Study on the prevalence of donkey trypanosomosis in Awi zone northwest Ethiopia

The study on trypanosomosis of donkeys was conducted from October 2009 to March 2010 in four districts of Awi zone including Jawi district of tsetse infested, Abadera and Chara districts found at the edge of tsetse infested area and Dangla of tsetse free district. A total of 384 randomly selected donkeys (86 from Abadera, 87 from Chara, 94 from Dangla and 117 from Jawi) were sampled and examined using haematocrit centrifugation technique. The overall prevalence of trypanosomosis of donkeys was 1.6% (n=6). The observed prevalence was not significantly (P > 0.05) different among the four districts. Trypanosoma vivax (75%) and Trypanosoma congolense (25%) were the most common trypanosome species encountered during the study period. No significance difference was observed between male and female donkeys both in prevalence of infection and mean PCV (P > 0.05). The mean PCV of infected donkey (23.50 ± 3.782) was significantly (P < 0.05) lower than that of non infected donkeys (34.70 ± 4.44). The body condition score of the donkey was significantly associated with both prevalence of infection and mean PCV (P < 0.05). The study revealed that trypanosomosis in donkeys in the study areas indicates the presence of both cyclical and non-cyclical transmitted trypanosomes which require inclusion of equines in the control program of trypanosomosis in the study areas

ECONOMICS OF HERBICIDE WEED MANAGEMENT IN WHEAT IN ETHIOPIA

Effective use of herbicides for the control of annual grass and broadleaf weeds in wheat ( Triticum aestivum L.) was not a reality in Ethiopia, until in recent years. This study aimed at evaluating different post-emergence herbicides against annual grasses and broadleaf weeds in wheat for selection and incorporation into an integrated weed management (IWM) system. The study was conducted at Kulumsa Agricultural Research Centre main station, Bekoji and Lole farm fields. Treatments included herbicides, namely, Mesosulfron methyl+Idosulfuron methyl sodium (liquid) 1 lit ha-1 a.i. Pyroxsulam (liquid) 0.5 l ha-1 a.i. hand weeding twice (30-35 and 55-60 days after emergence (DAE)); and a weedy check. Among the annual grass weeds, Snowdenia polystachya , Avena fatua , Bromus pectinatus , Phalaris paradoxa and Setaria pumila ; and most broad leaf weeds like Polygonum nepalense , Guizotia scabra , Galinsoga parviflora and Gallium spurium were controlled with herbicide efficacy ranging from 75 to 100%. Mesosulfron methyl +Idosulfron methyl sodium, Pyroxulam and hand weeded twice plots out-yielded the weedy check by 63, 58 and 53%, respectively. Maximum wheat grain yield (5,184 kg ha-1), biomass (12,808 kg ha-1), thousand kernel weight (48.55) and hectoliter weight (74.2) were obtained due to the application of Mesosulfron methyl+Idosulfuron methyl sodium. In addition, the herbicide had a yield advantage over Pyroxsulam, two hand weedings and the weedy check by 12, 21 and 63%, respectively. Application of Mesosulfron methyl + Idosulfuron methyl sodium (US$1,596.31 ha-1) had the highest net field benefit compared to Pyroxsulam (US$1,379.21 ha-1), two hand weeding (US$1,126.7 ha-1) and weedy check (US$574.1 ha-1) by 13.6, 29 and 64%, respectively. Moreover, the herbicide was also economically profitable to farmers, providing a marginal rate of return (MRR) of 1,737%. Sensitivity analysis (aMRR) also remained the most profitable even when the price of herbicide increased by 20%. Hence, Mesosulfron methyl +Idosulfuron methyl sodium at a rate of 1 lit ha-1 is thebest herbicide for the effective control of annual grasses and broad leaf weeds in wheat and can be used as one of the component in Integrated Weed Management Program (IWM) in wheat fields.l\u2019utilisation efficace d\u2019herbicides pour le contr\uf4le d\u2019herbe annuelle et de mauvaises herbes broadleaf dans le bl\ue9 ( Triticum aestivum L.) n\u2019\ue9tait pas une r\ue9alit\ue9 en \ue9thiopie, jusqu\u2019\ue0 au cours des derni\ue8res ann\ue9es. cette \ue9tude visait du fait d\u2019\ue9valuer de diff\ue9rents herbicides de post-\ue9mersion contre les herbes annuelles et les mauvaises herbes broadleaf dans le bl\ue9 pour la s\ue9lection et l\u2019incorporation dans une administration de mauvaise herbe int\ue9gr\ue9e (iwm) le syst\ue8me. l\u2019\ue9tude a \ue9t\ue9 accomplie au centre de recherche agricole kulumsa la station principale, Bekoji et les champs de ferme Lole. les traitements ont inclus des herbicides, \ue0 savoir, le m\ue9thyle de mesosulfron le sodium de m\ue9thyle d\u2019idosulfuron 1 (liquide) allum\ue9 ha-1 a.i. pyroxsulam 0.5 l (liquides) ha-1 main d\u2019a.i. d\ue9sherbant deux fois (30-35 et 55-60 jours apr\ue8s l\u2019\ue9mersion (dae)); et un ch\ue8que malingre. Parmi les mauvaises herbes d\u2019herbe annuelles, Snowdenia polystachya , Avena fatua , Bromus pectinatus , Phalaris paradoxa et Setaria pumila ; et les plus larges mauvaises herbes de feuille comme Polygonum nepalense , Guizotia scabra , Galinsoga parviflora et le Gallium spurium ont \ue9t\ue9 contr\uf4l\ue9es avec l\u2019effet d\u2019herbicide aux limites de 75 \ue0 100 %. Le m\ue9thyle de Mesosulfron que le sodium de m\ue9thyle d\u2019Idosulfron, Pyroxulam et la main d\ue9sherb\ue9e complotent deux fois dehors - a produit le ch\ue8que malingre par 63, 58 et 53 %, respectivement. La production de grain de bl\ue9 maximum (5,184 kg ha-1), la biomasse (12,808 kg ha-1), un mille de poids cardinal (48.55) et de poids d\u2019hectolitre (74.2) a \ue9t\ue9 obtenue en raison de l\u2019application de m\ue9thyle Mesosulfron le sodium de m\ue9thyle d\u2019Idosulfuron, Pyroxulam et la main d\ue9sherb\ue9e conspirent deux fois dehors - a produit le ch\ue8que malingre par 63, 58 et 53 %, respectivement. La production de grain de bl\ue9 maximum (5,184 kg ha-1), la biomasse (12,808 kg ha-1), un mille de poids cardinal (48.55) et de poids d\u2019hectolitre (74.2) a \ue9t\ue9 obtenue en raison de l\u2019application de m\ue9thyle Mesosulfron le sodium de m\ue9thyle d\u2019Idosulfuron. En plus, l\u2019herbicide avait un avantage de production sur Pyroxsulam, deux main weedings et le ch\ue8que malingre par 12, 21 et 63 %, respectivement. L\u2019application de m\ue9thyle Mesosulfron le sodium de m\ue9thyle d\u2019Idosulfuron (US1,596.31 ha-1) avait le plus haut avantage net de terrain compar\ue9 \ue0 Pyroxsulam (US1,379.21 ha-1), deux main d\ue9sherbante (US1,126.7 ha-1) et ch\ue8que malingre (US574.1 ha-1) par 13.6, 29 et 64 %, respectivement. e plus, l\u2019herbicide \ue9tait aussi \ue9conomiquement profitable aux fermiers, en fournissant un taux marginal de retour (MRR) de 1,737 %. L\u2019analyse de sensibilit\ue9 (aMRR) est aussi rest\ue9e le plus profitable m\ueame lorsque le prix d\u2019herbicide a augment\ue9 de 20 %. Dor\ue9navant, le m\ue9thyle de Mesosulfron le sodium de m\ue9thyle d\u2019Idosulfuron \ue0 un taux de 1 allum\ue9 ha 1 est l\u2019herbicide thebest pour le contr\uf4le efficace d\u2019herbes annuelles et de larges mauvaises herbes de feuille dans le bl\ue9 et peut \ueatre utilis\ue9 comme une de la composante dans le Programme d\u2019Administration de Mauvaise herbe Int\ue9gr\ue9 (IWM) dans les champs de bl\ue9

Antimicrobial resistance among migrants in Europe: a systematic review and meta-analysis

BACKGROUND: Rates of antimicrobial resistance (AMR) are rising globally and there is concern that increased migration is contributing to the burden of antibiotic resistance in Europe. However, the effect of migration on the burden of AMR in Europe has not yet been comprehensively examined. Therefore, we did a systematic review and meta-analysis to identify and synthesise data for AMR carriage or infection in migrants to Europe to examine differences in patterns of AMR across migrant groups and in different settings. METHODS: For this systematic review and meta-analysis, we searched MEDLINE, Embase, PubMed, and Scopus with no language restrictions from Jan 1, 2000, to Jan 18, 2017, for primary data from observational studies reporting antibacterial resistance in common bacterial pathogens among migrants to 21 European Union-15 and European Economic Area countries. To be eligible for inclusion, studies had to report data on carriage or infection with laboratory-confirmed antibiotic-resistant organisms in migrant populations. We extracted data from eligible studies and assessed quality using piloted, standardised forms. We did not examine drug resistance in tuberculosis and excluded articles solely reporting on this parameter. We also excluded articles in which migrant status was determined by ethnicity, country of birth of participants' parents, or was not defined, and articles in which data were not disaggregated by migrant status. Outcomes were carriage of or infection with antibiotic-resistant organisms. We used random-effects models to calculate the pooled prevalence of each outcome. The study protocol is registered with PROSPERO, number CRD42016043681. FINDINGS: We identified 2274 articles, of which 23 observational studies reporting on antibiotic resistance in 2319 migrants were included. The pooled prevalence of any AMR carriage or AMR infection in migrants was 25·4% (95% CI 19·1-31·8; I2 =98%), including meticillin-resistant Staphylococcus aureus (7·8%, 4·8-10·7; I2 =92%) and antibiotic-resistant Gram-negative bacteria (27·2%, 17·6-36·8; I2 =94%). The pooled prevalence of any AMR carriage or infection was higher in refugees and asylum seekers (33·0%, 18·3-47·6; I2 =98%) than in other migrant groups (6·6%, 1·8-11·3; I2 =92%). The pooled prevalence of antibiotic-resistant organisms was slightly higher in high-migrant community settings (33·1%, 11·1-55·1; I2 =96%) than in migrants in hospitals (24·3%, 16·1-32·6; I2 =98%). We did not find evidence of high rates of transmission of AMR from migrant to host populations. INTERPRETATION: Migrants are exposed to conditions favouring the emergence of drug resistance during transit and in host countries in Europe. Increased antibiotic resistance among refugees and asylum seekers and in high-migrant community settings (such as refugee camps and detention facilities) highlights the need for improved living conditions, access to health care, and initiatives to facilitate detection of and appropriate high-quality treatment for antibiotic-resistant infections during transit and in host countries. Protocols for the prevention and control of infection and for antibiotic surveillance need to be integrated in all aspects of health care, which should be accessible for all migrant groups, and should target determinants of AMR before, during, and after migration. FUNDING: UK National Institute for Health Research Imperial Biomedical Research Centre, Imperial College Healthcare Charity, the Wellcome Trust, and UK National Institute for Health Research Health Protection Research Unit in Healthcare-associated Infections and Antimictobial Resistance at Imperial College London

Stem Cell Therapy: Pieces of the Puzzle

Acute ischemic injury and chronic cardiomyopathies can cause irreversible loss of cardiac tissue leading to heart failure. Cellular therapy offers a new paradigm for treatment of heart disease. Stem cell therapies in animal models show that transplantation of various cell preparations improves ventricular function after injury. The first clinical trials in patients produced some encouraging results, despite limited evidence for the long-term survival of transplanted cells. Ongoing research at the bench and the bedside aims to compare sources of donor cells, test methods of cell delivery, improve myocardial homing, bolster cell survival, and promote cardiomyocyte differentiation. This article reviews progress toward these goals

Global economic burden of unmet surgical need for appendicitis

Background: There is a substantial gap in provision of adequate surgical care in many low-and middle-income countries. This study aimed to identify the economic burden of unmet surgical need for the common condition of appendicitis. Methods: Data on the incidence of appendicitis from 170 countries and two different approaches were used to estimate numbers of patients who do not receive surgery: as a fixed proportion of the total unmet surgical need per country (approach 1); and based on country income status (approach 2). Indirect costs with current levels of access and local quality, and those if quality were at the standards of high-income countries, were estimated. A human capital approach was applied, focusing on the economic burden resulting from premature death and absenteeism. Results: Excess mortality was 4185 per 100 000 cases of appendicitis using approach 1 and 3448 per 100 000 using approach 2. The economic burden of continuing current levels of access and local quality was US $92 492 million using approach 1 and$73 141 million using approach 2. The economic burden of not providing surgical care to the standards of high-income countries was $95 004 million using approach 1 and$75 666 million using approach 2. The largest share of these costs resulted from premature death (97.7 per cent) and lack of access (97.0 per cent) in contrast to lack of quality. Conclusion: For a comparatively non-complex emergency condition such as appendicitis, increasing access to care should be prioritized. Although improving quality of care should not be neglected, increasing provision of care at current standards could reduce societal costs substantially

Effects of hospital facilities on patient outcomes after cancer surgery: an international, prospective, observational study

Background Early death after cancer surgery is higher in low-income and middle-income countries (LMICs) compared with in high-income countries, yet the impact of facility characteristics on early postoperative outcomes is unknown. The aim of this study was to examine the association between hospital infrastructure, resource availability, and processes on early outcomes after cancer surgery worldwide.Methods A multimethods analysis was performed as part of the GlobalSurg 3 study-a multicentre, international, prospective cohort study of patients who had surgery for breast, colorectal, or gastric cancer. The primary outcomes were 30-day mortality and 30-day major complication rates. Potentially beneficial hospital facilities were identified by variable selection to select those associated with 30-day mortality. Adjusted outcomes were determined using generalised estimating equations to account for patient characteristics and country-income group, with population stratification by hospital.Findings Between April 1, 2018, and April 23, 2019, facility-level data were collected for 9685 patients across 238 hospitals in 66 countries (91 hospitals in 20 high-income countries; 57 hospitals in 19 upper-middle-income countries; and 90 hospitals in 27 low-income to lower-middle-income countries). The availability of five hospital facilities was inversely associated with mortality: ultrasound, CT scanner, critical care unit, opioid analgesia, and oncologist. After adjustment for case-mix and country income group, hospitals with three or fewer of these facilities (62 hospitals, 1294 patients) had higher mortality compared with those with four or five (adjusted odds ratio [OR] 3.85 [95% CI 2.58-5.75]; p<0.0001), with excess mortality predominantly explained by a limited capacity to rescue following the development of major complications (63.0% vs 82.7%; OR 0.35 [0.23-0.53]; p<0.0001). Across LMICs, improvements in hospital facilities would prevent one to three deaths for every 100 patients undergoing surgery for cancer.Interpretation Hospitals with higher levels of infrastructure and resources have better outcomes after cancer surgery, independent of country income. Without urgent strengthening of hospital infrastructure and resources, the reductions in cancer-associated mortality associated with improved access will not be realised

Pooled analysis of WHO Surgical Safety Checklist use and mortality after emergency laparotomy

Background The World Health Organization (WHO) Surgical Safety Checklist has fostered safe practice for 10 years, yet its place in emergency surgery has not been assessed on a global scale. The aim of this study was to evaluate reported checklist use in emergency settings and examine the relationship with perioperative mortality in patients who had emergency laparotomy. Methods In two multinational cohort studies, adults undergoing emergency laparotomy were compared with those having elective gastrointestinal surgery. Relationships between reported checklist use and mortality were determined using multivariable logistic regression and bootstrapped simulation. Results Of 12 296 patients included from 76 countries, 4843 underwent emergency laparotomy. After adjusting for patient and disease factors, checklist use before emergency laparotomy was more common in countries with a high Human Development Index (HDI) (2455 of 2741, 89.6 per cent) compared with that in countries with a middle (753 of 1242, 60.6 per cent; odds ratio (OR) 0.17, 95 per cent c.i. 0.14 to 0.21, P <0001) or low (363 of 860, 422 per cent; OR 008, 007 to 010, P <0.001) HDI. Checklist use was less common in elective surgery than for emergency laparotomy in high-HDI countries (risk difference -94 (95 per cent c.i. -11.9 to -6.9) per cent; P <0001), but the relationship was reversed in low-HDI countries (+121 (+7.0 to +173) per cent; P <0001). In multivariable models, checklist use was associated with a lower 30-day perioperative mortality (OR 0.60, 0.50 to 073; P <0.001). The greatest absolute benefit was seen for emergency surgery in low- and middle-HDI countries. Conclusion Checklist use in emergency laparotomy was associated with a significantly lower perioperative mortality rate. Checklist use in low-HDI countries was half that in high-HDI countries.Peer reviewe

Surgical site infection after gastrointestinal surgery in high-income, middle-income, and low-income countries: a prospective, international, multicentre cohort study

Background: Surgical site infection (SSI) is one of the most common infections associated with health care, but its importance as a global health priority is not fully understood. We quantified the burden of SSI after gastrointestinal surgery in countries in all parts of the world. Methods: This international, prospective, multicentre cohort study included consecutive patients undergoing elective or emergency gastrointestinal resection within 2-week time periods at any health-care facility in any country. Countries with participating centres were stratified into high-income, middle-income, and low-income groups according to the UN's Human Development Index (HDI). Data variables from the GlobalSurg 1 study and other studies that have been found to affect the likelihood of SSI were entered into risk adjustment models. The primary outcome measure was the 30-day SSI incidence (defined by US Centers for Disease Control and Prevention criteria for superficial and deep incisional SSI). Relationships with explanatory variables were examined using Bayesian multilevel logistic regression models. This trial is registered with ClinicalTrials.gov, number NCT02662231. Findings: Between Jan 4, 2016, and July 31, 2016, 13 265 records were submitted for analysis. 12 539 patients from 343 hospitals in 66 countries were included. 7339 (58·5%) patient were from high-HDI countries (193 hospitals in 30 countries), 3918 (31·2%) patients were from middle-HDI countries (82 hospitals in 18 countries), and 1282 (10·2%) patients were from low-HDI countries (68 hospitals in 18 countries). In total, 1538 (12·3%) patients had SSI within 30 days of surgery. The incidence of SSI varied between countries with high (691 [9·4%] of 7339 patients), middle (549 [14·0%] of 3918 patients), and low (298 [23·2%] of 1282) HDI (p < 0·001). The highest SSI incidence in each HDI group was after dirty surgery (102 [17·8%] of 574 patients in high-HDI countries; 74 [31·4%] of 236 patients in middle-HDI countries; 72 [39·8%] of 181 patients in low-HDI countries). Following risk factor adjustment, patients in low-HDI countries were at greatest risk of SSI (adjusted odds ratio 1·60, 95% credible interval 1·05–2·37; p=0·030). 132 (21·6%) of 610 patients with an SSI and a microbiology culture result had an infection that was resistant to the prophylactic antibiotic used. Resistant infections were detected in 49 (16·6%) of 295 patients in high-HDI countries, in 37 (19·8%) of 187 patients in middle-HDI countries, and in 46 (35·9%) of 128 patients in low-HDI countries (p < 0·001). Interpretation: Countries with a low HDI carry a disproportionately greater burden of SSI than countries with a middle or high HDI and might have higher rates of antibiotic resistance. In view of WHO recommendations on SSI prevention that highlight the absence of high-quality interventional research, urgent, pragmatic, randomised trials based in LMICs are needed to assess measures aiming to reduce this preventable complication