of the data capture forms leading to difficulties in form-filling. Careful preparation of the survey, timing of planned activities, a strong emphasis on data capture tools and data management, and timely supervision are essential for a proper implementation of a national drug resistance survey

Young adolescent girls are at high risk for adverse pregnancy outcomes in sub-Saharan Africa: an observational multicountry study

Objectives: One of Africa's most important challenges is to improve maternal and neonatal health. The identification of groups at highest risk for adverse pregnancy outcomes is important for developing and implementing targeted prevention programmes. This study assessed whether young adolescent girls constitute a group at increased risk for adverse birth outcomes among pregnant women in sub-Saharan Africa. Setting: Data were collected prospectively as part of a large randomised controlled clinical trial evaluating intermittent preventive treatment of malaria in pregnancy (NCT00811421—Clinical Trials.gov), conducted between September 2009 and December 2013 in Benin, Gabon, Mozambique and Tanzania. Participants: Of 4749 participants, pregnancy outcomes were collected for 4388 deliveries with 4183 live births including 83 multiple gestations. Of 4100 mothers with a singleton live birth delivery, 24% (975/4100) were adolescents (≤19 years of age) and 6% (248/4100) were aged ≤16 years. Primary and secondary outcome measures: Primary outcomes of this predefined analysis were preterm delivery and low birth weight. Results: The overall prevalence of low birthweight infants and preterm delivery was 10% (371/3851) and 4% (159/3862), respectively. Mothers aged ≤16 years showed higher risk for the delivery of a low birthweight infant (OR: 1.96; 95% CI 1.35 to 2.83). Similarly, preterm delivery was associated with young maternal age (≤16 years; OR: 2.62; 95% CI 1.59 to 4.30). In a subanalysis restricted to primiparous women: preterm delivery, OR 4.28; 95% CI 2.05 to 8.93; low birth weight, OR: 1.29; 95% CI 0.82 to 2.01. Conclusions: Young maternal age increases the risk for adverse pregnancy outcomes and it is a stronger predictor for low birth weight and preterm delivery than other established risk factors in sub-Saharan Africa. This finding highlights the need to improve adolescent reproductive health in sub-Saharan Africa

Genetic analysis indicate superiority of perfomance of cape goosberry (Physalis peruviana L.) hybrids

The use of hybrids as a new type of cape gooseberry (Physalis peruviana L.) cultivars could improve yield in this crop, but little or no information is available on hybrid perfomance. We studied several vegetative characters, yield, fruit weight and fruit shape, soluble solids content (SSC), titratable acidity (TA) and ascorbic acid content (AAC) in three hybrids of cape gooseberry and their parents grown outdoors and in a glasshouse. The highest yields were obtained with hybrids, specially in a glasshouse. Interaction dominance environment for yield was very important; a higher dominance effect was detected in the glasshouse, than that observed outdoors. Quality characters were highly affected by the environment and showed variable results for the different families. For fruit composition traits, the additive and additive environment interactions were most important. Broad-sense heritability for all characters was high to medium (0.48-0.91), indicating that a high response to selection would be expected. Hybrids can improve cape gooseberry yield without impairing fruit quality.Leiva-Brondo, M.; Prohens Tomás, J.; Nuez Viñals, F. (2001). Genetic analysis indicate superiority of perfomance of cape goosberry (Physalis peruviana L.) hybrids. Journal of New Seeds. 3(3):71-84. doi:10.1300/J153v03n03_04718433Abak, K., Güler, H. Y., Sari, N., & Paksoy, M. (1994). EARLINESS AND YIELD OF PHYSALIS (P. IXOCARPA BROT. AND P. PERUVIANA L.) IN GREENHOUSE, LOW TUNNEL AND OPEN FIELD. Acta Horticulturae, (366), 301-306. doi:10.17660/actahortic.1994.366.37Kang, M. S. (1997). Using Genotype-by-Environment Interaction for Crop Cultivar Development. Advances in Agronomy Volume 62, 199-252. doi:10.1016/s0065-2113(08)60569-6Klinac, D. J. (1986). Cape gooseberry (Physalis peruviana) production systems. New Zealand Journal of Experimental Agriculture, 14(4), 425-430. doi:10.1080/03015521.1986.10423060Mather, K., & Jinks, J. L. (1977). Introduction to Biometrical Genetics. doi:10.1007/978-94-009-5787-9Mazer, S. J., & Schick, C. T. (1991). Constancy of population parameters for life history and floral traits in Raphanus sativus L. I. Norms of reaction and the nature of genotype by environment interactions. Heredity, 67(2), 143-156. doi:10.1038/hdy.1991.74Nyquist, W. E., & Baker, R. J. (1991). Estimation of heritability and prediction of selection response in plant populations. Critical Reviews in Plant Sciences, 10(3), 235-322. doi:10.1080/07352689109382313Pearcy, R. W. (1990). Sunflecks and Photosynthesis in Plant Canopies. Annual Review of Plant Physiology and Plant Molecular Biology, 41(1), 421-453. doi:10.1146/annurev.pp.41.060190.002225Péron, J. Y., Demaure, E., & Hannetel, C. (1989). POSSIBILITIES OF TROPICAL SOLANACEAE AND CUCURBITACEAE INTRODUCTION IN FRANCE. Acta Horticulturae, (242), 179-186. doi:10.17660/actahortic.1989.242.24Proctor, F. J. (1990). THE EUROPEAN COMMUNITY MARKET FOR TROPICAL FRUIT AND FACTORS LIMITING GROWTH. Acta Horticulturae, (269), 29-40. doi:10.17660/actahortic.1990.269.

Utilisation of an operative difficulty grading scale for laparoscopic cholecystectomy

Background A reliable system for grading operative difficulty of laparoscopic cholecystectomy would standardise description of findings and reporting of outcomes. The aim of this study was to validate a difficulty grading system (Nassar scale), testing its applicability and consistency in two large prospective datasets. Methods Patient and disease-related variables and 30-day outcomes were identified in two prospective cholecystectomy databases: the multi-centre prospective cohort of 8820 patients from the recent CholeS Study and the single-surgeon series containing 4089 patients. Operative data and patient outcomes were correlated with Nassar operative difficultly scale, using Kendall’s tau for dichotomous variables, or Jonckheere–Terpstra tests for continuous variables. A ROC curve analysis was performed, to quantify the predictive accuracy of the scale for each outcome, with continuous outcomes dichotomised, prior to analysis. Results A higher operative difficulty grade was consistently associated with worse outcomes for the patients in both the reference and CholeS cohorts. The median length of stay increased from 0 to 4 days, and the 30-day complication rate from 7.6 to 24.4% as the difficulty grade increased from 1 to 4/5 (both p < 0.001). In the CholeS cohort, a higher difficulty grade was found to be most strongly associated with conversion to open and 30-day mortality (AUROC = 0.903, 0.822, respectively). On multivariable analysis, the Nassar operative difficultly scale was found to be a significant independent predictor of operative duration, conversion to open surgery, 30-day complications and 30-day reintervention (all p < 0.001). Conclusion We have shown that an operative difficulty scale can standardise the description of operative findings by multiple grades of surgeons to facilitate audit, training assessment and research. It provides a tool for reporting operative findings, disease severity and technical difficulty and can be utilised in future research to reliably compare outcomes according to case mix and intra-operative difficulty

Fitness Tradeoffs of Antibiotic Resistance in Extraintestinal Pathogenic Escherichia coli

Evolutionary trade-offs occur when selection on one trait has detrimental effects on other traits. In pathogenic microbes, it has been hypothesized that antibiotic resistance trades off with fitness in the absence of antibiotic. Although studies of single resistance mutations support this hypothesis, it is unclear whether trade-offs are maintained over time, due to compensatory evolution and broader effects of genetic background. Here, we leverage natural variation in 39 extraintestinal clinical isolates of Escherichia coli to assess trade-offs between growth rates and resistance to fluoroquinolone and cephalosporin antibiotics. Whole-genome sequencing identifies a broad range of clinically relevant resistance determinants in these strains. We find evidence for a negative correlation between growth rate and antibiotic resistance, consistent with a persistent trade-off bet