Human Enteroviruses isolated during acute flaccid paralysis surveillance in Ghana: implications for the post eradication era

Introduction: Surveillance of acute flaccid surveillance (AFP) has been used world-wide to monitor the control and eradication of circulating wildpolioviruses. The Polio Laboratory since its accreditation in 1996 has supported the Disease Surveillance Department for AFP surveillance. Thisstudy aims to isolate and characterize human enteroviruses from patients with AFP in Ghana. Method: Stool suspension was prepared from 308samples received in 2009 from the surveillance activities throughout the country and inoculated on both RD and L20B cell lines. Isolates thatshowed growth on L20B were selected for real-time RT-PCR using degenerate and non-degenerate primers and probes. RD isolates were however characterized by microneutralisation technique with antisera pools from RIVM, The Netherlands and viruses that were untypable subjected toneutralization assay using antibodies specific for E71. Results: Of the 308 samples processed, 17 (5.5%) grew on both L20B and RD cells while 32(10.4%) grew on RD only. All 28 isolates from L20B were characterized by rRT-PCR as Sabin-like polioviruses. No wild poliovirus or VDPV wasfound. However from the microneutralisation assay, six different enteroviruses were characterized. Among these, Coxsackie B viruses were most predominant followed by Echovirus. Three children from whom non-polio enteroviruses were isolated had residual paralysis while one child with VAPP found. The non-polio enteroviruses circulated throughout the country with the majority (20.7%) from Ashanti region. Conclusion: Thisstudy showed the absence of wild or vaccine-derived poliovirus circulation in the country. However, the detection of three non-polio enterovirusesand one Sabin-like poliovirus with residual paralysis call for continuous surveillance even in the post polio eradication era

Packet Switched vs. Time Multiplexed FPGA Overlay Networks

Dedicated, spatially configured FPGA interconnect is efficient for applications that require high throughput connections between processing elements (PEs) but with a limited degree of PE interconnectivity (e.g. wiring up gates and datapaths). Applications which virtualize PEs may require a large number of distinct PE-to-PE connections (e.g. using one PE to simulate 100s of operators, each requiring input data from thousands of other operators), but with each connection having low throughput compared with the PE’s operating cycle time. In these highly interconnected conditions, dedicating spatial interconnect resources for all possible connections is costly and inefficient. Alternatively, we can time share physical network resources by virtualizing interconnect links, either by statically scheduling the sharing of resources prior to runtime or by dynamically negotiating resources at runtime. We explore the tradeoffs (e.g. area, route latency, route quality) between time-multiplexed and packet-switched networks overlayed on top of commodity FPGAs. We demonstrate modular and scalable networks which operate on a Xilinx XC2V6000-4 at 166MHz. For our applications, time-multiplexed, offline scheduling offers up to a 63% performance increase over online, packet-switched scheduling for equivalent topologies. When applying designs to equivalent area, packet-switching is up to 2× faster for small area designs while time-multiplexing is up to 5× faster for larger area designs. When limited to the capacity of a XC2V6000, if all communication is known, time-multiplexed routing outperforms packet-switching; however when the active set of links drops below 40% of the potential links, packet-switched routing can outperform time-multiplexing

Low Level of Transmitted HIV Drug Resistance at Two HIV Care Centres in Ghana: A Threshold Survey

Background: As access to antiretroviral therapy (ART) increases, the emergence and transmission of HIV drug resistant strains becomes a major problem. The World Health Organization (WHO) therefore recommends an initial minimum-resource method to signal when transmitted HIV drug resistance (HIVDR) requires action.Objective: This survey sought to generate information on the presence of HIV drug-resistant strains in the locality where Ghana’s ART for HIV was first introduced.Methods: The Ghana HIVDR threshold survey (TS) was conducted and analyzed according to WHO strategy for surveillance of HIVDR in the Eastern Region of Ghana. Sixty (60) plasma specimens were collected from 2007 to 2009 by an unlinked anonymous method from HIV seropositive pregnant women, aged between 15 to24 years, who were with their first pregnancy and ART naive. Genotyping was done as follows; Ribonucleic acid (RNA) was extracted from the samples and the protease (PR) and reverse transcriptase (RT) genes amplified and sequenced. The sequences were then analyzed for HIV drug resistance mutations using Stanford University HIV Drug Resistance Database.Results: Only two individuals were found with major HIVDR mutations: one each in the PR and RT genes. Thus the level of HIVDR in the study population in 2009 was classified as low (< 5%).Conclusion: As at February 2009, transmitted drug resistance was not a serious problem in the Eastern Region of Ghana. However, it is important to continue monitoring tHIVDR in order to understand the dynamics of the evolution of HIV drug resistance in the country

Prognostic model to predict postoperative acute kidney injury in patients undergoing major gastrointestinal surgery based on a national prospective observational cohort study.

Background: Acute illness, existing co-morbidities and surgical stress response can all contribute to postoperative acute kidney injury (AKI) in patients undergoing major gastrointestinal surgery. The aim of this study was prospectively to develop a pragmatic prognostic model to stratify patients according to risk of developing AKI after major gastrointestinal surgery. Methods: This prospective multicentre cohort study included consecutive adults undergoing elective or emergency gastrointestinal resection, liver resection or stoma reversal in 2-week blocks over a continuous 3-month period. The primary outcome was the rate of AKI within 7 days of surgery. Bootstrap stability was used to select clinically plausible risk factors into the model. Internal model validation was carried out by bootstrap validation. Results: A total of 4544 patients were included across 173 centres in the UK and Ireland. The overall rate of AKI was 14·2 per cent (646 of 4544) and the 30-day mortality rate was 1·8 per cent (84 of 4544). Stage 1 AKI was significantly associated with 30-day mortality (unadjusted odds ratio 7·61, 95 per cent c.i. 4·49 to 12·90; P < 0·001), with increasing odds of death with each AKI stage. Six variables were selected for inclusion in the prognostic model: age, sex, ASA grade, preoperative estimated glomerular filtration rate, planned open surgery and preoperative use of either an angiotensin-converting enzyme inhibitor or an angiotensin receptor blocker. Internal validation demonstrated good model discrimination (c-statistic 0·65). Discussion: Following major gastrointestinal surgery, AKI occurred in one in seven patients. This preoperative prognostic model identified patients at high risk of postoperative AKI. Validation in an independent data set is required to ensure generalizability

Global wealth disparities drive adherence to COVID-safe pathways in head and neck cancer surgery

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