Evaluation of the suicide registration system in Maputo and Matola, Mozambique, 2016-2018

Introduction: Suicide is a major public health problem worldwide and a major cause of death in young adults. Mozambique had one the highest suicide rate in Africa with 23.2 suicides per 100 000 inhabitants. We aimed to evaluate the Suicide Registration System in the cities of Maputo and Matola (SRSMM) to have an overview of the system and to assess the suicide burden in the population. Methods: We extracted data from the “external cause” death registration system, available at the Legal Medicine Service at the Maputo Central Hospital (LMS/HCM) from 2016 to 2018.The evaluation was based on the updated CDC guidelines. Results: The SRSMM is a complex system with multiple data sources. It is a system with excellent data quality (96.2% complete), is representative (87.5% coverage) and is useful for identifying the cause of death. The system remained stable throughout the analysis period, except for 4 months in 2017, during which did not register deaths. From 2016 to 2018, 289 registered suicide cases were analyzed. A total of 219 (75.8%) were men aged 20-39. The most common suicide method was hanging, with 249 cases (86.2%). Conclusion: Though the SRSMM is a complex system, it has good data quality, is representative, and is useful for improving vital statistics and identifying risk groups. The findings of this evaluation demonstrate the need to add key variables on the system that can allow meaningful analysis on risk factors and interventions; and to expand the system nationally in order to have an overview of the severity of suicide

Genomic investigations of unexplained acute hepatitis in children

Since its first identification in Scotland, over 1,000 cases of unexplained paediatric hepatitis in children have been reported worldwide, including 278 cases in the UK1. Here we report an investigation of 38 cases, 66 age-matched immunocompetent controls and 21 immunocompromised comparator participants, using a combination of genomic, transcriptomic, proteomic and immunohistochemical methods. We detected high levels of adeno-associated virus 2 (AAV2) DNA in the liver, blood, plasma or stool from 27 of 28 cases. We found low levels of adenovirus (HAdV) and human herpesvirus 6B (HHV-6B) in 23 of 31 and 16 of 23, respectively, of the cases tested. By contrast, AAV2 was infrequently detected and at low titre in the blood or the liver from control children with HAdV, even when profoundly immunosuppressed. AAV2, HAdV and HHV-6 phylogeny excluded the emergence of novel strains in cases. Histological analyses of explanted livers showed enrichment for T cells and B lineage cells. Proteomic comparison of liver tissue from cases and healthy controls identified increased expression of HLA class 2, immunoglobulin variable regions and complement proteins. HAdV and AAV2 proteins were not detected in the livers. Instead, we identified AAV2 DNA complexes reflecting both HAdV-mediated and HHV-6B-mediated replication. We hypothesize that high levels of abnormal AAV2 replication products aided by HAdV and, in severe cases, HHV-6B may have triggered immune-mediated hepatic disease in genetically and immunologically predisposed children

Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

Funder: European Society of Intensive Care Medicine; doi: http://dx.doi.org/10.13039/501100013347Funder: Flemish Society for Critical Care NursesAbstract: Purpose: Intensive care unit (ICU) patients are particularly susceptible to developing pressure injuries. Epidemiologic data is however unavailable. We aimed to provide an international picture of the extent of pressure injuries and factors associated with ICU-acquired pressure injuries in adult ICU patients. Methods: International 1-day point-prevalence study; follow-up for outcome assessment until hospital discharge (maximum 12 weeks). Factors associated with ICU-acquired pressure injury and hospital mortality were assessed by generalised linear mixed-effects regression analysis. Results: Data from 13,254 patients in 1117 ICUs (90 countries) revealed 6747 pressure injuries; 3997 (59.2%) were ICU-acquired. Overall prevalence was 26.6% (95% confidence interval [CI] 25.9–27.3). ICU-acquired prevalence was 16.2% (95% CI 15.6–16.8). Sacrum (37%) and heels (19.5%) were most affected. Factors independently associated with ICU-acquired pressure injuries were older age, male sex, being underweight, emergency surgery, higher Simplified Acute Physiology Score II, Braden score 3 days, comorbidities (chronic obstructive pulmonary disease, immunodeficiency), organ support (renal replacement, mechanical ventilation on ICU admission), and being in a low or lower-middle income-economy. Gradually increasing associations with mortality were identified for increasing severity of pressure injury: stage I (odds ratio [OR] 1.5; 95% CI 1.2–1.8), stage II (OR 1.6; 95% CI 1.4–1.9), and stage III or worse (OR 2.8; 95% CI 2.3–3.3). Conclusion: Pressure injuries are common in adult ICU patients. ICU-acquired pressure injuries are associated with mainly intrinsic factors and mortality. Optimal care standards, increased awareness, appropriate resource allocation, and further research into optimal prevention are pivotal to tackle this important patient safety threat

Correction to: Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

The original version of this article unfortunately contained a mistake

Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

Funder: European Society of Intensive Care Medicine; doi: http://dx.doi.org/10.13039/501100013347Funder: Flemish Society for Critical Care NursesAbstract: Purpose: Intensive care unit (ICU) patients are particularly susceptible to developing pressure injuries. Epidemiologic data is however unavailable. We aimed to provide an international picture of the extent of pressure injuries and factors associated with ICU-acquired pressure injuries in adult ICU patients. Methods: International 1-day point-prevalence study; follow-up for outcome assessment until hospital discharge (maximum 12 weeks). Factors associated with ICU-acquired pressure injury and hospital mortality were assessed by generalised linear mixed-effects regression analysis. Results: Data from 13,254 patients in 1117 ICUs (90 countries) revealed 6747 pressure injuries; 3997 (59.2%) were ICU-acquired. Overall prevalence was 26.6% (95% confidence interval [CI] 25.9–27.3). ICU-acquired prevalence was 16.2% (95% CI 15.6–16.8). Sacrum (37%) and heels (19.5%) were most affected. Factors independently associated with ICU-acquired pressure injuries were older age, male sex, being underweight, emergency surgery, higher Simplified Acute Physiology Score II, Braden score 3 days, comorbidities (chronic obstructive pulmonary disease, immunodeficiency), organ support (renal replacement, mechanical ventilation on ICU admission), and being in a low or lower-middle income-economy. Gradually increasing associations with mortality were identified for increasing severity of pressure injury: stage I (odds ratio [OR] 1.5; 95% CI 1.2–1.8), stage II (OR 1.6; 95% CI 1.4–1.9), and stage III or worse (OR 2.8; 95% CI 2.3–3.3). Conclusion: Pressure injuries are common in adult ICU patients. ICU-acquired pressure injuries are associated with mainly intrinsic factors and mortality. Optimal care standards, increased awareness, appropriate resource allocation, and further research into optimal prevention are pivotal to tackle this important patient safety threat

The Use of Polliniferous Resources by Melipona capixaba

Pollen types present in samples from corbiculae of Melipona capixaba (Moure and Camargo) (Hymenoptera: Apidae: Meliponina) worker bees were analyzed, as well as pollen samples from food pots inside the hives in three sites located at the bees’ original habitat. The aim was to find out the sources used as a trophic resource by this species. The dominant pollen grains in the spectrum of the samples belonged to the families Myrtaceae and Melastomataceae. Eucalyptus was the most frequent pollen type in the corbiculae in Conceição do Castelo municipality; Eucalyptus, Myrcia, and Melastomatacea/Combretaceae in the Fazenda do Estado district; and Eucalyptus and Myrcia in the São Paulo de Aracê district, both in the Domingos Martins municipality. Eucalyptus and Melastomataceae/Combretaceae were the predominant pollen types in the food pots. Eucalyptus was the most prevalent type all year round or most of the year. The most common pollen types in the months that Eucalyptus was not present or dominant in the samples were of remaining native forest species, “ruderal” (field) plants, fruit-bearing plants, and introduced ornamental plants

Unravelling 5-oxoprolinuria (pyroglutamic aciduria) due to bi-allelic OPLAHmutations: 20 new mutations in 14 families

Primary 5-oxoprolinuria (pyroglutamic aciduria) is caused by a genetic defect in the γ-glutamyl cycle, affecting either glutathione synthetase or 5-oxoprolinase. While several dozens of patients with glutathione synthetase deficiency have been reported, with hemolytic anemia representing the clinical key feature, 5-oxoprolinase deficiency due to OPLAH mutations is less frequent and so far has not attracted much attention. This has prompted us to investigate the clinical phenotype as well as the underlying genotype in patients from 14 families of various ethnic backgrounds who underwent diagnostic mutation analysis following the detection of 5-oxoprolinuria. In all patients with 5-oxoprolinuria studied, bi-allelic mutations in OPLAH were indicated. An autosomal recessive mode of inheritance for 5-oxoprolinase deficiency is further supported by the identification of a single mutation in all 9/14 parent sample sets investigated (except for the father of one patient whose result suggests homozygosity), and the absence of 5-oxoprolinuria in all tested heterozygotes. It is remarkable, that all 20 mutations identified were novel and private to the respective families. Clinical features were highly variable and in several sib pairs, did not segregate with 5-oxoprolinuria. Although a pathogenic role of 5-oxoprolinase deficiency remains possible, this is not supported by our findings. Additional patient ascertainment and long-term follow-up is needed to establish the benign nature of this inborn error of metabolism. It is important that all symptomatic patients with persistently elevated levels of 5-oxoproline and no obvious explanation are investigated for the genetic etiology

Cholera Incidence and Mortality in Sub-Saharan African Sites during Multi-country Surveillance

International audienc

Gender, age and season of occurrence of cholera suspect cases.

<p>N = 6280.</p

Suspect cases with culture done and Suspect cases with positive culture for <i>Vibrio cholera</i> (first part).

<p>Surveillance zone, Beira city, Mozambique (A); surveillance zone, Koumassi-Vridi-Port Boët district, Abidjan, Cote d’Ivoire (B); surveillance zone, Lake district, Togo (C); surveillance zone, Mbale-Manafwa-Butaleja districts, Uganda (D); surveillance zone, Lome-Golfe districts, Togo (E); surveillance zone, Conakry, Guinea (F); Dark blue bars show cases with culture test done, light blue bars show cases with culture test not done, green bars show cases with <i>Vibrio cholera</i> identified by culture, and yellow bars show cases having a culture negative for <i>Vibrio cholera</i>. The dashed line shows the first month of the enhanced Africhol surveillance. The dotted line shows the last month of the enhanced Africhol surveillance.</p