Liver injury caused by a herbal and dietary supplement: a case report

We present a case of a previously healthy male admitted with acute hepatitis while using a body building supplement. An exhaustive laboratory workup for causes of hepatitis was unrevealing. He responded well to withdrawal of the supplement and a course of corticosteroids

INFORMED CONSENT FOR CLINICAL TRIALS: A REVIEW

Objective: To identify and highlight challenges related to informed consent processfor clinical trials in sub-Saharan Africa.Data sources: Published original research findings and reviews in the English literature,together with anecdotal information from our current professional experiences withclinical trials.Design: Review of peer-reviewed articles.Data extraction: Online searches were done and requests for reprints from correspondingauthors and institutional subscription.Data synthesis: Information categorised accordingly.Results: Informed consent for clinical trials conducted in sub-Saharan Africa (SSA) isnot always “truly informed” or “truly voluntary”. Guidelines for obtaining informedconsent are often difficult to implement because of low literacy levels, socio-economicand cultural factors. The local ethics committees, whose role is critical in informedconsent, are weak, ill-equipped or non-existent in some countries. Many participantsmay have incomplete understanding of the various aspects of the clinical trials due tolanguage barriers, the way information is disclosed or terms used for informed consentdocuments. In some settings, clinical trials are the only access to health care servicesfor the local population. Further, participants may enroll with perceived notion ofcure of their conditions, for monetary or material benefits.Conclusions: There is need for national guidelines on clinical research including ethicsreview, compensation of subjects, requirements for research investigators, facilitiesand ethics committees as well as budgetary allocation. These guidelines must not onlyaddress specific and unique local circumstances but also meet minimum internationalclinical research standards. Local bioethics and research capacity should be developedand strengthened with research sponsors contributing towards this. Local research isneeded on the validity and reliability of informed consent for clinical trials and factorsinfluencing that in different socio-cultural settings in SSA

Pathogenic and commensal Escherichia coli from irrigation water show potential in transmission of extended spectrum and AmpC β-lactamases determinants to isolates from lettuce

There are few studies on the presence of extendedspectrum β-lactamases and AmpC β-lactamases (ESBL/AmpC) in bacteria that contaminate vegetables. The role of the production environment in ESBL/ AmpC gene transmission is poorly understood. The occurrence of ESBL/AmpC in Escherichia coli (n = 46) from lettuce and irrigation water and the role of irrigation water in the transmission of resistant E. coli were studied. The presence of ESBL/AmpC, genetic similarity and phylogeny were typed using genotypic and phenotypic techniques. The frequency of β-lactamase gene transfer was studied in vitro. ESBLs/AmpC were detected in 35 isolates (76%). Fourteen isolates (30%) produced both ESBLs/AmpC. Prevalence was highest in E. coli from lettuce (90%). Twenty-two isolates (48%) were multi-resistant with between two and five ESBL/AmpC genes. The major ESBL determinant was the CTX-M type (34 isolates). DHA (33% of isolates) were the dominant AmpC β lactamases. There was a high conjugation efficiency among the isolates, ranging from 3.5 × 10−2 to 1 × 10−2 ± 1.4 × 10−1 transconjugants per recipient. Water isolates showed a significantly higher conjugation frequency than those from lettuce. A high degree of genetic relatedness between E. coli from irrigation water and lettuce indicated possible common ancestry and pathway of transmission.We acknowledge the TWAS Fellowship for Research and Advanced Training, National Research Foundation and Vice-Chancellor Postdoctoral Fellowship Programme at the University of Pretoria for financing P. M. K. Njage during the research work. The sequence analysis facility was funded by the National Research Foundation of South Africa.http://onlinelibrary.wiley.com/journal/10.1111/(ISSN)1751-7915am201

Extended-spectrum β-lactamase, shigatoxin and haemolysis capacity of O157 and non-O157 E. coli serotypes from producer-distributor bulk milk

We investigated for virulence genes (stx1, stx2 and hlyA), serotypes and extended-spectrum β-lactamases (ESBLs) producing capacity in O157 and non-O157 Escherichia coli isolated from producer-distributor bulk milk (PDBM). Fifteen different E. coli O-serogroups were observed from the isolates (n=121). The prevalence of stx1 and stx2 genes among the E. coli isolates was 8.3% and 11.6% (n=121), respectively, while 5.8% harboured both stx1 and stx2. Four E. coli isolates (3.3%) had ESBLs producing capacity, resisted multiple cephalosporins and aztreonam, and carried stx genes. Cluster analysis using GTG5 finger printing revealed a diversity of E. coli seropathotypes in PDBM which are known to be associated with human diarrhoeal diseases. These results highlight a potential risk posed on human health by the consumption of PDBM contaminated with pathogenic E. coli. A further quantitative risk assessment of the impact of pathogenic E. coli contamination in PDBM on human health is therefore recommended.Milk South Africahttp://www.elsevier.com/locate/idairyj2018-03-31hb2017Food Scienc

Editorial: Structured operational research and training in the public health sector: the Kenyan experience

No Abstrac

Systematic-review and meta-analysis on effect of decontamination interventions on prevalence and concentration of Campylobacter spp. during primary processing of broiler chickens

Please read abstract in the article.Partly supported by the Australia Awards Africa Post-Doctoral Fellowship.https://www.elsevier.com/locate/fmhj2023Consumer ScienceFood Scienc

Characterization of Escherichia coli and other Enterobacteriaceae in producer-distributor bulk milk

The current study was undertaken to characterize Escherichia coli and other Enterobacteriaceae in raw and pasteurized producer-distributor bulk milk (PDBM). A total of 258 samples were collected from purchase points in 8 provinces in South Africa. The samples were tested for antibiotic residues, phosphatase, total aerobic bacteria, coliforms, and E. coli counts. Matrixassisted laser desorption/ionization time-of-flight mass spectrometry was used for identification of isolates. Escherichia coli isolates were characterized for virulence factors, antimicrobial resistance, serotypes, and presumptive E. coli O157:H7. Antibiotic residues and alkaline phosphatase were detected in 2% of both raw and pasteurized PDBM (n = 258) and 21% pasteurized PDBM (n = 104) samples, respectively. A total of 729 isolates belonging to 21 genera and 59 species were identified. Escherichia coli, Enterobacter cloacae, Klebsiella oxytoca, and Raoultella ornithinolytica were the most abundant species. Spoilage Enterobacteriaceae species exceeded 50% of the total isolates. Escherichia coli was detected and isolated from 36% of the milk samples. Thirty-one E. coli isolates harbored virulence genes stx1/stx2 and 38% (n = 121) were presumptive O157:H7. The prevalence of samples with presumptive shigatoxin producing E. coli was 10%. Antimicrobialresistant E. coli isolates were detected in 70% of the milk samples with 36% of stx1/stx2 positive E. coli showing multi-drug resistance. Information obtained from the study will be used for modeling the public health risk posed by milkborne pathogens in PDBM, which in many cases is consumed by poor and vulnerable members of the population.Milk South Africa (Pretoria, Republic of South Africa)http://www.journals.elsevier.com/journal-of-dairy-sciencehb2017Food Scienc