Antibiotic stewardship and its impact on antibiotic use at the child health directorate of a teaching hospital in Ghana

Purpose: The study was intended to ascertain the existence of an antibiotic stewardship programme at the Child Health Directorate of Komfo Anokye Teaching Hospital (KATH) and assess the knowledge of health professionals about the importance of the antimicrobial stewardship programme. Again, it sort to assess the experience of participants with pharmacotherapy of infections and patient outcomes with generic and innovative brands of antibiotics. The third was to assess reporting on adverse reactions and storage conditions of the antibiotics.Design/Methodology/ Approach: This was a cross-sectional study involving health professionals who participated in the provision of infectious disease management services. Eighty-eight (88) professionals were involved in the study, comprising nurses (n=51), medical doctors (n=21), pharmacists (n=8), biomedical scientists (n=5) and public health officers (n=3).Findings: The majority (75 %, n=66) reported treatment failure with generic brands of antibiotics compared to innovator brands. Thirty-four percent of the participants reported adverse drug reactions (ADRs) on antibiotic therapy to superiors instead of filling out ADR forms.Research Limitations: The study was done in one Directorate in the hospital and thus cannot be generalized to reflect the situation in all teaching hospitals in Ghana.Practical implication: The evidence obtained highlighted the need for pragmatic antimicrobial stewardship (AMS) at the directorate to help optimize the management of childhood infections and minimize the emergence and spread of antibiotic resistance.Originality/Value. This was an original project designed to generate evidence to inform interventions to promote the responsible use of antimicrobials in children

COMBINING ABILITY AND GENETIC ANALYSIS OF FRUIT AND LEAF YIELD IN GBOMA EGGPLANT

Gboma eggplant ( Solanum macrocapon L.) of the family Solanaceae is an important fruit and leafy indigenous vegetable in Africa. Despite the numerous nutritional, medicinal and economic benefits derived from the crop, little is known about the genetic parameters governing the inheritance and combining ability of the yield components. Thus, a study was conducted to investigate genetic information on the relevant yield components of the crop. Results showed significant mean squares for General Combining Ability, Specific Combining Ability effects for number of leaves per plant, fruit width and plant height, indicating the combining effect of additive, non-additive and maternal effects for expression for those traits. Conversely, significant (P< 0.05) SCA effects for number of branches per plant, leaf length, leaf width and fresh leaf weight indicated the preponderance of non-additive gene effect. GCA/SCA ratios for the various traits indicated that the relative contribution of additive to non-additive effects varied widely from trait to trait. Significant reciprocal effects for most of the traits were an indication that cytoplasmic or maternal gene effects played a major role in modifying the inheritance of the yield parameters, and that the choice of the maternal parent is relevant in breeding for these traits. Estimated GCA effect among the parents revealed that CAGRIC 03 has a breeding value for number of branches, plant height, fruit length, leaf length and fresh leaf weight, which makes it a valuable material for development of improved varieties. CAGRIC 01 was the promising combiner to increase fruit weight and number of leaves per plant. Hybrid P1xP2 was the best specific combiner to increase fruit width, leaf width and fruit width. High heritability estimates for most of the traits indicate that genetic variation was higher than the environmental variation in the study.Aubergine gboma ( Solanum macrocapon L.) de la famille des solanac\ue9esest un fruit important et l\ue9gumes indig\ue8nes feuillues en Afrique. Malgr\ue9 de nombreux avantages nutritionnels, m\ue9dicinaux et \ue9conomiques d\ue9coulant de la culture, peu est connu sur les param\ue8tres g\ue9n\ue9tiques r\ue9gissant l\u2019h\ue9ritage et la capacit\ue9 de combinaison des composants de rendement. Ainsi, une \ue9tude \ue9tait initi\ue9e pour g\ue9n\ue9rer del\u2019information g\ue9n\ue9tique sur d\u2019importants composants de rendementde la culture. Les r\ue9sultats ont montr\ue9 des carr\ue9s moyens significatifs pour \ue0 l\u2019aptitude generale de combinaison, les effets de la capacit\ue9 sp\ue9cifique de combinaison pour le nombre de feuilles par plante, la largeur des fruits et la hauteur de plant, ce qui t\ue9moign edes effets additifs et non additif et maternels combin\ue9s pour l\u2019expression de ces traits. Inversement, les effets significatifs (P <0,05) de CCSsur le nombre de branches par plant, la longueuret la largeur des feuilles ainsi que le poids de feuilles fra\ueeches indiquent la pr\ue9pond\ue9rance de l\u2019effet du g\ue8ne non-additif. Les rapports GCA/SCA pour les diff\ue9rents traits indiquent que la contribution relative de l\u2019additif aux effets non additifs variait largement d\u2019un trait \ue0 l\u2019autre. Des effets r\ue9ciproques significatifs pour la plupart des traits indiqueque les effets g\ue9n\ue9tiques cytoplasmique sou maternels ont jou\ue9 un r\uf4le majeur dans la modification de l\u2019h\ue9ritage des param\ue8tres de rendement et que le choix du parent maternel est pertinent dans l\u2019am\ue9lioration de ces traits. L\u2019effetestim\ue9 deGCA chez les parents a r\ue9v\ue9l\ue9 que CAGRIC 03 est d\u2019 une valeur ameliorative pour le nombre de branches, la hauteur de la plante, la longueur des fruits, la longueur des feuilles et le poids des feuilles fra\ueeches, ce qui en fait un mat\ue9riel pr\ue9cieux pour le d\ue9veloppement de vari\ue9t\ue9s am\ue9lior\ue9es. CAGRIC 01 \ue9tait le combinateur prometteur pour augmenter le poids de fruits et le nombre de feuilles par plant. L\u2019hybride P1xP2 \ue9tait le meilleur combineur sp\ue9cifique pour augmenter la largeur du fruit, la largeur des feuilles et la largeur du fruit. Des valeurs \ue9lev\ue9es d\u2019h\ue9ritabilit\ue9 pour la plupart des traits indiquent que la variation g\ue9n\ue9tique \ue9tait plus \ue9lev\ue9e que la variation environnementale dans l\u2019\ue9tude

Global, regional, and national incidence, prevalence, and mortality of HIV, 1980-2017, and forecasts to 2030, for 195 countries and territories: A systematic analysis for the Global Burden of Diseases, Injuries, and Risk Factors Study 2017

Background Understanding the patterns of HIV/AIDS epidemics is crucial to tracking and monitoring the progress of prevention and control efforts in countries. We provide a comprehensive assessment of the levels and trends of HIV/AIDS incidence, prevalence, mortality, and coverage of antiretroviral therapy (ART) for 1980-2017 and forecast these estimates to 2030 for 195 countries and territories. Methods We determined a modelling strategy for each country on the basis of the availability and quality of data. For countries and territories with data from population-based seroprevalence surveys or antenatal care clinics, we estimated prevalence and incidence using an open-source version of the Estimation and Projection Package - a natural history model originally developed by the UNAIDS Reference Group on Estimates, Modelling, and Projections. For countries with cause-specific vital registration data, we corrected data for garbage coding (ie, deaths coded to an intermediate, immediate, or poorly defined cause) and HIV misclassification. We developed a process of cohort incidence bias adjustment to use information on survival and deaths recorded in vital registration to back-calculate HIV incidence. For countries without any representative data on HIV, we produced incidence estimates by pulling information from observed bias in the geographical region. We used a re-coded version of the Spectrum model (a cohort component model that uses rates of disease progression and HIV mortality on and off ART) to produce agesex- specific incidence, prevalence, and mortality, and treatment coverage results for all countries, and forecast these measures to 2030 using Spectrum with inputs that were extended on the basis of past trends in treatment scale-up and new infections. Findings Global HIV mortality peaked in 2006 with 1·95 million deaths (95% uncertainty interval 1·87-2·04) and has since decreased to 0·95 million deaths (0·91-1·01) in 2017. New cases of HIV globally peaked in 1999 (3·16 million, 2·79-3·67) and since then have gradually decreased to 1·94 million (1·63-2·29) in 2017. These trends, along with ART scale-up, have globally resulted in increased prevalence, with 36·8 million (34·8-39·2) people living with HIV in 2017. Prevalence of HIV was highest in southern sub-Saharan Africa in 2017, and countries in the region had ART coverage ranging from 65·7% in Lesotho to 85·7% in eSwatini. Our forecasts showed that 54 countries will meet the UNAIDS target of 81% ART coverage by 2020 and 12 countries are on track to meet 90% ART coverage by 2030. Forecasted results estimate that few countries will meet the UNAIDS 2020 and 2030 mortality and incidence targets. Interpretation Despite progress in reducing HIV-related mortality over the past decade, slow decreases in incidence, combined with the current context of stagnated funding for related interventions, mean that many countries are not on track to reach the 2020 and 2030 global targets for reduction in incidence and mortality. With a growing population of people living with HIV, it will continue to be a major threat to public health for years to come. The pace of progress needs to be hastened by continuing to expand access to ART and increasing investments in proven HIV prevention initiatives that can be scaled up to have population-level impact. © 2019 The Author(s)

Colorectal Endoscopic Stenting Trial (CReST) for obstructing left-sided colorectal cancer: randomized clinical trial

Background Colorectal cancer often presents with obstruction needing urgent, potentially life-saving decompression. The comparative efficacy and safety of endoluminal stenting versus emergency surgery as initial treatment for such patients is uncertain. Methods Patients with left-sided colonic obstruction and radiological features of carcinoma were randomized to endoluminal stenting using a combined endoscopic/fluoroscopic technique followed by elective surgery 1–4 weeks later, or surgical decompression with or without tumour resection. Treatment allocation was via a central randomization service using a minimization procedure stratified by curative intent, primary tumour site, and severity score (Acute Physiology And Chronic Health Evaluation). Co-primary outcome measures were duration of hospital stay and 30-day mortality. Secondary outcomes were stoma formation, stenting completion and complication rates, perioperative morbidity, 6-month survival, 3-year recurrence, resource use, adherence to chemotherapy, and quality of life. Analyses were undertaken by intention to treat. Results Between 23 April 2009 and 22 December 2014, 245 patients from 39 hospitals were randomized. Stenting was attempted in 119 of 123 allocated patients (96.7 per cent), achieving relief of obstruction in 98 of 119 (82.4 per cent). For the 89 per cent treated with curative intent, there were no significant differences in 30-day postoperative mortality (3.6 per cent (4 of 110) versus 5.6 per cent (6 of 107); P = 0.48), or duration of hospital stay (median 19 (i.q.r. 11–34) versus 18 (10–28) days; P = 0.94) between stenting followed by delayed elective surgery and emergency surgery. Among patients undergoing potentially curative treatment, stoma formation occurred less frequently in those allocated to stenting than those allocated to immediate surgery (47 of 99 (47.5 per cent) versus 72 of 106 (67.9 per cent); P = 0.003). There were no significant differences in perioperative morbidity, critical care use, quality of life, 3-year recurrence or mortality between treatment groups. Conclusion Stenting as a bridge to surgery reduces stoma formation without detrimental effects. Registration number: ISRCTN13846816 (http://www.controlled-trials.com)