Successful open surgical repair of an infrarenal, abdominal aortic aneurysm (AAA) in a young Malawian female: A case report

A 39-year-old woman presented to Queen Elizabeth Central Hospital in Blantyre, Malawi  with a 3-week history of worsening peri-umbilical abdominal pain radiating to the lower back associated with anorexia, nausea and vomiting. There was no history of trauma, diarrhoea, obstipation, fevers, or urinary symptoms. She reported history of ‘spinal surgery’ performed 6 years prior due to a herniated intervertebral lumbar disk

Successful open surgical repair of an infrarenal, abdominal aortic aneurysm (AAA) in a young Malawian female: A case report

A 39-year-old lady presented to Queen Elizabeth Central Hospital in Blantyre, Malawi with a 3-week history of worsening peri-umbilical abdominal pain radiating to the lower back associated with anorexia, nausea and vomiting. There was no history of trauma, diarrhoea, obstipation, fevers, or urinary symptoms

Unusual presentation of atrial Myxoma in a young Malawian male: Case report and review of literature

We report a 30-year-old male who presented with signs and symptoms of right heart failure who was later diagnosed with right-sided atrial myxoma. This patient, unfortunately, died while waiting for cardiac surgery outside Malawi and postmortem was not done to ascertain the cause of death

Inter-country COVID-19 contagiousness variation in eight African countries

DATA AVAILABILITY STATEMENT : Publicly available datasets were analyzed in this study. This data can be found here: https://raw.githubusercontent.com/CSSEGISandData/COVID-19/master/csse_covid_19_data/csse_covid_19_time_series/time_series_covid19_confirmed_global.csv.The estimates of contiguousness parameters of an epidemic have been used for health-related policy and control measures such as non-pharmaceutical control interventions (NPIs). The estimates have varied by demographics, epidemic phase, and geographical region. Our aim was to estimate four contagiousness parameters: basic reproduction number (R0), contact rate, removal rate, and infectious period of coronavirus disease 2019 (COVID-19) among eight African countries, namely Angola, Botswana, Egypt, Ethiopia, Malawi, Nigeria, South Africa, and Tunisia using Susceptible, Infectious, or Recovered (SIR) epidemic models for the period 1 January 2020 to 31 December 2021. For reference, we also estimated these parameters for three of COVID-19’s most severely affected countries: Brazil, India, and the USA. The basic reproduction number, contact and remove rates, and infectious period ranged from 1.11 to 1.59, 0.53 to 1.0, 0.39 to 0.81; and 1.23 to 2.59 for the eight African countries. For the USA, Brazil, and India these were 1.94, 0.66, 0.34, and 2.94; 1.62, 0.62, 0.38, and 2.62, and 1.55, 0.61, 0.39, and 2.55, respectively. The average COVID-19 related case fatality rate for 8 African countries in this study was estimated to be 2.86%. Contact and removal rates among an affected African population were positively and significantly associated with COVID-19 related deaths (p-value < 0.003). The larger than one estimates of the basic reproductive number in the studies of African countries indicate that COVID-19 was still being transmitted exponentially by the 31 December 2021, though at different rates. The spread was even higher for the three countries with substantial COVID-19 outbreaks. The lower removal rates in the USA, Brazil, and India could be indicative of lower death rates (a proxy for good health systems). Our findings of variation in the estimate of COVID-19 contagiousness parameters imply that countries in the region may implement differential COVID-19 containment measures.The South African Medical Research Council.https://www.frontiersin.org/journals/public-healtham2023Statistic

Household Air Pollution and Acute Lower Respiratory Infections in Adults: A Systematic Review.

INTRODUCTION: Household air pollution from solid fuel burning kills over 4 million people every year including half a million children from acute lower respiratory infections. Although biologically plausible, it is not clear whether household air pollution is also associated with acute lower respiratory infections in adults. We systematically reviewed the literature on household air pollution and acute lower respiratory infection in adults to identify knowledge gaps and research opportunities. METHODS: Ten bibliographic databases were searched to identify studies of household air pollution and adult acute lower respiratory infection. Data were extracted from eligible studies using standardised forms. RESULTS: From 4617 titles, 513 abstracts and 72 full-text articles were reviewed. Eight studies met the inclusion criteria of which 2 found a significant adjusted increased risk of acute lower respiratory infection, 2 identified a univariate association whilst 4 found no significant association. Study quality was generally limited. Heterogeneity in methods and findings precluded meta-analysis. DISCUSSION: A systematic review of the literature found limited evidence for an association between household air pollution and risk of acute lower respiratory infection in adults. Additional research, with carefully defined exposure and outcome measures, is required to complete the risk profile caused by household air pollution in adults. REGISTRATION NUMBER: CRD42015028042

Global Retinoblastoma Presentation and Analysis by National Income Level.

Importance: Early diagnosis of retinoblastoma, the most common intraocular cancer, can save both a child's life and vision. However, anecdotal evidence suggests that many children across the world are diagnosed late. To our knowledge, the clinical presentation of retinoblastoma has never been assessed on a global scale. Objectives: To report the retinoblastoma stage at diagnosis in patients across the world during a single year, to investigate associations between clinical variables and national income level, and to investigate risk factors for advanced disease at diagnosis. Design, Setting, and Participants: A total of 278 retinoblastoma treatment centers were recruited from June 2017 through December 2018 to participate in a cross-sectional analysis of treatment-naive patients with retinoblastoma who were diagnosed in 2017. Main Outcomes and Measures: Age at presentation, proportion of familial history of retinoblastoma, and tumor stage and metastasis. Results: The cohort included 4351 new patients from 153 countries; the median age at diagnosis was 30.5 (interquartile range, 18.3-45.9) months, and 1976 patients (45.4%) were female. Most patients (n = 3685 [84.7%]) were from low- and middle-income countries (LMICs). Globally, the most common indication for referral was leukocoria (n = 2638 [62.8%]), followed by strabismus (n = 429 [10.2%]) and proptosis (n = 309 [7.4%]). Patients from high-income countries (HICs) were diagnosed at a median age of 14.1 months, with 656 of 666 (98.5%) patients having intraocular retinoblastoma and 2 (0.3%) having metastasis. Patients from low-income countries were diagnosed at a median age of 30.5 months, with 256 of 521 (49.1%) having extraocular retinoblastoma and 94 of 498 (18.9%) having metastasis. Lower national income level was associated with older presentation age, higher proportion of locally advanced disease and distant metastasis, and smaller proportion of familial history of retinoblastoma. Advanced disease at diagnosis was more common in LMICs even after adjusting for age (odds ratio for low-income countries vs upper-middle-income countries and HICs, 17.92 [95% CI, 12.94-24.80], and for lower-middle-income countries vs upper-middle-income countries and HICs, 5.74 [95% CI, 4.30-7.68]). Conclusions and Relevance: This study is estimated to have included more than half of all new retinoblastoma cases worldwide in 2017. Children from LMICs, where the main global retinoblastoma burden lies, presented at an older age with more advanced disease and demonstrated a smaller proportion of familial history of retinoblastoma, likely because many do not reach a childbearing age. Given that retinoblastoma is curable, these data are concerning and mandate intervention at national and international levels. Further studies are needed to investigate factors, other than age at presentation, that may be associated with advanced disease in LMICs

Smallholder Agricultural Commercialization and Poverty: Empirical Evidence of Panel Data from Kenya

Despite inconclusive evidence of the impact of agricultural commercialization on smallholder welfare, many developing countries with majority of their population engaged in smallholder agriculture continue to pursue this agricultural transformation process. Past empirical studies have been criticized for methodological flaws and where real negative evidence existed, then this has been attributed to policy failures rather than commercialization process per se. Using panel data collected from Kenya, this study fits an endogenous switching regression model in a correlated random effects framework to analyze impacts of agricultural commercialization on household poverty proxied by annual household per capita expenditure on food and non-food items including own produced and consumed crops and livestock products. The results show that agricultural commercialization significantly increases annual per capita household expenditure among commercialized and non-commercialized had they commercialized. The annual per capita expenditure gap existing between commercialized and non-commercialized households emanates from their differences in amounts of resources owned (57%) and efficiency of using these resources (43%). Closing this expenditure gap (poverty gap) require improving the amount of resources owned and resource use efficiency among non-commercialized households. Therefore, policy options geared toward stimulating and/or enhancing smallholder agricultural commercialization are encourages as a poverty reduction strategy

Transcriptome Analysis of Recombinant Protein Secretion by Aspergillus nidulans and the Unfolded-Protein Response In Vivo

Filamentous fungi have a high capacity for producing large amounts of secreted proteins, a property that has been exploited for commercial production of recombinant proteins. However, the secretory pathway, which is key to the production of extracellular proteins, is rather poorly characterized in filamentous fungi compared to yeast. We report the effects of recombinant protein secretion on gene expression levels in Aspergillus nidulans by directly comparing a bovine chymosin-producing strain with its parental wild-type strain in continuous culture by using expressed sequence tag microarrays. This approach demonstrated more subtle and specific changes in gene expression than those observed when mimicking the effects of protein overproduction by using a secretion blocker. The impact of overexpressing a secreted recombinant protein more closely resembles the unfolded-protein response in vivo