Induction of labour with titrated oral Misoprostol suspension: a comparative study with vaginal Misoprostol

A CAJM journal article comparing the effectiveness of titrated orally and vaginally administered misoprostol for induction of labour administered at the University of Zimbabwe Teaching Hospital..Objective: To compare the effectiveness of titrated orally and vaginally administered misoprostol for induction of labour. Study Design: Unmasked randomized controlled trial. Setting: Department of Obstetrics and Gynaecology University of Zimbabwe, Harare. Subjects: Pregnant women with singleton foetus in cephalic presentation booked for induction of labour, were randomized to receive titrated orally or vaginally administered misoprostol. Main Outcome Measures: The main outcomes were the duration of labour and induction to delivery interval. The secondary outcomes were neonatal and maternal complications. Methods: 134 women were recruited into the study; 69 and 65 were randomized into orally and vaginally administered misoprostol respectively. Results: The baseline characteristics in the two groups were similar. Women induced with titrated oral misoprostol suspension had a shorter interval from administration of the drug to initiation of uterine contractions (OR = 0.94 .95% Cl 0.42 to 2.12 ) and a longer duration of labour (OR = 0.36; 95% Cl 0.16 to 0.79). Labour was augmented with oxytocin in the oral group. The mean drug dose was 28mcg in the oral group. There was no difference in the mode of delivery between the two groups. Hypertonic uterine contractions were not detected. Ruptured uterus did not occur in the study population. There were more neonatal admissions in the vaginal than the oral group (OR = 1.03 .95% Cl 0.29 to 1.39). Conclusion: Titrated oral misoprostol suspension is as effective and safe as vaginal misoprostol for induction of labour even in poor resource countries where intrapartum monitoring is inadequate

Impact of early initiation versus national standard of care of antiretroviral therapy in Swaziland's public sector health system : study protocol for a stepped-wedge randomized trial

Background: There is robust clinical evidence to support offering early access to antiretroviral treatment (ART) to all HIV-positive individuals, irrespective of disease stage, to both improve patient health outcomes and reduce HIV incidence. However, as the global treatment guidelines shift to meet this evidence, it is still largely unknown if early access to ART for all (also referred to as "treatment as prevention" or " universal test and treat") is a feasible intervention in the resource-limited countries where this approach could have the biggest impact on the course of the HIV epidemics. The MaxART Early Access to ART for All (EAAA) implementation study was designed to determine the feasibility, acceptability, clinical outcomes, affordability, and scalability of offering early antiretroviral treatment to all HIV-positive individuals in Swaziland's public sector health system. Methods: This is a three-year stepped-wedge randomized design with open enrollment for all adults aged 18 years and older across 14 government-managed health facilities in Swaziland's Hhohho Region. Primary endpoints are retention and viral suppression. Secondary endpoints include ART initiation, adherence, drug resistance, tuberculosis, HIV disease progression, patient satisfaction, and cost per patient per year. Sites are grouped to transition two at a time from the control (standard of care) to intervention (EAAA) stage at each four-month step. This design will result in approximately one half of the total observation time to accrue in the intervention arm and the other half in the control arm. Our estimated enrolment number, which is supported by conservative power calculations, is 4501 patients over the course of the 36-month study period. A multidisciplinary, mixed-methods approach will be adopted to supplement the randomized controlled trial and meet the study aims. Additional study components include implementation science, social science, economic evaluation, and predictive HIV incidence modeling. Discussion: A stepped-wedge randomized design is a causally strong and robust approach to determine if providing antiretroviral treatment for all HIV-positive individuals is a feasible intervention in a resource-limited, public sector health system. We expect our study results to contribute to health policy decisions related to the HIV response in Swaziland and other countries in sub-Saharan Africa

International Graduate Student Labor as Mergers and Acquisitions

This study critically examines the self-reported experiences of international graduate students using a framework understanding internationalization as acquisitions and mergers. Students reported positive experiences with their advisors. However, students’ accounts of laboratories and other research settings were diverse, ranging from co-contributors to knowledge and respected collaborators to employed cheap labor that their advisors depended upon for their own gains. In some cases, these students feared that their funding would be cut off or dismissed from the program (and consequently deported from the US) if they challenged their advisors. Whether such apprehensions were valid is unknown as this study focused on perceptions of the students only. The findings do lead to important future directions for research and practice

Correlation between radiological and histopathological findings in patients undergoing nephrectomy for presumed renal cell carcinoma on computed tomography scan at Grey’s Hospital

Background: The incidence of renal cell carcinoma (RCC) is increasing globally owing to the increased use of cross-sectional imaging. Computed tomography (CT) scan is the modality of choice in the diagnosis and pre-operative assessment of RCC. Nephrectomy is the standard treatment for RCC and pre-surgery biopsy is not routinely practised. The accuracy of CT diagnosis and staging in a South African population has not been established. Objectives: To determine the accuracy of CT scan in the diagnosis and pre-operative staging of RCC at Grey’s Hospital. Methods: A retrospective chart review was performed; CT scan reports and histopathological results of adult patients who underwent nephrectomy for presumed RCC on CT scan between January 2010 and December 2016 were compared. Results: Fifty patients met the inclusion criteria for the study. CT significantly overestimated the size of renal masses by 0.7 cm (p = 0.045) on average. The positive predictive value of CT for RCC was 81%. Cystic tumours and those 4 cm and smaller were more likely to be benign. CT demonstrated good specificity for extra-renal extension, vascular invasion and lymph node involvement, but poor sensitivity. Conclusion: In our South African study population, CT is accurate at diagnosing RCC, but false-positives do occur. Non-enhancing or poorly enhancing, cystic, fat-containing and small lesions (4 cm or smaller) are more likely to be benign and ultrasound-guided biopsy should be considered to avoid unnecessary surgery. CT assessment of extra-renal extension and vascular invasion is challenging and additional imaging modalities such as magnetic resonance imaging (MRI) venogram, duplex Doppler ultrasound or Positron emission tomography–computed tomography (PET/CT) may be beneficial

Histopathological changes in the reproductive system (ovaries and testes) of Oreochromis mossambicus following exposure to DDT

A b s t r a c t This study assesses the effects of 1,1-bis (4-chlorophenyl)-2,2,2-trichloroethane (DDT) on the reproduction and gonadal histology of adult Mozambique tipalia (Oreochromis mossambicus). The fish were allowed to breed, following exposure to 2 and 5 jig/l of waterborne technical-grade DDT for 40 days. Fertilized eggs were artificially incubated. In the 5 jig/l exposure, posthatch survival was significantly lower, and prevalence of larval skeletal deformities significantly higher, compared to the control (p<0.05). Incomplete axial development was the common gross deformity in posthatch larvae, caused by failure to develop chondroblasts posterior to the buccopharyngeal cavity. There were no significant differences in the gonadosomatic index of exposed and non-exposed male and female adults. The exposure caused increased oocyte atresia in the ovaries and disorganization of seminiferous lobules in the testes of adults. DDT exposure reduced survival and increased deformities in larvae, at levels that did not cause severe histopathological changes to parental gonads

Using detergent to enhance detection sensitivity of African trypanosomes in human CSF and blood by Loop-Mediated Isothermal Amplification (LAMP)

<p><b>Background:</b> The loop-mediated isothermal amplification (LAMP) assay, with its advantages of simplicity, rapidity and cost effectiveness, has evolved as one of the most sensitive and specific methods for the detection of a broad range of pathogenic microorganisms including African trypanosomes. While many LAMP-based assays are sufficiently sensitive to detect DNA well below the amount present in a single parasite, the detection limit of the assay is restricted by the number of parasites present in the volume of sample assayed; i.e. 1 per µL or 103 per mL. We hypothesized that clinical sensitivities that mimic analytical limits based on parasite DNA could be approached or even obtained by simply adding detergent to the samples prior to LAMP assay.</p> <p><b>Methodology/Principal Findings:</b> For proof of principle we used two different LAMP assays capable of detecting 0.1 fg genomic DNA (0.001 parasite). The assay was tested on dilution series of intact bloodstream form Trypanosoma brucei rhodesiense in human cerebrospinal fluid (CSF) or blood with or without the addition of the detergent Triton X-100 and 60 min incubation at ambient temperature. With human CSF and in the absence of detergent, the LAMP detection limit for live intact parasites using 1 µL of CSF as the source of template was at best 103 parasites/mL. Remarkably, detergent enhanced LAMP assay reaches sensitivity about 100 to 1000-fold lower; i.e. 10 to 1 parasite/mL. Similar detergent-mediated increases in LAMP assay analytical sensitivity were also found using DNA extracted from filter paper cards containing blood pretreated with detergent before card spotting or blood samples spotted on detergent pretreated cards.</p> <p><b>Conclusions/Significance:</b> This simple procedure for the enhanced detection of live African trypanosomes in biological fluids by LAMP paves the way for the adaptation of LAMP for the economical and sensitive diagnosis of other protozoan parasites and microorganisms that cause diseases that plague the developing world.</p&gt

A Viral Vectored Prime-Boost Immunization Regime Targeting the Malaria Pfs25 Antigen Induces Transmission-Blocking Activity

The ookinete surface protein Pfs25 is a macrogamete-to-ookinete/ookinete stage antigen of Plasmodium falciparum, capable of exerting high-level anti-malarial transmission-blocking activity following immunization with recombinant protein-in-adjuvant formulations. Here, this antigen was expressed in recombinant chimpanzee adenovirus 63 (ChAd63), human adenovirus serotype 5 (AdHu5) and modified vaccinia virus Ankara (MVA) viral vectored vaccines. Two immunizations were administered to mice in a heterologous prime-boost regime. Immunization of mice with AdHu5 Pfs25 at week 0 and MVA Pfs25 at week 10 (Ad-MVA Pfs25) resulted in high anti-Pfs25 IgG titers, consisting of predominantly isotypes IgG1 and IgG2a. A single priming immunization with ChAd63 Pfs25 was as effective as AdHu5 Pfs25 with respect to ELISA titers at 8 weeks post-immunization. Sera from Ad-MVA Pfs25 immunized mice inhibited the transmission of P. falciparum to the mosquito both ex vivo and in vivo. In a standard membrane-feeding assay using NF54 strain P. falciparum, oocyst intensity in Anopheles stephensi mosquitoes was significantly reduced in an IgG concentration-dependent manner when compared to control feeds (96% reduction of intensity, 78% reduction in prevalence at a 1 in 5 dilution of sera). In addition, an in vivo transmission-blocking effect was also demonstrated by direct feeding of immunized mice infected with Pfs25DR3, a chimeric P. berghei line expressing Pfs25 in place of endogenous Pbs25. In this assay the density of Pfs25DR3 oocysts was significantly reduced when mosquitoes were fed on vaccinated as compared to control mice (67% reduction of intensity, 28% reduction in prevalence) and specific IgG titer correlated with efficacy. These data confirm the utility of the adenovirus-MVA vaccine platform for the induction of antibodies with transmission-blocking activity, and support the continued development of this alternative approach to transmission-blocking malaria subunit vaccines

The psychosocial determinants of the intention to test for HIV among young men in KwaZulu-Natal province, South Africa

: Voluntary counselling and testing is one of the effective prevention strategies against the HIV/AIDS epidemic. This study investigated the psychosocial determinants of the intention to be tested for HIV among young men in South Africa’s KwaZulu-Natal province using the theory of planned behaviour as the guiding framework. A facilitator-administered questionnaire was used to collect data among 350 isiZulu-speaking men between the ages of 18 and 35. Results show that 24% reported ever having tested. Intention to test showed strong positive correlations with subjective norm to test (r = 0.67), intention to use condoms (r = 0.65), intention to reduce alcohol use (r = 0.60), subjective norm to reduce alcohol use (r = 0.54), and subjective norm to use condoms (r = 0.51). For multiple regression, attitude, subjective norm and perceived behavioural control explained 43% of the variance in intention to test, with subjective norm and perceived behavioural control making significant unique contributions. An additional 12% of the variance was explained by intention to reduce alcohol and drug use, and use condoms

Deeper knowledge of shallow waters: reviewing the invertebrate fauna of southern African temporary wetlands

Temporary lentic wetlands are becoming increasingly recognised for their collective role in contributing to biodiversity at the landscape scale. In southern Africa, a region with a high density of such wetlands, information characterising the fauna of these systems is disparate and often obscurely published. Here we provide a collation and synthesis of published research on the aquatic invertebrate fauna inhabiting temporary lentic wetlands of the region. We expose the poor taxonomic knowledge of most groups, which makes it difficult to comment on patterns of richness and endemism. Only a few groups (e.g. large branchiopods, ostracods, copepods and cladocerans) appear to reach higher richness and/or endemicity in temporary wetlands compared to their permanent wetland counterparts. IUCN Red List information is lacking for most taxa, thus making it difficult to comment on the conservation status of much of the invertebrate fauna. However, except for a few specialist groups, many of the taxa inhabiting these environments appear to be habitat generalists that opportunistically exploit these waterbodies and this is hypothesised as one of the reasons why endemism appears to be low for most taxa. Given that taxonomy underpins ecology, the urgent need for more foundational taxonomic work on these systems becomes glaringly apparent

A method of active case detection to target reservoirs of asymptomatic malaria and gametocyte carriers in a rural area in Southern Province, Zambia

<p>Abstract</p> <p>Background</p> <p>Asymptomatic reservoirs of malaria parasites are common yet are difficult to detect, posing a problem for malaria control. If control programmes focus on mosquito control and treatment of symptomatic individuals only, malaria can quickly resurge if interventions are scaled back. Foci of parasite populations must be identified and treated. Therefore, an active case detection system that facilitates detection of asymptomatic parasitaemia and gametocyte carriers was developed and tested in the Macha region in southern Zambia.</p> <p>Methods</p> <p>Each week, nurses at participating rural health centres (RHC) communicated the number of rapid diagnostic test (RDT) positive malaria cases to a central research team. During the dry season when malaria transmission was lowest, the research team followed up each positive case reported by the RHC by a visit to the homestead. The coordinates of the location were obtained by GPS and all consenting residents completed a questionnaire and were screened for malaria using thick blood film, RDT, nested-PCR, and RT-PCR for asexual and sexual stage parasites. Persons who tested positive by RDT were treated with artemether/lumefantrine (Coartem^®). Data were compared with a community-based study of randomly selected households to assess the prevalence of asymptomatic parasitaemia in the same localities in September 2009.</p> <p>Results</p> <p>In total, 186 and 141 participants residing in 23 case and 24 control homesteads, respectively, were screened. In the case homesteads for which a control population was available (10 of the 23), household members of clinically diagnosed cases had a 8.0% prevalence of malaria using PCR compared to 0.7% PCR positive individuals in the control group (p = 0.006). The case and control groups had a gametocyte prevalence of 2.3% and 0%, respectively but the difference was not significant (p = 0.145).</p> <p>Conclusions</p> <p>This pilot project showed that active case detection is feasible and can identify reservoirs of asymptomatic infection. A larger sample size, data over multiple low transmission seasons, and in areas with different transmission dynamics are needed to further validate this approach.</p