Impact of anticoagulation and antiplatelet therapy on dialysis catheter fibrin sheath formation

PURPOSEFibrin sheaths are a significant cause of dialysis catheter dysfunction. This study aimed to determine the role of anticoagulation, antiplatelet medications, and other factors in delaying fibrin sheath formation.METHODSAn institutional review board-approved retrospective review of all patients treated for tunneled dialysis catheter fibrin sheaths from January 2014 to January 2020 was undertaken. All catheters were symmetric tipped, 14.5 F in diameter, and placed via the internal jugular vein. Seventy patients with venographically confirmed fibrin sheaths that developed after de novo catheter placement were identified. Recurrent fibrin sheaths were excluded. The impact of anticoagulation and antiplatelet therapy, as well as statin therapy, catheter side (right or left), hematocrit, platelet count, prothrombin time (PT), and international normalized ratio (INR), on the time to fibrin sheath formation was determined.RESULTSPatients on anticoagulation had a longer median catheter implantation time of 109.2 days (interquartile range (IQR): 29.3-178.5 days) compared to 80.7 days (IQR: 28.0-168.6 days) among patients not on anticoagulation. Catheter dwell time among patients taking antiplatelet therapy was 86.0 days (IQR: 31.5-160.7 days) versus 74.4 days (IQR: 27.5-202.4 days) for patients not on antiplatelet medication. Patients taking statins versus those not taking statins had median catheter dwell times of 97.5 days (IQR: 27.5-138.5 days) and 62.4 days (IQR: 29.9-259.6 days), respectively. Time to fibrin sheath formation was not significantly associated with hematocrit (P =.16), platelet count (0.12), PT (P =.51), or INR (P =.74).CONCLUSIONAnticoagulation has no significant benefit in delaying sheath formation in patients with tunneled dialysis catheters. Hematologic and coagulation parameters at the time of catheter placement were also not associated with catheter dwell time

Examples of risk tools for pests in Peanut (Arachis hypogaea) developed for five countries using Microsoft Excel

Suppressing pest populations below economically-damaging levels is an important element of sustainable peanut (Arachis hypogaea L.) production. Peanut farmers and their advisors often approach pest management with similar goals regardless of where they are located. Anticipating pest outbreaks using field history and monitoring pest populations are fundamental to protecting yield and financial investment. Microsoft Excel was used to develop individual risk indices for pests, a composite assessment of risk, and costs of risk mitigation practices for peanut in Argentina, Ghana, India, Malawi, and North Carolina (NC) in the United States (US). Depending on pests and resources available to manage pests, risk tools vary considerably, especially in the context of other crops that are grown in sequence with peanut, cultivars, and chemical inputs. In Argentina, India, and the US where more tools (e.g., mechanization and pesticides) are available, risk indices for a wide array of economically important pests were developed with the assumption that reducing risk to those pests likely will impact peanut yield in a positive manner. In Ghana and Malawi where fewer management tools are available, risks to yield and aflatoxin contamination are presented without risk indices for individual pests. The Microsoft Excel platform can be updated as new and additional information on effectiveness of management practices becomes apparent. Tools can be developed using this platform that are appropriate for their geography, environment, cropping systems, and pest complexes and management inputs that are available. In this article we present examples for the risk tool for each country.Fil: Jordan, David L.. University of Georgia; Estados Unidos. North Carolina State University; Estados UnidosFil: Buol, Greg S.. North Carolina State University; Estados UnidosFil: Brandenburg, Rick L.. North Carolina State University; Estados UnidosFil: Reisig, Dominic. North Carolina State University; Estados UnidosFil: Nboyine, Jerry. Council for Scientific and Industrial Research Savanna Agricultural Research Institute; GhanaFil: Abudulai, Mumuni. Council for Scientific and Industrial Research Savanna Agricultural Research Institute; GhanaFil: Oteng Frimpong, Richard. Council for Scientific and Industrial Research Savanna Agricultural Research Institute; GhanaFil: Mochiah, Moses Brandford. Council for Scientific and Industrial Research Crops Research Institute; GhanaFil: Asibuo, James Y.. Council for Scientific and Industrial Research Crops Research Institute; GhanaFil: Arthur, Stephen. Council for Scientific and Industrial Research Crops Research Institute; GhanaFil: Akromah, Richard. Kwame Nkrumah University Of Science And Technology; GhanaFil: Mhango, Wezi. Lilongwe University Of Agriculture And Natural Resources; MalauiFil: Chintu, Justus. Chitedze Agricultural Research Service, Lilongwe; MalauiFil: Morichetti, Sergio. Aceitera General Deheza; ArgentinaFil: Paredes, Juan Andres. Instituto Nacional de Tecnología Agropecuaria. Centro de Investigaciones Agropecuarias. Instituto de Patología Vegetal; Argentina. Instituto Nacional de Tecnología Agropecuaria. Centro de Investigaciones Agropecuarias. Unidad de Fitopatología y Modelización Agrícola - Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Córdoba. Unidad de Fitopatología y Modelización Agrícola; ArgentinaFil: Monguillot, Joaquín Humberto. Instituto Nacional de Tecnología Agropecuaria. Centro de Investigaciones Agropecuarias. Instituto de Patología Vegetal; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; ArgentinaFil: Singh Jadon, Kuldeep. Central Arid Zone Research Institute, Jodhpur; IndiaFil: Shew, Barbara B.. North Carolina State University; Estados UnidosFil: Jasrotia, Poonam. Indian Institute Of Wheat And Barley Research, Karnal; IndiaFil: Thirumalaisamy, P. P.. India Council of Agricultural Research, National Bureau of Plant Genetic Resources; IndiaFil: Harish, G.. Directorate Of Groundnut Research, Junagadh; IndiaFil: Holajjer, Prasanna. National Bureau Of Plant Genetic Resources, New Delhi; IndiaFil: Maheshala, Nataraja. Directorate Of Groundnut Research, Junagadh; IndiaFil: MacDonald, Greg. University of Florida; Estados UnidosFil: Hoisington, David. University of Georgia; Estados UnidosFil: Rhoads, James. University of Georgia; Estados Unido

Perceived stressors of climate vulnerability across scales in the Savannah zone of Ghana: a participatory approach

Smallholder farmers in sub-Saharan Africa are confronted with climatic and non-climatic stressors. Research attention has focused on climatic stressors, such as rainfall variability, with few empirical studies exploring non-climatic stressors and how these interact with climatic stressors at multiple scales to affect food security and livelihoods. This focus on climatic factors restricts understanding of the combinations of stressors that exacerbate the vulnerability of farming households and hampers the development of holistic climate change adaptation policies. This study addresses this particular research gap by adopting a multi-scale approach to understand how climatic and non-climatic stressors vary, and interact, across three spatial scales (household, community and district levels) to influence livelihood vulnerability of smallholder farming households in the Savannah zone of northern Ghana. This study across three case study villages utilises a series of participatory tools including semi-structured interviews, key informant interviews and focus group discussions. The incidence, importance, severity and overall risk indices for stressors are calculated at the household, community, and district levels. Results show that climatic and non-climatic stressors were perceived differently; yet, there were a number of common stressors including lack of money, high cost of farm inputs, erratic rainfall, cattle destruction of crops, limited access to markets and lack of agricultural equipment that crossed all scales. Results indicate that the gender of respondents influenced the perception and severity assessment of stressors on rural livelihoods at the community level. Findings suggest a mismatch between local and district level priorities that have implications for policy and development of agricultural and related livelihoods in rural communities. Ghana’s climate change adaptation policies need to take a more holistic approach that integrates both climatic and non-climatic factors to ensure policy coherence between national climate adaptation plans and District development plans

Clearance of viable Mycobacterium ulcerans from Buruli ulcer lesions during antibiotic treatment as determined by combined 16S rRNA reverse transcriptase /IS 2404 qPCR assay.

INTRODUCTION: Buruli ulcer (BU) caused by Mycobacterium ulcerans is effectively treated with rifampicin and streptomycin for 8 weeks but some lesions take several months to heal. We have shown previously that some slowly healing lesions contain mycolactone suggesting continuing infection after antibiotic therapy. Now we have determined how rapidly combined M. ulcerans 16S rRNA reverse transcriptase / IS2404 qPCR assay (16S rRNA) became negative during antibiotic treatment and investigated its influence on healing. METHODS: Fine needle aspirates and swab samples were obtained for culture, acid fast bacilli (AFB) and detection of M. ulcerans 16S rRNA and IS2404 by qPCR (16S rRNA) from patients with IS2404 PCR confirmed BU at baseline, during antibiotic and after treatment. Patients were followed up at 2 weekly intervals to determine the rate of healing. The Kaplan-Meier survival analysis was used to analyse the time to clearance of M. ulcerans 16S rRNA and the influence of persistent M ulcerans 16S rRNA on time to healing. The Mann Whitney test was used to compare the bacillary load at baseline in patients with or without viable organisms at week 4, and to analyse rate of healing at week 4 in relation to detection of viable organisms. RESULTS: Out of 129 patients, 16S rRNA was detected in 65% of lesions at baseline. The M. ulcerans 16S rRNA remained positive in 78% of patients with unhealed lesions at 4 weeks, 52% at 8 weeks, 23% at 12 weeks and 10% at week 16. The median time to clearance of M. ulcerans 16S rRNA was 12 weeks. BU lesions with positive 16S rRNA after antibiotic treatment had significantly higher bacterial load at baseline, longer healing time and lower healing rate at week 4 compared with those in which 16S rRNA was not detected at baseline or had become undetectable by week 4. CONCLUSIONS: Current antibiotic therapy for BU is highly successful in most patients but it may be possible to abbreviate treatment to 4 weeks in patients with a low initial bacterial load. On the other hand persistent infection contributes to slow healing in patients with a high bacterial load at baseline, some of whom may need antibiotic treatment extended beyond 8 weeks. Bacterial load was estimated from a single sample taken at baseline. A better estimate could be made by taking multiple samples or biopsies but this was not ethically acceptable

Troop education and avian influenza surveillance in military barracks in Ghana, 2011

Abstract Background Influenza A viruses that cause highly pathogenic avian influenza (HPAI) also infect humans. In many developing countries such as Ghana, poultry and humans live in close proximity in both the general and military populations, increasing risk for the spread of HPAI from birds to humans. Respiratory infections such as influenza are especially prone to rapid spread among military populations living in close quarters such as barracks making this a key population for targeted avian influenza surveillance and public health education. Method Twelve military barracks situated in the coastal, tropical rain forest and northern savannah belts of the country were visited and the troops and their families educated on pandemic avian influenza. Attendants at each site was obtained from the attendance sheet provided for registration. The seminars focused on zoonotic diseases, influenza surveillance, pathogenesis of avian influenza, prevention of emerging infections and biosecurity. To help direct public health policies, a questionnaire was used to collect information on animal populations and handling practices from 102 households in the military barracks. Cloacal and tracheal samples were taken from 680 domestic and domesticated wild birds and analysed for influenza A using molecular methods for virus detection. Results Of the 1028 participants that took part in the seminars, 668 (65%) showed good knowledge of pandemic avian influenza and the risks associated with its infection. Even though no evidence of the presence of avian influenza (AI) infection was found in the 680 domestic and wild birds sampled, biosecurity in the households surveyed was very poor. Conclusion Active surveillance revealed that there was no AI circulation in the military barracks in April 2011. Though participants demonstrated good knowledge of pandemic avian influenza, biosecurity practices were minimal. Sustained educational programs are needed to further strengthen avian influenza surveillance and prevention in military barracks.</p