Acute management of ST-elevation myocardial infarction in a tertiary hospital in Kenya: are we complying with practice guidelines?

Introduction: Current practice guidelines emphasize the importance of rapid reperfusion of patients with ST-elevation myocardial infarction (STEMI). The aim of this study was to evaluate the current rate of compliance with evidence-based practice guidelines for the management of STEMI patients at a tertiary hospital in Kenya. Methods: This was a retrospective chart review. Data on patient characteristics, emergency treatment, and outcomes were collected on adults admitted with a diagnosis of STEMI from January 2012 to February 2013. Results: Data were collected for 45 patient presentations. There were 37 male patients (82%). The mean age was 59.7 ± 3.8 years. Of the 45 patients, 23 were Asian (51%), 18 were Black (40%) and four were Caucasian (9%). Thirty-five patients (78%) presented within 12 h of symptom onset. Within 10 min of arrival to the hospital, 40 patients (89%) had electrocardiographs performed and 39 patients (87%) were reviewed by a doctor. Medications given on presentation were aspirin (98%), clopidogrel (91%) and anticoagulants (73%). All patients received reperfusion therapy. Twenty-eight patients (62%) received fibrinolytic therapy and 17 patients (38%) had primary percutaneous coronary intervention. Door-to-needle time of43% of the cases. Door-to- balloon time was29% of the cases. All the patients survived to hospital discharge. The average length of stay was 5.3 ± 1.0 days. In-hospital complications occurred in six patients (13.3%). These included bleeding (three patients), stroke (one patient) and cardiogenic shock requiring intra- aortic balloon pump support (two patients). Conclusion: Whereas the majority of STEMI patients are evaluated within 10 min of presentation, less than 50% receive reperfusion therapy within the recommended time frame. While there are attempts to comply with evidence based guidelines in resource-limited settings, there is a need to improve acute care systems to target early reperfusion of STEMI patients

Concealment, communication and stigma: The perspectives of HIV-positive immigrant Black African men and their partners living in the United Kingdom

This study explored the perspectives of Black men, originally from East Africa, living in the United Kingdom and their families on what it means to live with diagnosed HIV. This article reports on concealment of HIV-positive status as a strategy adopted by the affected participants to manage the flow of information about their HIV-positive status. Analysis of the data, collected using in-depth interviews involving 23 participants, found widespread selective concealment of HIV-positive status. However, a few respondents had ‘come out’ publicly about their condition. HIV prevention initiatives should recognise concealment as a vital strategy in managing communication about one’s HIV-positive status

Kmt2c mutations enhance HSC self-renewal capacity and convey a selective advantage after chemotherapy

The myeloid tumor suppressor KMT2C is recurrently deleted in myelodysplastic syndrome (MDS) and acute myeloid leukemia (AML), particularly therapy-related MDS/AML (t-MDS/t-AML), as part of larger chromosome 7 deletions. Here, we show that KMT2C deletions convey a selective advantage to hematopoietic stem cells (HSCs) after chemotherapy treatment that may precipitate t-MDS/t-AML. Kmt2c deletions markedly enhance murine HSC self-renewal capacity without altering proliferation rates. Haploid Kmt2c deletions convey a selective advantage only when HSCs are driven into cycle by a strong proliferative stimulus, such as chemotherapy. Cycling Kmt2c-deficient HSCs fail to differentiate appropriately, particularly in response to interleukin-1. Kmt2c deletions mitigate histone methylation/acetylation changes that accrue as HSCs cycle after chemotherapy, and they impair enhancer recruitment during HSC differentiation. These findings help explain why Kmt2c deletions are more common in t-MDS/t-AML than in de novo AML or clonal hematopoiesis: they selectively protect cycling HSCs from differentiation without inducing HSC proliferation themselves

The efficiency of murine MLL-ENL–driven leukemia initiation changes with age and peaks during neonatal development

MLL rearrangements are translocation mutations that cause both acute lymphoblastic leukemia and acute myeloid leukemia (AML). These translocations can occur as sole clonal driver mutations in infant leukemias, suggesting that fetal or neonatal hematopoietic progenitors may be exquisitely sensitive to transformation by MLL fusion proteins. To test this possibility, we used transgenic mice to induce one translocation product, MLL-ENL, during fetal, neonatal, juvenile and adult stages of life. When MLL-ENL was induced in fetal or neonatal mice, almost all died of AML. In contrast, when MLL-ENL was induced in adult mice, most survived for >1 year despite sustained transgene expression. AML initiation was most efficient when MLL-ENL was induced in neonates, and even transient suppression of MLL-ENL in neonates could prevent AML in most mice. MLL-ENL target genes were induced more efficiently in neonatal progenitors than in adult progenitors, consistent with the distinct AML initiation efficiencies. Interestingly, transplantation stress mitigated the developmental barrier to leukemogenesis. Since fetal/neonatal progenitors were highly competent to initiate MLL-ENL-driven AML, we tested whether Lin28b, a fetal master regulator, could accelerate leukemogenesis. Surprisingly, Lin28b suppressed AML initiation rather than accelerating it. This may explain why MLL rearrangements often occur before birth in human infant leukemia patients, but transformation usually does not occur until after birth, when Lin28b levels decline. Our findings show that the efficiency of MLLENL- driven AML initiation changes through the course of pre- and postnatal development, and developmental programs can be manipulated to impede transformation

High-K dielectric sulfur-selenium alloys.

Upcoming advancements in flexible technology require mechanically compliant dielectric materials. Current dielectrics have either high dielectric constant, K (e.g., metal oxides) or good flexibility (e.g., polymers). Here, we achieve a golden mean of these properties and obtain a lightweight, viscoelastic, high-K dielectric material by combining two nonpolar, brittle constituents, namely, sulfur (S) and selenium (Se). This S-Se alloy retains polymer-like mechanical flexibility along with a dielectric strength (40 kV/mm) and a high dielectric constant (K = 74 at 1 MHz) similar to those of established metal oxides. Our theoretical model suggests that the principal reason is the strong dipole moment generated due to the unique structural orientation between S and Se atoms. The S-Se alloys can bridge the chasm between mechanically soft and high-K dielectric materials toward several flexible device applications

Adaptation planning: an integrated approach to understanding vulnerability in the Lake Victoria Basin

Decision makers need actionable information on the factors that inhibit household adaptation to climate variability and other changes, especially those changes reinforcing environmentally unsustainable livelihood strategies. In this paper, we show how a combination of quantitative and qualitative data can help assess current livelihood vulnerability and the social and institutional obstacles facing specific population groups that lock in risk and undermine opportunities. Detailed analysis of current household economies in two case study communities (one in Uganda and one in Kenya) in the Lake Victoria Basin, East Africa, was combined with a qualitative, intersectional exploration of constraints on income adaptation and diversification. Quantitative household economy analysis showed low levels of household disposable income overall and additionally, poor returns on investment from enterprises typically controlled by women. Qualitative research highlighted changes in gender roles driven by women’s entrepreneurial responses to reduced household income from traditional agricultural and natural resource-based activities. However, due to unequal access to finance and culturally mediated norms and expectations, many women’s enterprises were small scale and insecure. The broader political economy context is one of limited national investment in education and infrastructure, further constraining local opportunities for human and economic development. The approach described here was directed by the need to understand and quantify economic vulnerability, along with the cultural and institutional constraints on adaptation, as a basis for making better adaptation policies and interventions to build resilience over the longer term

Health, wellbeing and nutrition: Domain report

The escalation of global political, economic and ecological crises and associated price surges has contributed to interdependent forms of malnutrition – undernutrition, overweight and obesity – with enduring societal consequences. This study investigates the factors influencing the adoption of healthy diets in five African cities – Bukavu, DRC, Freetown, Sierra Leone, Kampala, Uganda, Lilongwe, Malawi and Nairobi, Kenya. It explores the engagement of policymakers, consumers, private actors and further stakeholders in food and health systems. Across all cities, rising food insecurity and the prevalence of non-communicable diseases (NCDs) linked to unhealthy dietary patterns, notably around consumption of ultra-processed foods, are observed. Despite urban residents generally experiencing lower food insecurity than rural counterparts, people with low incomes, particularly those living in informal settlements, remain vulnerable. Additional axes of vulnerability that intersect with low incomes are gender, age, disability and migrant/refugee status. Socioeconomic drivers that exacerbate food and nutrition insecurity include the high cost of nutritious diets, inadequate market, road, water and sanitation infrastructures, and the proliferation of unhealthy processed foods. Policy responses predominantly prioritise food quantity over quality, overlooking the importance of healthy diets. Additionally, profit-driven dynamics, within food and healthcare systems, and inconsistent resident knowledge of healthy, balanced diets, perpetuate the cycle of ill-health driven by poor nutrition, while informal food vendors, vital for low-income urbanites, face neglect or harassment. However, city governments possess avenues for intervention, such as awareness campaigns, social security mechanisms, and social and technical infrastructure support for water and sanitation, markets and street vendors. Primary healthcare services and community health workers play crucial roles in addressing malnutrition, youth development and adolescent health. Multisectoral collaboration is advocated for broadening the impact of strategic interventions from neighbourhood to city level. Reform efforts necessitate broad coalitions, encompassing governments, civil society and the private sector

Effects of larval competitors and predators on oviposition site selection of Anopheles gambiae sensu stricto.

We examined whether predators and competitors influence selection of oviposition sites by Anopheles gambiae Giles. Mosquitoes in cages laid significantly fewer eggs in rainwater conditioned with a predator (backswimmers, Notonecta sp.) than in unconditioned rainwater. Rainwater conditioned with a putative competitor (tadpoles, Xenopus sp.) also had fewer eggs than unconditioned rainwater. Similarly, mosquitoes laid significantly fewer eggs in rainwater conditioned with five and 50 An. gambiae larvae than in unconditioned rainwater. When larvae were present, significantly more eggs were laid in containers with five larvae than in containers with higher densities, but the differences in number of eggs laid were not significant among the densities of 40, 70, and 100 larvae. This study demonstrated that caged An. gambiae females avoid oviposition in habitats with supposed competitors and predators

Oviposition Site Preference and Egg Hatchability of Anopheles gambiae: Effects of Land Cover Types

We studied the oviposition site preference and egg hatchability of Anopheles gambiae Giles with water collected from farmlands, forests, and natural wetlands. Water types significantly affected oviposition preference. Mosquitoes deposited significantly more eggs in rainwater in both the dry and wet seasons than waters from forests and wetlands, suggesting that An. gambiae prefers water with few impurities for oviposition. In the dry season, An. gambiae females also deposited significantly more eggs in waters from farmlands than those from forests and natural wetlands, but these differences were not statistically significant during the wet season. In both indoor and natural conditions, egg mortality in natural wetland habitats was significantly higher than in farmland habitats. The average water temperature in natural wetland habitats was significantly lower than farmland habitats in the natural conditions, but it remained the same under indoor experimental conditions, suggesting that factors other than water temperature play an important role in egg hatchability. Together with the findings from previous studies on the effects of land cover on larval survivorship, our results support the hypothesis that variations in habitat conditions induced by different land cover types contribute to the heterogeneous spatial distribution of An. gambiae larvae in the western Kenya highland