Response of planktonic bacteria of New Calabar River to zinc stress

Toxicity of Zn2+ on four planktonic bacteria isolated from New Calabar River water was assessed via dehydrogenase assay. Pure cultures of the bacterial strains were exposed to various Zn2+  concentrations (0.2 - 2.0 mM) in a nutrient broth amended with glucose and TTC. The responses of the bacterial strains to Zn2+ is concentration-dependent. At 0.2 mM, Zn2+ stimulated dehydrogenase activity in Proteus sp. PLK2 and Micrococcus sp. PLK4. In all strains, dehydrogenase activity was progressively inhibited at concentrations greater than 0.2 mM. The IC50 ranges from 0.236 ± 0.044 to 0.864 ± 0.138 mM. Total inhibition occurred at concentrations ranging from 1.283 ± 0.068 to 2.469 ± 0.045 mM. The order of zinc tolerance is: Micrococcus sp. PLK4 > Proteus sp. PLK2 > Pseudomonas sp. PLK5 > Escherichia sp. PLK1. The result of the in vitro study indicated that the bacterial strains are sensitive to Zn2+ stress. Therefore, Zn2+ contamination would pose serious threat to their metabolism in natural environments.Key words: New Calabar River, zinc toxicity, planktonic bacteria, dehydrogenase

Spontaneous Perforation of the Bile Duct in Infants

Spontaneous perforation of the bile duct is a rare disease in children. To date, less than a hundred cases have been reported in English literature. A number of techniques have been applied to achieve preoperative diagnosis yet most cases are diagnosed at operation. A 3-month-old girl presented with fever, vomiting, progressive abdominal distension, jaundice and diarrhoea. Abdominal ultrasonography showed localized collection of fluid that displaced the small bowel to the right side of the abdomen. The fluid was found to be bilious on paracentesis. At laparotomy, biliary pseudocyst was found but the site of perforation was no longer identifiable. Excision of the containing wall and external drainage was carried out. 9 months after operation the child is well. A high index of suspicion should improve diagnosis and ensure early intervention.La perforation spontan\ue9e des canaux biliaires est une affection rare chez les enfants. A ce jour, moins de 100 cas ont \ue9t\ue9 rapport\ue9s dans la litt\ue9rature anglophone. Un certain nombre de techniques ont \ue9t\ue9 mises en oeuvre pour le diagnostic pr\ue9 op\ue9ratoire, n\ue9anmoins la plupart des cas sont de diagnostic per op\ue9ratoire. Une fille de 3 mois avait pr\ue9sent\ue9 de la fi\ue8vre, vomissements, distension progressive de l'abdomen, ict\ue8re et diarrh\ue9e. L'\ue9chographie de l'abdomen avait montr\ue9 une collection liquidienne localis\ue9e refoulant les anses gr\ueales vers le c\uf4t\ue9 droit de l'abdomen. La paracent\ue8se avait retrouv\ue9 un liquide bilieux. La laparotomie avait not\ue9 un pseudo kyste biliaire, mais le si\ue8ge de la perforation n'\ue9tait plus visible. La paroi du contenant a \ue9t\ue9 excis\ue9e et un drainage externe a \ue9t\ue9 r\ue9alis\ue9. Neuf mois apr\ue8s l'op\ue9ration, les suites \ue9taient simples. Une forte suspicion devrait mener au diagnostic et imposer une intervention pr\ue9coce

A qualitative study to identify community structures for management of severe malaria: a basis for introducing rectal artesunate in the under five years children in Nakonde District of Zambia

BACKGROUND: Malaria is a serious illness among children aged 5 years and below in Zambia, which carries with it many adverse effects including anemia and high parasites exposure that lead to infant and childhood mortality. Due to poor accessibility to modern health facilities, malaria is normally managed at home using indigenous and cosmopolitan medicines. In view of problems and implications associated with management of severe malaria at home, rectal artesunate is being proposed as a first aid drug to slow down multiplication of parasites in children before accessing appropriate treatment. METHODS: A qualitative study using standardised in-depth and Focuss Group Discussions (FGDs) guides to collect information from four (4) villages in Nakonde district, was conducted between February and March 2004. The guides were administered on 29 key informants living in the community and those whose children were admitted in the health facility. Participants in the 12 FGDs came from the 4 participating villages. Participants and key informants were fathers, younger and older mothers including grandmothers and other influential people at household level. Others were traditional healers, headmen, village secretaries, tradtional birth attendants, church leaders and black smiths. FGDs and interview transcriptions were coded to identify common themes that were related to recognition, classification and naming of malaria illness, care-seeking behaviour and community treatment practices for severe malaria. RESULTS: Parental prior knowledge of the disease was important as the majority of informants (23 out of 29) and participants (69 out of 97) mentioned four combined symptoms that were used to recognise severe malaria. The symptoms were excessive body hotness, convulsions, vomiting yellow things and bulging of the fontanelle. On the other hand, all informants mentioned two or more of symptoms associated with severe malaria. In all 12 FGDs, participants reported that treatment of severe malaria commenced with the family and moved into the community as the illness progressed. Although treatment of severe diarrheal effects, were common among the winamwanga, no rectal medicines to treat severe malaria were identified. Apart from the anti-malarial fansidar, which was mentioned by 23 in IDIs and 40 in FGDs, participants and informants also frequently mentioned indigenous medicines provided by healers and other respectable herbalists for repelling evil spirits, once a child had severe malaria. Mothers were the important arms for administration of ant-malarial drugs in the villages. Referrals began with healers to CHWs, where no CHWs existed healers directly referred sick children to the health facility. CONCLUSION: Our findings showed that there is a precedent for rectal application of traditional medicine for childhood illness. Therefore rectal artesunate may be a well-received intervention in Nakonde District, provided effective sensitisation, to mothers and CHWs is given which will strengthen the health care delivery system at community level

Filling a gap: HIV pediatric surveillance in resource contrained settings

ABSTRACT: Objectives and Background: While HIV surveillance systems have seen marked improvements in recent years, advances in pediatric surveillance have been limited. HIV prevalence data among children and youth are scarce, hindering prevention, care and treatment programs for these populations. Methods: This paper provides a review of approaches to pediatric HIV surveillance as discussed in March 2009 at the 2nd Global HIV/AIDS Surveillance Meeting in Bangkok, Thailand. Discussion: Pediatric HIV surveillance systems that incorporate data collection on risk factors and HIV prevalence should be established at the country level. A well-functioning case reporting system is ideal; however, this may not be possible in resource-constrained settings. Additional approaches to pediatric HIV surveillance include case-based reporting linked to prevention of mother to child transmission (PMTCT) or early infant diagnosis (EID) programs, population-based household surveys to provide prevalence and behavioral data, testing conducted at immunization clinic visits, and mortality surveillance through methods such as verbal autopsies. In addition, special surveys such as pediatric inpatient surveys, school-based surveys and out-of-school youth surveys may be incorporated to target specific groups for surveillance. Other data sources that may be considered include treatment, tuberculosis (TB), voluntary counseling and testing (VCT), and sexually transmitted infection (STI) registries. Conclusions: Pediatric HIV surveillance is necessary for understanding pediatric needs, improving adherence to international guidelines on HIV diagnoses and treatment of children, and monitoring the impact of intervention programs. As with any surveillance methodology, each approach to pediatric surveillance should be considered in light of available capacity and resources for implementation, sustainability, and limitations.

Comparison of iron status 28 d after provision of antimalarial treatment with iron therapy compared with antimalarial treatment alone in Ugandan children with severe malaria

Background: The provision of iron with antimalarial treatment is the standard of care for concurrent iron deficiency and malaria. However, iron that is given during a malaria episode may not be well absorbed or used, particularly in children with severe malaria and profound inflammation. Objectives: We aimed to 1) determine baseline values of iron and inflammatory markers in children with severe malarial anemia (SMA), children with cerebral malaria (CM), and community children (CC) and 2) compare markers in iron-deficient children in each group who received 28 d of iron supplementation during antimalarial treatment with those in children who did not receive iron during treatment.. Design: Seventy-nine children with CM, 77 children with SMA, and 83 CC who presented to Mulago Hospital, Kampala, Uganda, were enrolled in a 28-d iron-therapy study. Children with malaria received antimalarial treatment. All children with CM or SMA, as well as 35 CC, had zinc protoporphyrin (ZPP) concentrations ≥80 μmol/mol heme and were randomly assigned to receive a 28-d course of iron or no iron. We compared iron markers at day 0 among study groups (CM, SMA, and CC groups) and at day 28 between children in each group who were randomly assigned to receive iron or to not receive iron. Results: At day 0, children with CM and SMA had greater values of C-reactive protein, ferritin, and hepcidin than those of CC. At day 28, interactions between study and treatment group were NS. Children in the no-iron compared with iron groups had similar mean values for hemoglobin (115 compared with 113 g/L, respectively; P = 0.73) and ZPP (124 compared with 124 μmol/mol heme, respectively; P = 0.96) but had lower median ferritin [101.0 μg/L (95% CI: 84.2, 121.0 μg/L) compared with 152.9 μg/L (128.8, 181.6 μg/L), respectively; P ≤ 0.001] and hepcidin [45.8 ng/mL (36.8, 56.9 ng/mL) compared with 83.1 ng/mL (67.6, 102.2 ng/mL), respectively; P < 0.011]. Conclusions: Severe inflammation is a characterization of children with CM and SMA. The withholding of iron from children with severe malaria is associated with lower ferritin and hepcidin at day 28 but not a lower hemoglobin concentration. This trial was registered at clinicaltrials.gov as NCT01093989

Integrating Mental Health Screening into Routine Community Maternal and Child Health Activity: Experience from Prevention of Mother-to-child HIV transmission (PMTCT) trial in Nigeria.

Although the prevalence of mental health disorders in Nigeria is comparable to most developed countries, access to mental health care in Nigeria is limited. Improving access to care requires innovative approaches that deliver mental health interventions at the community level. The aim of this study was to determine the feasibility and acceptability of integrating mental health screening into an existing community-based program for prevention of mother-to-child transmission of HIV targeted at pregnant women and their male partners

Age-related differences in cell-specific cytokine production by acutely ill Malawian patients*

Age-related changes in human cell-specific cytokine responses to acute illness have not been well examined. We therefore evaluated age-related differences in T, B and natural killer (NK) peripheral blood lymphocyte cytokine responses of 309 acutely ill hospitalized people in Malawi, Africa, <1 month–61 years of age. We used four-colour flow cytometry and performed Wilcoxon rank sum and Kruskal–Wallis tests, Pearson (rp) and Spearman (rs) correlations, and linear and logistic regression analyses to control for human immunodeficiency virus infection (HIV) status, the percentages of lymphocytes expressing CD4, and the nature of the acute infection. The percentages of CD8− and CD8* T cells producing induced IL-8 decreased with age (rs = −0·44 and −0·53). The percentages of T cells producing TNF-α were higher, and the percentages producing IL-10 were lower, in those ≥13 than those <13 years old (medians: 17·7 versus 10·5 and 1·4 versus 3·0, respectively). The percentages of CD8− T cells producing IFN-γ were higher and stable in those ≥1 year old compared to infants (medians: 23·5 versus 10·4); the percentages of NK producing IFN-γ were higher post-infancy and then declined to relatively low levels with increasing age. The percentages of T cells producing IL-2 were highest in those 5–<31 years old (median 5·6) and lowest in those ≥31 years old (median 1·9). The ratios of the percentages of T cells producing IL-4 to those producing IL-8 and to those producing IL-10 both increased with age. These data suggest that innate immunity, represented by NK IFN-γ production, dominates in early life. A number of shifts occur after infancy and before adolescence, including a proinflammatory shift from IL-8 to TNF-γ and a type 2 shift from IL-10 to IL-4 dominance. These findings suggest distinct age-related differences in the human response to acute illness and may be useful in directing future efforts at immunomodulatory therapies