Lower Limb Amputation at the 34 Military Hospital in Freetown, Sierra Leone: Causes and Indications.

The global prevalence of diabetes mellitus is increasing substantially. This overall increment leads to the growth in the number of individuals with diabetic complications including lower limb amputation. In low-income countries like Sierra Leone, lack of access to adequate health care, poverty and social stigma attached to “amputation” all prevent people from seeking early medical treatment for diabetic foot.The purpose of this study was to document the causes and indications of lower limb amputations and to make appropriate recommendations to the health sector of Sierra Leone.This retrospective study was conducted at 34 Military Hospital, one of the major referral hospitals in Freetown, between January 2011 and December 2014. A team of medical staff was trained to extract data. The operating theatre and ward case records were searched for information (age, gender, cause and indication for amputation) of all the patients who underwent amputation during this period. The findings were statistically documented in tables.Twenty-seven patients (24 males and 3 females) were involved in the study. The age distribution was 15-65 years (Mean 43). Majority (77.7%) of the patients presented with gangrenous and infected diabetic feet, 18.5 % was due to Road Traffic Accident and 3.8% due to complication of HIV infection. The commonest level was transtibial amputation 85% and 67% was right sided. Hospital stay was 20-50 days (average 35). There was no postoperative mortality.As most amputations were done for diabetic feet, there is need for diabetes sensitization and prevention campaigns for the general public and improvement of diabetic care for individual patients including proper glycemic control and risk factors prevention. Increased funding is required by the health sector of Sierra Leone to implement these measures. Prevention of road traffic accidents by training/educating the drivers should also be considered by Sierra Leone Road Transport Authority.

Elemental Composition Analysis of Soil Samples from Bayelsa State in the Niger Delta Region of Nigeria

This study analysis the elemental composition and concentration of elements in the soils of the study area to ascertain degree of elemental enhancement in the soil resulting from anthropogenic activities with possible soil contamination, human health and environmental detriment. The study area was divided into eight grids and two soil samples per grid from over burden to a depth of 900mm was collected randomly in each grid. The samples were prepared using standard methods and analyzed with a linear accelerator. The number of detectable elements and their quantitative information was extracted from the elemental spectral signatures. . The result showed a high concentration value in some elements in the soil samples above values of elemental concentrations in soils from other reported studied region. In addition, Aluminium, Strontium, Barium, Gallium etc also showed an extremely high value in their concentration that exceeds the world wide mean range upper limit values in crustal soil study published. The study indicates some degree of potential contamination and therefore necessitate a regular periodic monitoring study to reduce potential health detriment to humans and the environment to as low as reasonably possible

Rumors of disease in the global village: outbreak verification.

Emerging infectious diseases and the growth of information technology have produced new demands and possibilities for disease surveillance and response. Increasing numbers of outbreak reports must be assessed rapidly so that control efforts can be initiated and unsubstantiated reports can be identified to protect countries from unnecessary economic damage. The World Health Organization has set up a process for timely outbreak verification to convert large amounts of data into accurate information for suitable action. We describe the context and processes of outbreak verification and information dissemination

Extraction and Characterization of Linoleic Acid from the Leaves of the Traditional Medicinal Plant Caloncoba Echinata in Sierra Leone

Dried powdered organs of Caloncoba echinata plant were subjected to organoleptic evaluation and Fluorescence properties. The reagent which gave the most fluorescent character was used to extract a compound from the plant materials. 3.14% (2.50 g) of an oily substance was extracted from 79.62g of powdered leaves of Caloncoba echinata in 450 mL 10% of HNO3 and allowed to stand for 72 hours. The extract was filtered using a Buchner funnel attached to portable Vacuum Pump and the acidic crude extracted with petroleum ether (10 mL x 3).The crude oily compound was separated from the mixture, purified weighed and labelled as LKL01. Sample LK01 tested positive for terpenoids and unsaturation with Saponification and Iodine Values of 201.96 and 177.66 respectively indicating that the compound is very suitable soap production and cosmetic purposes. Chemical and spectroscopic analysis and from literature revealed the compound to be Linoleic acid. This is the first report of the presence of Linoleic acid in the leaves of Caloncoba echinata. Linoleic acid has been reported to be used as an emollient and thickening agent in cosmetics, antioxidant and an anti-inflammatory agent in the treatment of burns, cold sores and other minor wounds supporting the use of Caloncoba echinata plant in traditional medicine

A model for identifying owner's needs in the building life cycle

Building life cycle is a process which covers not only the construction phase but also the feasibility, the design and the operation phases. Identifying the owner s needs in all phases of this process is of paramount importance for achieving satisfactory results for the building project. Additionally, the owner s needs should be fulfilled by the work scope of every stakeholder involved in the project. Nevertheless, these needs are not always adequately considered in building projects. Thus, the purpose of the research reported in this paper has been to develop a model that allows for the identification of the owner s needs in all phases of the building life cycle. The article presents a six level classification system for the information required in the project and a two-dimensional model that maps the life cycle and the logical actions to be undertaken in each phase. The model has been corroborated and improved by applying the Delphi technique to a panel of ten experts in two rounds. The practical use of the model is through the systematic application of a series of questionnaires built upon the information classification system for determining the owner s needs. The paper details the operation phase of the model as an illustrative example and a case study on a residential building project of twelve apartments in Spain.This research was partially funded by the J. Gomez-Cerezo Foundation (Spain) and the Spanish Ministry of Infrastructure (grant 2004-36). The authors thank the ten experts who participated in the Delphi study and Dr Debra Westall who thoroughly revised the text.Alshubbak, A.; Pellicer, E.; Catalá Alís, J.; Teixeira, JM. (2015). A model for identifying owner's needs in the building life cycle. Journal of Civil Engineering and Management. 21(8):1046-1060. doi:10.3846/13923730.2015.1027257S1046106021

Safety and immunogenicity of the two-dose heterologous Ad26.ZEBOV and MVA-BN-Filo Ebola vaccine regimen in children in Sierra Leone: a randomised, double-blind, controlled trial

Background—Children account for a substantial proportion of cases and deaths from Ebola virus disease. We aimed to assess the safety and immunogenicity of a two-dose heterologous vaccine regimen, comprising the adenovirus type 26 vector-based vaccine encoding the Ebola virus glycoprotein (Ad26.ZEBOV) and the modified vaccinia Ankara vectorbased vaccine, encoding glycoproteins from the Ebola virus, Sudan virus, and Marburg virus, and the nucleoprotein from the Tai Forest virus (MVA-BN-Filo), in a paediatric population in Sierra Leone. Methods—This randomised, double-blind, controlled trial was done at three clinics in Kambia district, Sierra Leone. Healthy children and adolescents aged 1–17 years were enrolled in three age cohorts (12–17 years, 4–11 years, and 1–3 years) and randomly assigned (3:1), via computer-generated block randomisation (block size of eight), to receive an intramuscular injection of either Ad26.ZEBOV (5 × 1010 viral particles; first dose) followed by MVA-BN-Filo (1 × 108 infectious units; second dose) on day 57 (Ebola vaccine group), or a single dose of meningococcal quadrivalent (serogroups A, C, W135, and Y) conjugate vaccine (MenACWY; first dose) followed by placebo (second dose) on day 57 (control group). Study team personnel (except for those with primary responsibility for study vaccine preparation), participants, and their parents or guardians were masked to study vaccine allocation. The primary outcome was safety, measured as the occurrence of solicited local and systemic adverse symptoms during 7 days after each vaccination, unsolicited systemic adverse events during 28 days after each vaccination, abnormal laboratory results during the study period, and serious adverse events or immediate reportable events throughout the study period. The secondary outcome was immunogenicity (humoral immune response), measured as the concentration of Ebola virus glycoprotein-specific binding antibodies at 21 days after the second dose. The primary outcome was assessed in all participants who had received at least one dose of study vaccine and had available reactogenicity data, and immunogenicity was assessed in all participants who had received both vaccinations within the protocol-defined time window, had at least one evaluable post-vaccination sample, and had no major protocol deviations that could have influenced the immune response. This study is registered at ClinicalTrials.gov, NCT02509494. Findings—From April 4, 2017, to July 5, 2018, 576 eligible children or adolescents (192 in each of the three age cohorts) were enrolled and randomly assigned. The most common solicited local adverse event during the 7 days after the first and second dose was injection-site pain in all age groups, with frequencies ranging from 0% (none of 48) of children aged 1–3 years after placebo injection to 21% (30 of 144) of children aged 4–11 years after Ad26.ZEBOV vaccination. The most frequently observed solicited systemic adverse event during the 7 days was headache in the 12–17 years and 4–11 years age cohorts after the first and second dose, and pyrexia in the 1–3 years age cohort after the first and second dose. The most frequent unsolicited adverse event after the first and second dose vaccinations was malaria in all age cohorts, irrespective of the vaccine types. Following vaccination with MenACWY, severe thrombocytopaenia was observed in one participant aged 3 years. No other clinically significant laboratory abnormalities were observed in other study participants, and no serious adverse events related to the Ebola vaccine regimen were reported. There were no treatment-related deaths. Ebola virus glycoprotein-specific binding antibody responses at 21 days after the second dose of the Ebola virus vaccine regimen were observed in 131 (98%) of 134 children aged 12–17 years (9929 ELISA units [EU]/mL [95% CI 8172–12 064]), in 119 (99%) of 120 aged 4–11 years (10 212 EU/mL [8419–12 388]), and in 118 (98%) of 121 aged 1–3 years (22 568 EU/mL [18 426–27 642]). Interpretation—The Ad26.ZEBOV and MVA-BN-Filo Ebola vaccine regimen was well tolerated with no safety concerns in children aged 1–17 years, and induced robust humoral immune responses, suggesting suitability of this regimen for Ebola virus disease prophylaxis in children

Safety and long-term immunogenicity of the two-dose heterologous Ad26.ZEBOV and MVA-BN-Filo Ebola vaccine regimen in adults in Sierra Leone: a combined open-label, non-randomised stage 1, and a randomised, double-blind, controlled stage 2 trial

Background The Ebola epidemics in west Africa and the Democratic Republic of the Congo highlight an urgent need for safe and effective vaccines to prevent Ebola virus disease. We aimed to assess the safety and long-term immunogenicity of a two-dose heterologous vaccine regimen, comprising the adenovirus type 26 vector-based vaccine encoding the Ebola virus glycoprotein (Ad26.ZEBOV) and the modified vaccinia Ankara vector-based vaccine, encoding glycoproteins from Ebola virus, Sudan virus, and Marburg virus, and the nucleoprotein from the Tai Forest virus (MVA-BN-Filo), in Sierra Leone, a country previously affected by Ebola. Methods The trial comprised two stages: an open-label, non-randomised stage 1, and a randomised, double-blind, controlled stage 2. The study was done at three clinics in Kambia district, Sierra Leone. In stage 1, healthy adults (aged ≥18 years) residing in or near Kambia district, received an intramuscular injection of Ad26.ZEBOV (5×1010 viral particles) on day 1 (first dose) followed by an intramuscular injection of MVA-BN-Filo (1×108 infectious units) on day 57 (second dose). An Ad26.ZEBOV booster vaccination was offered at 2 years after the first dose to stage 1 participants. The eligibility criteria for adult participants in stage 2 were consistent with stage 1 eligibility criteria. Stage 2 participants were randomly assigned (3:1), by computer-generated block randomisation (block size of eight) via an interactive web-response system, to receive either the Ebola vaccine regimen (Ad26.ZEBOV followed by MVA-BN-Filo) or an intramuscular injection of a single dose of meningococcal quadrivalent (serogroups A, C, W135, and Y) conjugate vaccine (MenACWY; first dose) followed by placebo on day 57 (second dose; control group). Study team personnel, except those with primary responsibility for study vaccine preparation, and participants were masked to study vaccine allocation. The primary outcome was the safety of the Ad26.ZEBOV and MVA-BN-Filo vaccine regimen, which was assessed in all participants who had received at least one dose of study vaccine. Safety was assessed as solicited local and systemic adverse events occurring in the first 7 days after each vaccination, unsolicited adverse events occurring in the first 28 days after each vaccination, and serious adverse events or immediate reportable events occurring up to each participant’s last study visit. Secondary outcomes were to assess Ebola virus glycoprotein-specific binding antibody responses at 21 days after the second vaccine in a per-protocol set of participants (ie, those who had received both vaccinations within the protocol-defined time window, had at least one evaluable post-vaccination sample, and had no major protocol deviations that could have influenced the immune response) and to assess the safety and tolerability of the Ad26.ZEBOV booster vaccination in stage 1 participants who had received the booster dose. This study is registered at ClinicalTrials.gov, NCT02509494. Findings Between Sept 30, 2015, and Oct 19, 2016, 443 participants (43 in stage 1 and 400 in stage 2) were enrolled; 341 participants assigned to receive the Ad26.ZEBOV and MVA-BN-Filo regimen and 102 participants assigned to receive the MenACWY and placebo regimen received at least one dose of study vaccine. Both regimens were well tolerated with no safety concerns. In stage 1, solicited local adverse events (mostly mild or moderate injection-site pain) were reported in 12 (28%) of 43 participants after Ad26.ZEBOV vaccination and in six (14%) participants after MVA-BN-Filo vaccination. In stage 2, solicited local adverse events were reported in 51 (17%) of 298 participants after Ad26.ZEBOV vaccination, in 58 (24%) of 246 after MVA-BN-Filo vaccination, in 17 (17%) of 102 after MenACWY vaccination, and in eight (9%) of 86 after placebo injection. In stage 1, solicited systemic adverse events were reported in 18 (42%) of 43 participants after Ad26.ZEBOV vaccination and in 17 (40%) after MVA-BN-Filo vaccination. In stage 2, solicited systemic adverse events were reported in 161 (54%) of 298 participants after Ad26.ZEBOV vaccination, in 107 (43%) of 246 after MVA-BN-Filo vaccination, in 51 (50%) of 102 after MenACWY vaccination, and in 39 (45%) of 86 after placebo injection. Solicited systemic adverse events in both stage 1 and 2 participants included mostly mild or moderate headache, myalgia, fatigue, and arthralgia. The most frequent unsolicited adverse event after the first dose was headache in stage 1 and malaria in stage 2. Malaria was the most frequent unsolicited adverse event after the second dose in both stage 1 and 2. No serious adverse event was considered related to the study vaccine, and no immediate reportable events were observed. In stage 1, the safety profile after the booster vaccination was not notably different to that observed after the first dose. Vaccine-induced humoral immune responses were observed in 41 (98%) of 42 stage 1 participants (geometric mean binding antibody concentration 4784 ELISA units [EU]/mL [95% CI 3736–6125]) and in 176 (98%) of 179 stage 2 participants (3810 EU/mL [3312–4383]) at 21 days after the second vaccination. Interpretation The Ad26.ZEBOV and MVA-BN-Filo vaccine regimen was well tolerated and immunogenic, with persistent humoral immune responses. These data support the use of this vaccine regimen for Ebola virus disease prophylaxis in adults

Leprosy post-exposure prophylaxis with single-dose rifampicin

_Objective:_ Leprosy post-exposure prophylaxis with single-dose rifampicin (SDRPEP) has proven effective and feasible, and is recommended by WHO since 2018. This SDR-PEP toolkit was developed through the experience of the leprosy postexposure prophylaxis (LPEP) programme. It has been designed to facilitate and standardise the implementation of contact tracing and SDR-PEP administration in regions and countries that start the intervention. _Results:_ Four tools were developed, incorporating the current evidence for SDRPEP and the methods and learnings from the LPEP project in eight countries. (1) th

The possible role of local air pollution in climate change in West Africa

The climate of West Africa is characterized by a sensitive monsoon system that is associated with marked natural precipitation variability. This region has been and is projected to be subject to substantial global and regional-scale changes including greenhouse-gas-induced warming and sea-level rise, land-use and land-cover change, and substantial biomass burning. We argue that more attention should be paid to rapidly increasing air pollution over the explosively growing cities of West Africa, as experiences from other regions suggest that this can alter regional climate through the influences of aerosols on clouds and radiation, and will also affect human health and food security. We need better observations and models to quantify the magnitude and characteristics of these impacts