Keratinolytic and Opportunistic Pathogenic Fungi from Carpet Dust in Mosques and Residentialhouses in Duhok, Kurdistan Region, Iraq

One hundred samples of carpet dusts (50 samples from residential houses and 50 samples from mosques) were collected from different sites in Duhok province during the year 2014 to 2015 for the objective of the study of the occurrence of keratinolytic and other potentially pathogenic fungi using hair baiting method. A total of 24 fungal species (17 species from house dust) and (12 species from mosque dust) in addition to non-sporulating mycelia and yeasts were isolated and identified. The keratinolytic species Arthroderma cuniculi, Chrysosporium tropicum and Gymnoascus ressii were detected. Potentially pathogenic fungi in the genera Aspergillus, Arthrographis,Geomyces, Microascus,Scopulariopsis and Neoscytalidium were also able to colonize and grow on baited hairs

Identification of Candida Spp. Isolated From Urine by Phenotypic Methods and Multiplex Pcr in Duhok, Iraq

The present study was aimed to isolate and identify Candida species from urine samples obtained from patients with urinary tract infection from Duhok province. Species identification was based on colony color on chromogenic Candida agar as well as multiplex PCR method. Results revealed the prevalence of non-albicans Candida. C.krusei was the most frequently isolated species with the prevalence of 26.3% followed by C.kefyr 23.68%, C.glabrata (18.42% and C.albicans 15.78%. Multiplex PCR method seemed to be more accurate and reliable for identification of Candida yeast

Antagonism of Trichoderma harzianum and Clonostachys rosea against fungi associated with grapevine decline in Kurdistan region - Iraq

This study was carried out to test in vitro the efficiency of Clonostachys rosea and Trichoderma harzianum as bicontrol agents against fungi isolated from declining grapevine trees in Iraq. In vitro assays showed a good antagonistic activity of C. rosea against the colony growth of Phaeoacremonium aleophilum and Cylindrocarpon destructans; the values of x coefficient were 0.90 of each with significance differences comparing with antagonism behavior against B. parva (x=1.43). T.harzianum showed highly response against the growth of all tested fungi with x coefficient ranged between 0.50 - 0.65; which was higher than that of C.rosea. The test revealed significant growth inhibition of C.rosea against P.aleophilum, which were 46.60%, 55.17%, 74.33% in the concentrations 5%, 10%, and 15% respectively. No inhibition appeared in the growth of both Botryosphaeria parva and Macrophomina phaseolina .The filtrate of T. harzianum decreased the growth of P. aleophilum to 19% and 19.83% with the filtrate concentrations 10% and 15% respectively. B.parvawas also affected by the concentration 10% and 15% of T harzianum, the inhibition reached to 12.66% and 12.82% respectively. The inhibition in the growth of M. phaseolina ranged between 20 – 28%, but in the C. destrcuctans have recorded the lowest inhibition percentages in the concentration 5% (5.25%) and 10% (6.91%)

Pathogenicity of Phaeoacremonium Aleophilum Associated with Grapevine Decline in Kurdistan Region-Iraq

The disease severity of Phaeoacremonium.  aleophilum on the symptomatic leaves of  Taefi (cv.) ranged between 0.27-0.32 after two and four months of inoculation with significant difference from  Rashmew (cv.) Pathogenicity test was performed on two cultivars, Taefi and Rashmew, under the greenhouse conditions. One year-old rooted grape cuttings were inoculated with P. aleophilum  by two methods, injecting the spore suspension into the green shoots, and artificial inoculation of wounded shoots with mycelial mat. Symptoms appeared as brownish to black discoloration in a longitudinal section of all plant shoots. The highest canker length (20.67 mm) was produced after four months of wounding on Taefi shoots with significant difference from control treatment. Inoculation by wounding shoots was more effective than injecting shoots. P. aleophilum caused significant reduction in fresh and dry weight of green shoots compared with non- inoculated treatment. Under field condition, two methods of inoculation were adopted, wounding the green shoots, and drilling a hole into the grapevine arms followed by inoculation with mycelial mat. The highest canker length (17.50 mm) was obtained after 5 months on wounded shoots of Rashmew (cv.) with a significant difference from  Taefi (cv.).This pathogen has been reported for the first time in Iraq

Causes of Early Childhood Deaths in Urban Dhaka, Bangladesh

Data on causes of early childhood death from low-income urban areas are limited. The nationally representative Bangladesh Demographic and Health Survey 2007 estimates 65 children died per 1,000 live births. We investigated rates and causes of under-five deaths in an urban community near two large pediatric hospitals in Dhaka, Bangladesh and evaluated the impact of different recall periods. We conducted a survey in 2006 for 6971 households and a follow up survey in 2007 among eligible remaining households or replacement households. The initial survey collected information for all children under five years old who died in the previous year; the follow up survey on child deaths in the preceding five years. We compared mortality rates based on 1-year recall to the 4 years preceding the most recent 1 year. The initial survey identified 58 deaths among children <5 years in the preceding year. The follow up survey identified a mean 53 deaths per year in the preceding five years (SD±7.3). Under-five mortality rate was 34 and neonatal mortality was 15 per thousand live births during 2006–2007. The leading cause of under-five death was respiratory infections (22%). The mortality rates among children under 4 years old for the two time periods (most recent 1-year recall and the 4 years preceding the most recent 1 year) were similar (36 versus 32). The child mortality in urban Dhaka was substantially lower than the national rate. Mortality rates were not affected by recall periods between 1 and 5 years

Safety and effi cacy of alternative antibiotic regimens compared with 7 day injectable procaine benzylpenicillin and gentamicin for outpatient treatment of neonates and young infants with clinical signs of severe infection when referral is not possible: a randomised, open-label, equivalence trial

Background Severe infections remain one of the main causes of neonatal deaths worldwide. Possible severe infection is diagnosed in young infants (aged 0–59 days) according to the presence of one or more clinical signs. The recommended treatment is hospital admission with 7–10 days of injectable antibiotic therapy. In low-income and middle-income countries, barriers to hospital care lead to delayed, inadequate, or no treatment for many young infants. We aimed to identify eff ective alternative antibiotic regimens to expand treatment options for situations where hospital admission is not possible. Methods We did this randomised, open-label, equivalence trial in four urban hospitals and one rural fi eld site in Bangladesh to determine whether two alternative antibiotic regimens with reduced numbers of injectable antibiotics combined with oral antibiotics had similar effi cacy and safety to the standard regimen, which was also used as outpatient treatment. We randomly assigned infants who showed at least one clinical sign of severe, but not critical, infection (except fast breathing alone), whose parents refused hospital admission, to one of the three treatment regimens. We stratifi ed randomisation by study site and age (<7 days or 7–59 days) using computer-generated randomisation sequences. The standard treatment was intramuscular procaine benzylpenicillin and gentamicin once per day for 7 days (group A). The alternative regimens were intramuscular gentamicin once per day and oral amoxicillin twice per day for 7 days (group B) or intramuscular procaine benzylpenicillin and gentamicin once per day for 2 days, then oral amoxicillin twice per day for 5 days (group C). The primary outcome was treatment failure within 7 days after enrolment. Assessors of treatment failure were masked to treatment allocation. Primary analysis was per protocol. We used a prespecifi ed similarity margin of 5% to assess equivalence between regimens. This study is registered with ClinicalTrials.gov, number NCT00844337. Findings Between July 1, 2009, and June 30, 2013, we recruited 2490 young infants into the trial. We assigned 830 infants to group A, 831 infants to group B, and 829 infants to group C. 2367 (95%) infants fulfi lled per-protocol criteria. 78 (10%) of 795 per-protocol infants had treatment failure in group A compared with 65 (8%) of 782 infants in group B (risk diff erence –1·5%, 95% CI –4·3 to 1·3) and 64 (8%) of 790 infants in group C (–1·7%, –4·5 to 1·1). In group A, 14 (2%) infants died before day 15, compared with 12 (2%) infants in group B and 12 (2%) infants in group C. Non-fatal relapse rates were similar in all three groups (12 [2%] infants in group A vs 13 [2%] infants in group B and 10 [1%] infants in group C). Interpretation Our results suggest that the two alternative antibiotic regimens for outpatient treatment of clinical signs of severe infection in young infants whose parents refused hospital admission are as effi cacious as the standard regimen. This fi nding could increase treatment options in resource-poor settings when referral care is not available or acceptable

Evaluation of a Cluster-Randomized Controlled Trial of a Package of Community-Based Maternal and Newborn Interventions in Mirzapur, Bangladesh

To evaluate a delivery strategy for newborn interventions in rural Bangladesh.A cluster-randomized controlled trial was conducted in Mirzapur, Bangladesh. Twelve unions were randomized to intervention or comparison arm. All women of reproductive age were eligible to participate. In the intervention arm, community health workers identified pregnant women; made two antenatal home visits to promote birth and newborn care preparedness; made four postnatal home visits to negotiate preventive care practices and to assess newborns for illness; and referred sick neonates to a hospital and facilitated compliance. Primary outcome measures were antenatal and immediate newborn care behaviours, knowledge of danger signs, care seeking for neonatal complications, and neonatal mortality.A total of 4616 and 5241 live births were recorded from 9987 and 11153 participants in the intervention and comparison arm, respectively. High coverage of antenatal (91% visited twice) and postnatal (69% visited on days 0 or 1) home visitations was achieved. Indicators of care practices and knowledge of maternal and neonatal danger signs improved. Adjusted mortality hazard ratio in the intervention arm, compared to the comparison arm, was 1.02 (95% CI: 0.80-1.30) at baseline and 0.87 (95% CI: 0.68-1.12) at endline. Primary causes of death were birth asphyxia (49%) and prematurity (26%). No adverse events associated with interventions were reported.Lack of evidence for mortality impact despite high program coverage and quality assurance of implementation, and improvements in targeted newborn care practices suggests the intervention did not adequately address risk factors for mortality. The level and cause-structure of neonatal mortality in the local population must be considered in developing interventions. Programs must ensure skilled care during childbirth, including management of birth asphyxia and prematurity, and curative postnatal care during the first two days of life, in addition to essential newborn care and infection prevention and management.Clinicaltrials.gov NCT00198627

Community-based asthma assessment in young children:Adaptations for a multicentre longitudinal study in South Asia

BACKGROUND: Systematic assessment of childhood asthma is challenging in low- and middle-income country (LMIC) settings due to the lack of standardised and validated methodologies. We describe the contextual challenges and adaptation strategies in the implementation of a community-based asthma assessment in four resource-constrained settings in Bangladesh, India, and Pakistan. METHOD: We followed a group of children of age 6–8 years for 12 months to record their respiratory health outcomes. The study participants were enrolled at four study sites of the ‘Aetiology of Neonatal Infection in South Asia (ANISA)’ study. We standardised the research methods for the sites, trained field staff for uniform data collection and provided a ‘Child Card’ to the caregiver to record the illness history of the participants. We visited the children on three different occasions to collect data on respiratory-related illnesses. The lung function of the children was assessed in the outreach clinics using portable spirometers before and after 6-minute exercise, and capillary blood was examined under light microscopes to determine eosinophil levels. RESULTS: We enrolled 1512 children, 95.5% (1476/1512) of them completed the follow-up, and 81.5% (1232/1512) participants attended the lung function assessment tests. Pre- and post-exercise spirometry was performed successfully in 88.6% (1091/1232) and 85.7% (1056/1232) of children who attempted these tests. Limited access to health care services, shortage of skilled human resources, and cultural diversity were the main challenges in adopting uniform procedures across all sites. Designing the study implementation plan based on the local contexts and providing extensive training of the healthcare workers helped us to overcome these challenges. CONCLUSION: This study can be seen as a large-scale feasibility assessment of applying spirometry and exercise challenge tests in community settings of LMICs and provides confidence to build capacity to evaluate children’s respiratory outcomes in future translational research studies

Scientific rationale for study design of community-based simplified antibiotic therapy trials in newborns and young infants with clinically diagnosed severe infections or fast breathing in South Asia and sub-Saharan Africa.

Background: Newborns and young infants suffer high rates of infections in South Asia and sub-Saharan Africa. Timely access to appropriate antibiotic therapy is essential for reducing mortality. In an effort to develop community case management guidelines for young infants, 0–59 days old, with clinically diagnosed severe infections, or with fast breathing, 4 trials of simplified antibiotic therapy delivered in primary care clinics (Pakistan, Democratic Republic of Congo, Kenya and Nigeria) or at home (Bangladesh and Nigeria) are being conducted. Methods: This article describes the scientific rationale for these trials, which share major elements of trial design. All the trials are in settings of high neonatal mortality, where hospitalization is not feasible or frequently refused. All use procaine penicillin and gentamicin intramuscular injections for 7 days as reference therapy and compare this to various experimental arms utilizing comparatively simpler combination regimens with fewer injections and oral amoxicillin. Conclusion: The results of these trials will inform World Health Organization policy regarding community case management of young infants with clinical severe infections or with fast breathing