Evaluating the impacts of flooding on the residents of Lagos, Nigeria

The occurrence of natural disasters is of growing concern globally due to increasing disruption, damage and loss of life. The rising flood frequency in Lagos, Nigeria, emphasises the need for improved flood prevention and management measures. This study evaluates the impacts of flooding on the residents of Lagos, Nigeria by focusing on five areas: Lekki, Victoria Island, Ikeja, Surulere and Ikorodu. Each area represents a different income level and population density. Flood managers in Lagos were also interviewed to understand the flood management and prevention situation from the government’s perspective, together with the barriers and drivers to effective flood management. Data collected from residents indicate that heavy rainfall, blocked and/or failure of drainage systems, and lack of land use planning were considered the most frequent contributors to the flooding problem. A high proportion of residents live in flood prone areas, having been unaware of the initial flood problem, or selecting the area due to proximity to work or affordability. Government initiated flood awareness campaigns aimed to inform residents. However, some residents continue to live in homes at risk from flooding due to sentimental values, whilst others simply cannot afford to move houses. Results revealed some of the impacts of flooding include displacement, damage to property, and disruption to movement and health issues. The study recommends that residents need to be more aware of proper waste disposal. The government also needs to implement controls on development on flood plain, ensure better and regular waste collection methods, proper maintenance of drainage systems and better flood defences are in place. Also, offering incentives should be in place for residents willing to move to minimise impacts of flooding

A nationally representative survey of healthcare provider counselling and provision of the female condom in South Africa and Zimbabwe

Objectives: Female condoms are the only female-initiated HIV and pregnancy prevention technology currently available. We examined female condom counselling and provision among providers in South Africa and Zimbabwe, high HIV-prevalence countries. Design: A cross-sectional study using a nationally representative survey. Setting: All facilities that provide family planning or HIV/sexually transmitted infection (STI) services. Participants: National probability sample of 1444 nurses and physicians who provide family planning or HIV/STI services. Primary and secondary outcome measures Female condom practices with different female patients, including adolescents, married women, women using hormonal contraception and by HIV status. Using multivariable logistic analysis, we measured variations in condom counselling by provider characteristics. Results: Most providers reported offering female condoms (88%; 1239/1415), but perceived a need for novel female barrier methods for HIV/STI prevention (85%; 1191/1396). By patient type, providers reported less frequent female condom counselling of adolescents (55%; 775/1411), women using hormonal contraception (65%; 909/1409) and married women (66%; 931/1416), compared to unmarried (74%; 1043/1414) or HIV-positive women (82%; 1161/1415). Multivariable results showed providers in South Africa were less likely to counsel women on female condoms than in Zimbabwe (OR=0.48, 95% CI 0.35 to 0.68, p≤0.001). However, South African providers were more likely to counsel women on male condoms (OR=2.39, 95% CI 1.57 to 3.65, p≤0.001). Nurses counselled patients on female condoms more frequently than physicians (OR=5.41, 95% CI 3.26 to 8.98, p≤0.001). HIV training, family planning training, location (urban vs rural) and facility type (hospital vs clinic) were not associated with greater condom counselling. Conclusions: Female condoms were integrated into provider counselling and care, although providers reported a need for new female-initiated multipurpose prevention technologies, suggesting female condoms do not meet all patient/provider needs or are not adequately well known or accessible. Providers should be included in HIV training efforts to raise awareness of new and existing products, and encouraged to educate all women

Evolución de pacientes con Lupus Eritematoso Sistémico diagnosticados de dengue en la epidemia del 2020

Introducción: El dengue es una virosis endémica en Paraguay. En los últimos años, se ha reportado su probable papel en la fisiopatología de las enfermedades autoinmunes, ya que puede desencadenarlas o exacerbarlas. Objetivos: Evaluar la evolución de los pacientes con Lupus Eritematoso Sistémico (LES) con diagnóstico de dengue en el periodo de tiempo entre enero de 2020 a marzo de 2020. Materiales y Métodos: Se realizó un estudio observacional, analítico de corte longitudinal, con una muestra de 19 pacientes con lupus eritematoso sistémico (LES), diagnosticados de dengue en etapa febril entre enero y marzo del año 2020. Se recogieron datos mediante un registro electrónico con datos específicos de las características clínicas previas al den- gue y las características evolutivas del dengue en los pacientes con LES. Se determinó el antígeno NS1 mediante pruebas rápidas inmunocromatográficas y se extrajo el ARN viral previo a la reacción de rRT-PCR. Se midió el índice de anticuerpos IgG e IgM anti-DENV. Resultados: La edad media fue de 32,10±13,83 años; el 84% eran mujeres y el 98% pro- cedían del Departamento Central. El 42% (8/19) de los pacientes afirmaron haber padecido dengue anteriormente. De los 19 pacientes, 15 presentaron una confirmación laboratorial mediante la detección del antígeno NS1, la PCR o la serología, como se muestra en el gráfico 1; los demás se incluyeron en esta cohorte por nexo epidemiológico. El DENV-4 fue el serotipo más frecuente, con un 64%. La media del tiempo de evolución del dengue fue de 3,84±1,259 días y los síntomas más comunes fueron la fiebre en un 74%(14/19) y las mialgias en un 63%(12/19). En cuanto a la evolución de los pacientes, el 42% (8/19) requirieron hospitalización, el 5,2%(1/19) ingresaron en UCI y no hubo fallecimientos. La media de SLEDAI al inicio de la infección por dengue fue de 2,5 puntos y a los tres meses fue de 3 puntos; no se halló una diferencia estadísticamente significativa entre los valores del score antes y después del dengue (p=0,451). Conclusión: La evolución del dengue en pacientes con LES fue favorable en los pacientes incluidos en este estudio. La PCR fue el método diagnóstico que con mayor frecuencia pudo detectar un resultado positivo en la etapa febril del dengue en pacientes con LES. Aunque se registraron ingresos hospitalarios, incluso en UCIA, no se produjo ningún fallecimiento por dengue en pacientes con LES

Serratia marcescens bacteremia traced to an infused narcotic

BACKGROUND From June 30, 1998, through March 21, 1999, several patients in the surgical intensive care unit of a hospital acquired Serratia marcescens bacteremia. We investigated this outbreak. METHODS A case was defined as the occurrence of S. marcescens bacteremia in any patient in the surgical intensive care unit during the period of the epidemic. To identify risk factors, we compared patients with S. marcescens bacteremia with randomly selected controls. Isolates from patients and from medications were evaluated by pulsed-field gel electrophoresis. The hair of one employee was tested for fentanyl. RESULTS Twenty-six patients with S. marcescens bacteremia were identified; eight (31 percent) had polymicrobial bacteremia, and seven of these had Enterobacter cloacae and S. marcescens in the same culture. According to univariate analysis, patients with S. marcescensbacteremia stayed in the surgical intensive care unit longer than controls (13.5 vs. 4.0 days, PS. marcescens and E. cloacae. The isolates from the case patients and from the fentanyl infusions had similar patterns on pulsed-field gel electrophoresis. After removal of the implicated respiratory therapist, no further cases occurred. Full Text of Results... CONCLUSIONS An outbreak of S. marcescens and E. cloacae bacteremia in a surgical intensive care unit was traced to extrinsic contamination of the parenteral narcotic fentanyl by a health care worker. Our findings underscore the risk of complications in patients that is associated with illicit narcotic use by health care workers

Effect of novel endoscope cleaning brush on duodenoscope contamination

Background and aims:Current duodenoscope reprocessing protocols are insufficient to prevent contamination and require adaptations to prevent endoscopy-associated infections (EAI). This study aimed to investigate the effect of a new endoscope cleaning brush on the contamination rate of ready-to-use duodenoscopes. Methods:This retrospective before-and-after intervention study collected duodenoscope surveillance culture results from March 2018 to June 2022. Contamination was defined as ≥1 colony-forming units of gastrointestinal or oral microorganisms (MGO). In December 2020, an endoscope cleaning brush with a sweeper design was introduced as the intervention in the manual cleaning of duodenoscopes. A logistic mixed effects model was used to study the effects of the intervention. Results:Data were collected from 176 culture sets before the new brush's introduction and 81 culture sets after. Pre-introduction, culture sets positive with MGO comprised 45.5% (95% CI: 38.3%-52.8%, 80/176), decreasing to 17.3% (95% CI: 10.6%-26.9%, 14/81) after implementing the new brush. Compared to the former brush, duodenoscopes cleaned with the new brush had lower odds of contamination with MGO (aOR=0.25, 95% CI: 0.11-0.58, p=0.001).Conclusions:Use of the new brush in manual cleaning reduced contamination with MGO and is expected to prevent EAIs. These findings should be confirmed in future prospective randomized studies.</p

Antigen-specific immune responses to influenza vaccine in utero

Initial immune responses to allergens may occur before birth, thereby modulating the subsequent development of atopy. This paradigm remains controversial, however, due to the inability to identify antigen-specific T cells in cord blood. The advent of MHC tetramers has revolutionized the detection of antigen-specific T cells. Tetramer staining of cord blood after CMV infection has demonstrated that effective CD8+ antigen-specific immune responses can follow intrauterine viral infections. We hypothesized that sensitization to antigens occurs in utero in humans. We studied cord blood B and T cell immune responses following vaccination against influenza during pregnancy. Anti-Fluzone and anti-matrix protein IgM antibodies were detected in 38.5% (27 of 70) and 40.0% (28 of 70), respectively, of cord blood specimens. Using MHC tetramers, HA-specific CD4+ T cells were detected among 25.0% (3 of 12) and 42.9% (6 of 14) of cord blood specimens possessing DRB1*0101 and DRB1*0401 HLA types, respectively, and were detected even when the DRB1 HLA type was inherited from the father. Matrix protein–specific CD8+ T cells were detected among 10.0% (2 of 20) of HLA-A*0201+ newborns. These results suggest that B and T cell immune responses occur in the fetus following vaccination against influenza and have important implications for determining when immune responses to environmental exposures begin

Heterogeneous patterns of tissue injury in NARP syndrome

Point mutations at m.8993T>C and m.8993T>G of the mtDNA ATPase 6 gene cause the neurogenic weakness, ataxia and retinitis pigmentosa (NARP) syndrome, a mitochondrial disorder characterized by retinal, central and peripheral neurodegeneration. We performed detailed neurological, neuropsychological and ophthalmological phenotyping of a mother and four daughters with NARP syndrome from the mtDNA m.8993T>C ATPase 6 mutation, including 3-T brain MRI, spectral domain optical coherence tomography (SD-OCT), adaptive optics scanning laser ophthalmoscopy (AOSLO), electromyography and nerve conduction studies (EMG-NCS) and formal neuropsychological testing. The degree of mutant heteroplasmy for the m.8993T>C mutation was evaluated by real-time allele refractory mutation system quantitative PCR of mtDNA from hair bulbs (ectoderm) and blood leukocytes (mesoderm). There were marked phenotypic differences between family members, even between individuals with the greatest degrees of ectodermal and mesodermal heteroplasmy. 3-T MRI revealed cerebellar atrophy and cystic and cavitary T2 hyperintensities in the basal ganglia. SD-OCT demonstrated similarly heterogeneous areas of neuronal and axonal loss in inner and outer retinal layers. AOSLO showed increased cone spacing due to photoreceptor loss. EMG-NCS revealed varying degrees of length-dependent sensorimotor axonal polyneuropathy. On formal neuropsychological testing, there were varying deficits in processing speed, visual–spatial functioning and verbal fluency and high rates of severe depression. Many of these cognitive deficits likely localize to cerebellar and/or basal ganglia dysfunction. High-resolution retinal and brain imaging in NARP syndrome revealed analogous patterns of tissue injury characterized by heterogeneous areas of neuronal loss

Real-Time Definition of Non-Randomness in the Distribution of Genomic Events

Features such as mutations or structural characteristics can be non-randomly or non-uniformly distributed within a genome. So far, computer simulations were required for statistical inferences on the distribution of sequence motifs. Here, we show that these analyses are possible using an analytical, mathematical approach. For the assessment of non-randomness, our calculations only require information including genome size, number of (sampled) sequence motifs and distance parameters. We have developed computer programs evaluating our analytical formulas for the real-time determination of expected values and p-values. This approach permits a flexible cluster definition that can be applied to most effectively identify non-random or non-uniform sequence motif distribution. As an example, we show the effectivity and reliability of our mathematical approach in clinical retroviral vector integration site distribution