Fournier’s gangrene in the HIV era

Background: Fournier’s gangrene is a devastating condition that affects mostly patients whose immunity has been reduced. There is increasing evidence for increasing incidence of the disease in those with HIV disease.Objective: To evaluate the presentation, bacteriology and outcome of Fournier’s gangrene in our area in recent times in view of the high prevalence in Nairobi and its environs.Results: One hundred and forty six patients were treated for Fournier’s gangrene during the study period; all were male. They had a mean age of 38.6 years (range 2 months – 86 years). HIV infection was the most common associated underlying illness (16.4 %), followed by diabetes mellitus and alcoholism (11%).Conclusions: HIV infection is emerging as leading predisposing factor and has overtaken diabetes in predisposing for Fournier’s gangrene in Kenyatta National Hospital.Keywords: Fournier’s gangrene, HIV

Socio-Economic and Health Consequences of Drugs and Substance Use in Gachie: : A Peri-Urban Town on the Outskirts of Nairobi

Drug and substance abuse is a major socioeconomic and health problem to the drug users, family and society and is reported to be on a steady global rise. In Kenya, drug abuse is a major societal problem especially in many cosmopolitan cities such as Nairobi and Mombasa and the surrounding immediate environs. The objective of this study was to evaluate the types of drugs, the socio-economic and health consequences of drug abuse among the inhabitants of Gachie Sub-Location, Kiambu County a town within the Nairobi suburbs. A snowballing sampling method was used to recruit a total of 246 study participants aged between 15-65years recruited into the study after consenting and meeting drug and substance use and dependence clinical evaluation according to UNCOPE criteria. Data on the type of drugs abused, socio-economic and health implications of drug use on both drug abusers and the community was captured using a structured questionnaire and the resulting data analysed using SPSS version 21. Over-the counter prescription drugs including, benzodiazepine, Cozepam (“ma-cc”), rohypnol (“ma-blue”), and benzhexol (“ma-white”) as well as the traditional heroine were the major abused drugs reported in the study. Approximately 85% of the sampled drug abusers were men abusing mainly the licit over- the counter prescription drugs and heroine as a result of their easy affordability and accessibility. Failed marriages, conflictual family and communal relationships, unemployment, life of destitution and poverty were the main socioeconomic consequences of drug abuse reported in the study, corroborating reports of some previous studies. Participants’s self-reported feeling of hyperactiveness and euphoria was the major health consequence repoted. This study thus indicates that drug use is slowly creeping into rural areas in the vicinity of major towns with prescription over the counter drugs taking a centre stage than the traditional hard drugs due to the associated low costs, availability and accessibility and can result in myriad socioeconomic consequences in the society. This data provides an insight of the spread of drugs from the traditional cities to the surrounding town environments as these areas provide a safe haven for drug peddlers and thus should be of great focus by drug law enforcers as they strategize and seek to curb drug abuse problem. Future similar studies involving larger area are recommended to acquire more dynamics of this proble

Investing in professionalized maintenance to increase social and economic returns from drinking water infrastructure in rural Kenya

Repairing rural water infrastructure quickly through professionalized maintenance can reduce costs and increase social and economic returns, with benefits for low income households and women. We estimate that over a ten-year period rural water users can spend as much on alternative water sources when waterpoints fail as is spent on the capital costs for handpumps or large piped schemes

Sex disparities in enrolment and reporting of outcomes by sex in contemporary clinical trials of atrial fibrillation

Background:Underrepresentation of females in randomized controlled trials (RCTs)limits generalizability and quality of the evidence guiding treatment of females. This study aimed to measure the sex disparities in participants' recruitment in RCTs of atrial fibrillation (AF) and determine associated factors, and to describe the frequency of outcomes reported by sex. Methods:MEDLINE was searched to identify RCTs of AF published between January 1, 2011, and November 20, 2021, in 12 top‐tier journals. We measured the enrollment of females using the enrollment disparity difference (EDD) which is the difference between the proportion of females in the trial and the proportion of females with AF in the underlying general population (obtained from the Global Burden of Disease). Random‐effects meta‐analyses of the EDD were performed, and multivariable meta‐regression was used to explore factors associated with disparity estimates. We also determined the proportion of trials that included sex‐stratified results. Results:Out of 1133 records screened, 142 trials were included, reporting on a total of 133 532 participants. The random‐effects summary EDD was−0.125 (95%confidence interval [CI] =−0.143 to−0.108), indicating that females were under‐enrolled by 12.5 percentage points. Female enrollment was higher in trials with higher sample size (750, adjusted odds ratio [aOR] 1.065, 95% CI:1.008–1.125), higher mean participants' age (aOR: 1.006, 95% CI: 1.002–1.009), and lower in trials conducted in North America compared to Europe (aOR: 0.945, 95% CI:0.898–0.995). Only 36 trials (25.4%) reported outcomes by sex, and of these 29(80.6%) performed statistical testing of the sex‐by‐treatment interaction. Conclusion:Females remain substantially less represented in RCTs of AF, and sex‐stratified reporting of primary outcomes is infrequent. These findings call for urgent action to improve sex equity in enrollment and sex‐stratified outcomes' reporting in RCTs of AF.Jean Jacques Noubiap, Gijo Thomas, Ulrich Flore Nyaga, John L. Fitzgerald, Celine Gallagher, Melissa E. Middeldorp, Prashanthan Sander

The validity of dementia diagnoses in routinely collected electronic health records in the United Kingdom: A systematic review.

PURPOSE: The purpose of the study is to assess the validity of codes or algorithms used to identify dementia in UK electronic health record (EHR) primary care and hospitalisation databases. METHODS: Relevant studies were identified by searching the MEDLINE/EMBASE databases from inception to June 2018, hand-searching reference lists, and consulting experts. The search strategy included synonyms for "Dementia", "Europe", and "EHR". Studies were included if they validated dementia diagnoses in UK primary care or hospitalisation databases, irrespective of validation method used. The Quality Assessment for Diagnostic Accuracy Studies-2 (QUADAS-2) tool was used to assess risk of bias. RESULTS: From 1469 unique records, 14 relevant studies were included. Thirteen validated individual diagnoses against a reference standard, reporting high estimates of validity. Most reported only the positive predictive value (PPV), with estimates ranging between 0.09 and 1.0 and 0.62 and 0.85 in primary care and hospitalisation databases, respectively. One study performed a rate comparison, indicating good generalisability of dementia diagnoses in The Health Improvement Network (THIN) database to the UK population. Studies were of low methodological quality. As studies were not comparable, no summary validity estimates were produced. CONCLUSION: While heterogenous across studies, reported validity estimates were generally high. However, the credibility of these estimates is limited by the methodological quality of studies, primarily resulting from insufficient blinding of researchers interpreting the reference test. Inadequate reporting, particularly of the specific codes validated, hindered comparison of estimates across studies. Future validation studies should make use of more robust reference tests, follow established reporting guidelines, and calculate all measures of validity

Molecular Epidemiology of Rotavirus Strains in Symptomatic and Asymptomatic Children in Manhiça District, Southern Mozambique 2008–2019

..870-15 SC; the United States Agency for International Development (USAID), grant number AID-656-F-16-00002 and Fundo Nacional de Investiga??o (FNI), Mo?ambique, grant number 245-INV, within the context of diarrhoeal disease surveillance platform implementation. F.M PhD is supported by Calouste Gulbenkian Foundation, grant number 234066. The authors convey many thanks to all the caregivers who consented to their children?s participation in both studies (GEMS and the diarrhoeal disease platform). They would also like to thank all the professionals in the hospitals and those on field recruitment for their full dedication and effort in children enrolment and collection of data and samples whenever possible. Publisher Copyright: © 2022 by the authors. Licensee MDPI, Basel, Switzerland.Group A rotaviruses remain the leading cause of diarrhoea in children aged <5 years. Mozambique introduced rotavirus vaccine (Rotarix® ) in September 2015. We report rotavirus geno-types circulating among symptomatic and asymptomatic children in Manhiça District, Mozambique, pre-and post-vaccine introduction. Stool was collected from enrolled children and screened for ro-tavirus by enzyme-immuno-sorbent assay. Positive specimens were genotyped for VP7 (G genotypes) and VP4 (P genotypes) by the conventional reverse transcriptase polymerase chain reaction. The combination G12P[8] was more frequently observed in pre-vaccine than in post-vaccine introduction, in moderate to severe diarrhoea (34%, 61/177 vs. 0, p < 0.0001) and controls (23%, 26/113 vs. 0, p = 0.0013) and mixed genotypes (36%, 24/67 vs. 7% 4/58, p = 0.0003) in less severe diarrhoea. We observed changes in post-vaccine compared to pre-vaccine introduction, where G3P[4] and G3P[8] were prevalent in moderate to severe diarrhoea (10%, 5/49 vs. 0, p = 0.0002; and 14%, 7/49 vs. 1%, 1/177, p < 0.0001; respectively), and in less severe diarrhoea (21%, 12/58 vs. 0, p = 0.003; and 24%, 14/58 vs. 0, p < 0.0001; respectively). Our surveillance demonstrated the circulation of similar genotypes contemporaneously among cases and controls, as well as switching from pre-to post-vaccine introduction. Continuous surveillance is needed to evaluate the dynamics of the changes in genotypes following vaccine introduction.publishersversionpublishe

Reduced repair of 8-hydroxyguanine in the human breast cancer cell line, HCC1937

BACKGROUND: Breast cancer is the second leading cause of cancer deaths in women in the United States. Although the causes of this disease are incompletely understood, oxidative DNA damage is presumed to play a critical role in breast carcinogenesis. A common oxidatively induced DNA lesion is 8-hydroxyguanine (8-OH-Gua), which has been implicated in carcinogenesis. The aim of this study was to investigate the ability of HCC1937 and MCF-7 breast cancer cell lines to repair 8-OH-Gua relative to a nonmalignant human mammary epithelial cell line, AG11134. METHODS: We used oligonucleotide incision assay to analyze the ability of the two breast cancer cell lines to incise 8-OH-Gua relative to the control cell line. Liquid chromatography/mass spectrometry (LC/MS) was used to measure the levels of 8-OH-Gua as its nucleoside, 8-OH-dG in the cell lines after exposure to H(2)O(2 )followed by 30 min repair period. Protein expression levels were determined by Western blot analysis, while the hOGG1 mRNA levels were analyzed by RT-PCR. Complementation of hOGG1 activity in HCC1937 cells was assessed by addition of the purified protein in the incision assay, and in vivo by transfection of pFlagCMV-4-hOGG1. Clonogenic survival assay was used to determine sensitivity after H(2)O(2)-mediated oxidative stress. RESULTS: We show that the HCC1937 breast cancer cells have diminished ability to incise 8-OH-Gua and they accumulate higher levels of 8-OH-dG in the nuclear genome after H(2)O(2 )treatment despite a 30 min repair period when compared to the nonmalignant mammary cells. The defective incision of 8-OH-Gua was consistent with expression of undetectable amounts of hOGG1 in HCC1937 cells. The reduced incision activity was significantly stimulated by addition of purified hOGG1. Furthermore, transfection of pFlagCMV-4-hOGG1 in HCC1937 cells resulted in enhanced incision of 8-OH-Gua. HCC1937 cells are more sensitive to high levels of H(2)O(2 )and have up-regulated SOD1 and SOD2. CONCLUSION: This study provides evidence for inefficient repair of 8-OH-Gua in HCC1937 breast cancer cell line and directly implicates hOGG1 in this defect

Re-Infection Outcomes following One- and Two-Stage Surgical Revision of Infected Hip Prosthesis:A Systematic Review and Meta-Analysis

The two-stage revision strategy has been claimed as being the "gold standard" for treating prosthetic joint infection. The one-stage revision strategy remains an attractive alternative option; however, its effectiveness in comparison to the two-stage strategy remains uncertain.To compare the effectiveness of one- and two-stage revision strategies in treating prosthetic hip infection, using re-infection as an outcome.Systematic review and meta-analysis.MEDLINE, EMBASE, Web of Science, Cochrane Library, manual search of bibliographies to March 2015, and email contact with investigators.Cohort studies (prospective or retrospective) conducted in generally unselected patients with prosthetic hip infection treated exclusively by one- or two-stage revision and with re-infection outcomes reported within two years of revision. No clinical trials were identified.Data were extracted by two independent investigators and a consensus was reached with involvement of a third. Rates of re-infection from 38 one-stage studies (2,536 participants) and 60 two-stage studies (3,288 participants) were aggregated using random-effect models after arcsine transformation, and were grouped by study and population level characteristics.In one-stage studies, the rate (95% confidence intervals) of re-infection was 8.2% (6.0-10.8). The corresponding re-infection rate after two-stage revision was 7.9% (6.2-9.7). Re-infection rates remained generally similar when grouped by several study and population level characteristics. There was no strong evidence of publication bias among contributing studies.Evidence from aggregate published data suggest similar re-infection rates after one- or two-stage revision among unselected patients. More detailed analyses under a broader range of circumstances and exploration of other sources of heterogeneity will require collaborative pooling of individual participant data.PROSPERO 2015: CRD42015016559