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Spatio-temporal patterns and landscape-associated risk of Buruli ulcer in Akonolinga, Cameroon

Background: Buruli ulcer (BU) is an extensively damaging skin infection caused by Mycobacterium ulcerans, whose transmission mode is still unknown. The focal distribution of BU and the absence of interpersonal transmission suggest a major role of environmental factors, which remain unidentified. This study provides the first description of the spatio-temporal variations of BU in an endemic African region, in Akonolinga, Cameroon. We quantify landscape-associated risk of BU, and reveal local patterns of endemicity. Methodology/Principal Findings: From January 2002 to May 2012, 787 new BU cases were recorded in 154 villages of the district of Akonolinga. Incidence per village ranged from 0 (n = 59 villages) to 10.4 cases/1000 person. years (py); median incidence was 0.4 cases/1,000py. Villages neighbouring the Nyong River flood plain near Akonolinga town were identified as the highest risk zone using the SPODT algorithm. We found a decreasing risk with increasing distance to the Nyong and identified 4 time phases with changes in spatial distribution. We classified the villages into 8 groups according to landscape characteristics using principal component analysis and hierarchical clustering. We estimated the incidence ratio (IR) associated with each landscape using a generalised linear model. BU risk was highest in landscapes with abundant wetlands, especially cultivated ones (IR = 15.7, 95% confidence interval [95% CI] = 15.7[4.2-59.2]), and lowest in reference landscape where primary and secondary forest cover was abundant. In intermediate-risk landscapes, risk decreased with agriculture pressure (from IR[95% CI] = 7.9[2.2-28.8] to 2.0[0.6-6.6]). We identified landscapes where endemicity was stable and landscapes where incidence increased with time. Conclusion/Significance: Our study on the largest series of BU cases recorded in a single endemic region illustrates the local evolution of BU and identifies the Nyong River as the major driver of BU incidence. Local differences along the river are explained by wetland abundance and human modification of the environment

The IMO Reference Data Model: One Solution Fits Most!

In 2019, the International Maritime Organization (IMO) made it mandatory to support the electronic clearance of ships entering foreign ports. In preparation, the IMO Facilitation Committee started to develop a reference data model to harmonise the most important standards for ship clearance. The first version was published in 2020. The model is already extending into other areas of ship-port data exchanges and it is now increasingly seen as a tool to coordinate development of new electronic data exchange standards for ship operations. The lack of such coordination has, up until now, been a significant problem—much better coordination is essential in the relatively small and highly international market that shipping represents.acceptedVersio

Mycobacterium ulcerans ecological dynamics and its association with freshwater ecosystems and aquatic communities : results from a 12-month environmental survey in Cameroon

Background: Mycobacterium ulcerans (MU) is the agent responsible for Buruli Ulcer (BU), an emerging skin disease with dramatic socioeconomic and health outcomes, especially in rural settings. BU emergence and distribution is linked to aquatic ecosystems in tropical and subtropical countries, especially to swampy and flooded areas. Aquatic animal organisms are likely to play a role either as host reservoirs or vectors of the bacilli. However, information on MU ecological dynamics, both in space and time, is dramatically lacking. As a result, the ecology of the disease agent, and consequently its mode of transmission, remains largely unknown, which jeopardizes public health attempts for its control. The objective of this study was to gain insight on MU environmental distribution and colonization of aquatic organisms through time. Methodology/Principal Findings: Longitudinal sampling of 32 communities of aquatic macro-invertebrates and vertebrates was conducted from different environments in two BU endemic regions in Cameroon during 12 months. As a result, 238,496 individuals were classified and MU presence was assessed by qPCR in 3,084 sample-pools containing these aquatic organisms. Our study showed a broad distribution of MU in all ecosystems and taxonomic groups, with important regional differences in its occurrence. Colonization dynamics fluctuated along the year, with the highest peaks in August and October. The large variations observed in the colonization dynamics of different taxonomic groups and aquatic ecosystems suggest that the trends shown here are the result of complex ecological processes that need further investigation. Conclusion/Perspectives: This is the largest field study on MU ecology to date, providing the first detailed description of its spatio-temporal dynamics in different aquatic ecosystems within BU endemic regions. We argue that coupling this data with fine-scale epidemiological data through statistical and mathematical models will provide a major step forward in the understanding of MU ecology and mode of transmission

Combined Inflammatory and Metabolic Defects Reflected by Reduced Serum Protein Levels in Patients with Buruli Ulcer Disease

Buruli ulcer is a skin disease caused by Mycobacterium ulcerans that is spreading in tropical countries, with major public health and economic implications in West Africa. Multi-analyte profiling of serum proteins in patients and endemic controls revealed that Buruli ulcer disease down-regulates the circulating levels of a large array of inflammatory mediators, without impacting on the leukocyte composition of peripheral blood. Notably, several proteins contributing to acute phase reaction, lipid metabolism, coagulation and tissue remodelling were also impacted. Their down-regulation was selective and persisted after the elimination of bacteria with antibiotic therapy. It involved proteins with various functions and origins, suggesting that M. ulcerans infection causes global and chronic defects in the host’s protein metabolism. Accordingly, patients had reduced levels of total serum proteins and blood urea, in the absence of signs of malnutrition, or functional failure of liver or kidney. Interestingly, slow healers had deeper metabolic and coagulation defects at the start of antibiotic therapy. In addition to providing novel insight into Buruli ulcer pathogenesis, our study therefore identifies a unique proteomic signature for this disease

Serum Alpha-Fetoprotein Predicts Treatment Outcome in Chronic Hepatitis C Patients Regardless of HCV Genotype

We examined the association between serum alpha-fetoprotein (AFP) level and sustained virological response (SVR) in 93 chronic hepatitis C patients. The SVR rate was much higher among patients with serum AFP levels below rather than above the median value (5.7 ng/ml) (58.7% and 19.2%, respectively; P<0.0001). Serum AFP should be added to the list of factors predictive of treatment response in chronic hepatitis C

Diagnósticos enfermeros en UFISS, UGA, Traumatología y CIR.

In 2006, after the addition of a new nurse in UFISS (Social-Sanitary Functional Interdisciplinary Unit), is detected the need of a common language for all nurses with which to conduct a data collection for the nursing reports. The aim of this study is to know the main nursing diagnoses in UFISS, Geriatrics, Traumatology and Surgery units, using the NANDA (North American Nursing Diagnosis Association) nursing diagnostic terminology. We performed a retrospective study of all the medical reports at UFISS in 2006, a prospective study of all medical reports at Geriatrics and geriatric patients at Traumatology and Surgery in various periods between 2008 and 2009. According to the results, the use of a validated method like NANDA diagnoses, has enabled to nurses to identify common altered needs and after that, to define Nursing Diagnoses and develop the optimal care plan for the patientIntroducción: La utilización de un método validado, ha permitido detectar las necesidades alteradas en relación a su etiología, definiendo los DdE (Diagnósticos de Enfermería) (3).La utilización de la Taxonomía NANDA 2 asegura la definición de la respuesta humana a un problema tanto dentro del marco profesional como jurídico, así mismo permite un lenguaje común en la práctica enfermera (6).Objetivos. Identificar los DdE más prevalentes en la población atendida por la UFISS (Unidad Funcional Interdisciplinar Socio-Sanitaria), UGA (Unidad de Geriatría Aguda), TRAUMATOLOGÍA y CIRUGÍA de la FHAG (Fundación Hospital Asilo de Granollers) utilizando la taxonomía NANDA.Métodos.UFFIS. Se estudian retrospectivamente todas las historias de la UFISS del año 2006. (674 consultas, entrando en estudio N= 390 estudiadas).Se estudian prospectivamente:COT (Cirugía Ortopédica Traumatológica). 24 pacientes geriátricos de la unidad de trauma ingresados durante los meses de Agosto-Septiembre 2008UGA. 49 pacientes ingresados durante los meses de Septiembre-Diciembre 2008CIR. 36 pacientes ingresados en mayo 2009.Valoración paciente: Abordaje Bio-Psico-Social (Entrevista enfermera al paciente y al cuidador principal).Funcional (Barthel). Instrumentales (Lawton). Cognitivo (Pfeiffer). Riesgo de úlceras (EMINA). Dolor (EVA)Resultados.UFISS: Se detectan 18 diagnósticos, como los más prevalentes valorados en la UFISS,COT: Se detectan 26 diagnósticos, 16 son comunes a los recogidos por la enfermera de la UFISS, los 10 restantes son los específicos detectados en el paciente orto geriátrico:UGA: Se detectan 30 diagnósticos, de los cuales 18 son comunes a la UFISS y los 12 restantes son específicos en el paciente geriátrico.CIR: Se detectan alrededor de 50 diagnósticos; pendiente tabulación final.Conclusiones: Se han definido los diagnósticos más prevalentes determinando los comunes a las diferentes áreas asistenciales. Dado que en nuestra institución la formación es mayoritariamente básica, con este estudio hemos conseguido: 1) difundir el lenguaje NANDA, 2) asegurar el dominio de estos diagnósticos, 3) que el profesional trabaje de forma más segura utilizando un lenguaje validado y entendible y 4) orientar a la futura implantación informática

Analysis of IL28B Variants in an Egyptian Population Defines the 20 Kilobases Minimal Region Involved in Spontaneous Clearance of Hepatitis C Virus

Spontaneous clearance of hepatitis C virus (HCV) occurs in ∼30% of acute infections. Host genetics play a major role in HCV clearance, with a strong effect of single nucleotide polymorphisms (SNPs) of the IL28B gene already found in different populations, mostly infected with viral genotypes 1 and 3. Egypt has the highest prevalence of HCV infection in the world, which is mostly due to viral genotype 4. We investigated the role of several IL28B SNPs in HCV spontaneous clearance in an Egyptian population. We selected nine SNPs within the IL28B genomic region covering the linkage disequilibrium (LD) block known to be associated with HCV clearance in European populations. These SNPs were genotyped in 261 HCV-infected Egyptian subjects (130 with spontaneous clearance and 131 with chronic infection). The most associated SNPs were rs12979860 (P = 1.6×10−7) and the non-synonymous IL28B SNP, rs8103142 (P = 1.6×10−7). Interestingly, three SNPs at the two bounds of the region were monomorphic, reducing the size of the LD block in which the causal variants are potentially located to ∼20 kilobases. HCV clearance in Egypt was associated with a region of IL28B smaller than that identified in European populations, and involved the non-synonymous IL28B SNP, rs8103142

Impact of five years of peer-mediated interventions on sexual behavior and sexually transmitted infections among female sex workers in Mombasa, Kenya

<p>Abstract</p> <p>Background</p> <p>Since 2000, peer-mediated interventions among female sex workers (FSW) in Mombasa Kenya have promoted behavioural change through improving knowledge, attitudes and awareness of HIV serostatus, and aimed to prevent HIV and other sexually transmitted infection (STI) by facilitating early STI treatment. Impact of these interventions was evaluated among those who attended peer education and at the FSW population level.</p> <p>Methods</p> <p>A pre-intervention survey in 2000, recruited 503 FSW using snowball sampling. Thereafter, peer educators provided STI/HIV education, condoms, and facilitated HIV testing, treatment and care services. In 2005, data were collected using identical survey methods, allowing comparison with historical controls, and between FSW who had or had not received peer interventions.</p> <p>Results</p> <p>Over five years, sex work became predominately a full-time activity, with increased mean sexual partners (2.8 versus 4.9/week; <it>P </it>< 0.001). Consistent condom use with clients increased from 28.8% (145/503) to 70.4% (356/506; <it>P </it>< 0.001) as well as the likelihood of refusing clients who were unwilling to use condoms (OR = 4.9, 95%CI = 3.7–6.6). In 2005, FSW who received peer interventions (28.7%, 145/506), had more consistent condom use with clients compared with unexposed FSW (86.2% versus 64.0%; AOR = 3.6, 95%CI = 2.1–6.1). These differences were larger among FSW with greater peer-intervention exposure. HIV prevalence was 25% (17/69) in FSW attending ≥ 4 peer-education sessions, compared with 34% (25/73) in those attending 1–3 sessions (P = 0.21). Overall HIV prevalence was 30.6 (151/493) in 2000 and 33.3% (166/498) in 2005 (<it>P </it>= 0.36).</p> <p>Conclusion</p> <p>Peer-mediated interventions were associated with an increase in protected sex. Though peer-mediated interventions remain important, higher coverage is needed and more efficacious interventions to reduce overall vulnerability and risk.</p