Detection of Crimean-Congo Haemorrhagic Fever cases in a severe undifferentiated febrile illness outbreak in the Federal Republic of Sudan: A retrospective epidemiological and diagnostic cohort study

BACKGROUND: Undifferentiated febrile illness (UFI) is one of the most common reasons for people seeking healthcare in low-income countries. While illness and death due to specific infections such as malaria are often well-quantified, others are frequently uncounted and their impact underappreciated. A number of high consequence infectious diseases, including Ebola virus, are endemic or epidemic in the Federal Republic of Sudan which has experienced at least 12 UFI outbreaks, frequently associated with haemorrhage and high case fatality rates (CFR), since 2012. One of these occurred in Darfur in 2015/2016 with 594 cases and 108 deaths (CFR 18.2%). The aetiology of these outbreaks remains unknown. METHODOLOGY/PRINCIPAL FINDINGS: We report a retrospective cohort study of the 2015/2016 Darfur outbreak, using a subset of 65 of 263 outbreak samples received by the National Public Health Laboratory which met selection criteria of sufficient sample volume and epidemiological data. Clinical features included fever (95.8%), bleeding (95.7%), headache (51.6%) and arthralgia (42.2%). No epidemiological patterns indicative of person-to-person transmission or health-worker cases were reported. Samples were tested at the Public Health England Rare and Imported Pathogens Laboratory using a bespoke panel of likely pathogens including haemorrhagic fever viruses, arboviruses and Rickettsia, Leptospira and Borrelia spp. Seven (11%) were positive for Crimean-Congo haemorrhagic fever virus (CCHFV) by real-time reverse transcription PCR. The remaining samples tested negative on all assays. CONCLUSIONS/SIGNIFICANCE: CCHFV is an important cause of fever and haemorrhage in Darfur, but not the sole major source of UFI outbreaks in Sudan. Prospective studies are needed to explore other aetiologies, including novel pathogens. The presence of CCHFV has critical infection, prevention and control as well as clinical implications for future response. Our study reinforces the need to boost surveillance, lab and investigative capacity to underpin effective response, and for local and international health security

Impact of opioid-free analgesia on pain severity and patient satisfaction after discharge from surgery: multispecialty, prospective cohort study in 25 countries

Background: Balancing opioid stewardship and the need for adequate analgesia following discharge after surgery is challenging. This study aimed to compare the outcomes for patients discharged with opioid versus opioid-free analgesia after common surgical procedures.Methods: This international, multicentre, prospective cohort study collected data from patients undergoing common acute and elective general surgical, urological, gynaecological, and orthopaedic procedures. The primary outcomes were patient-reported time in severe pain measured on a numerical analogue scale from 0 to 100% and patient-reported satisfaction with pain relief during the first week following discharge. Data were collected by in-hospital chart review and patient telephone interview 1 week after discharge.Results: The study recruited 4273 patients from 144 centres in 25 countries; 1311 patients (30.7%) were prescribed opioid analgesia at discharge. Patients reported being in severe pain for 10 (i.q.r. 1-30)% of the first week after discharge and rated satisfaction with analgesia as 90 (i.q.r. 80-100) of 100. After adjustment for confounders, opioid analgesia on discharge was independently associated with increased pain severity (risk ratio 1.52, 95% c.i. 1.31 to 1.76; P < 0.001) and re-presentation to healthcare providers owing to side-effects of medication (OR 2.38, 95% c.i. 1.36 to 4.17; P = 0.004), but not with satisfaction with analgesia (beta coefficient 0.92, 95% c.i. -1.52 to 3.36; P = 0.468) compared with opioid-free analgesia. Although opioid prescribing varied greatly between high-income and low- and middle-income countries, patient-reported outcomes did not.Conclusion: Opioid analgesia prescription on surgical discharge is associated with a higher risk of re-presentation owing to side-effects of medication and increased patient-reported pain, but not with changes in patient-reported satisfaction. Opioid-free discharge analgesia should be adopted routinely

Effects of tabtoxin on nitrogen metabolism

Tabtoxin is a chlorosis-inducing toxin produced by the plant pathogenic bacterium Pseudomonas syringae pv. tabaci. Previous studies have indicated that tabtoxin inhibits glutamine synthetase (EC 6.3.1.2) in vitro. We report here that tabtoxin also inhibits glutamine synthetase in vivo. The main evidence was that assimilation of exogenous 15NH3 into Asparagus sprengeri protein was rapidly inhibited in isolated cells exposed to tabtoxin. This was associated with an equivalent decline in glutamine synthetase activity in extracts of these cells and the accumulation of extracellular ammonia. Glutamine synthetase was also inhibited in leaves of Nicotiana tabacum L. cv. White Burley treated with tabtoxin and the affected tissue accumulated ammonia and became chlorotic. However, the development of symptoms and accumulation of ammonia was suppressed when the leaves were held in air containing 1% CO2 to reduce photorespiration. This indicates that the chlorotic symptom did not result from the inhibition of nitrogen assimilation but was a consequence of the interruption of the photorespiratory nitrogen cycle

Chemical fruit composition of Tunisian date palm 'Deglet Nour' collected at maturation from four different oases in Djerid region

peer reviewedThe Deglet Nour in Djerid Region is the most popular variety of date palm. Our study aims to provide information about physicochemical properties of dates Deglet Nour at Tamar stage from different oases in Djerid Region. The date fruits were collected from four different oases at different locations in South Tunisia: Traditional Continental Oasis (TCO), Traditional Mountain Oasis (TMO), Modern Continental Oasis (MCO), and Modern Palm Date Plantation (MPP). Fruit size and weight, Total Soluble Solids (TSS), pH, Titratable Acidity (TA), Dietary Fiber (DF), Protein content (MPT) and sugars were studied. The obtained results showed that physiochemical properties varied significantly according to the locations. Fruits from all oasis may be considered suitable for marketing as Deglet Nour dates from well-known producing areas. TSS, pH, TA, MPT and sugars were significantly important in dates from TMO oasis

Variability of physicochemical properties of ‘Deglet Nour’ date fruits collected from different oases in Djerid Region, Tunisia

Purpose : Quality and physical characteristics of date palm changes during growth and maturation stages of fruits in main production areas in the south of Tunisia. Research Method: The effect of season, ripening date and climatic conditions (temperature and relative humidity) on physicochemical characteristics of fresh dates “Deglet Nour” grown at four different oases were evaluated using multivariate analysis. Main findings: Dates from Traditional Mountain Oases (TMO) had the highest values of length, width, weight, moisture content for the two seasons. Those from Modern Palm Plantation (MPP) had the highest values of fiber content, water activity, glucose and fructose in 2014. In 2014 and 2015, date palm fruits of Modern Continental Oases (MCO) had the highest values of sucrose. The lower values of the different parameters were registered for dates from Traditional Continental Oases (TCO). Meteorological data from the experimental station recorded higher temperature and relative humidity during fruit maturation (July, August and September) in 2014 compared to 2015. Results showed that the good quality of dates was obtained in oases TMO that had higher relative humidity and lower temperature compared to other oases (MPP, MCO, and TCO). Such changes may have resulted from earlier pollination and higher temperatures during the maturation period. Considering the two seasons 2014 and 2015, the highest thermal coefficients were observed in MCO (3726 and 3704, respectively) and the lower ones in TCO (3083 and 3025, respectively). Research limitation: No limitations were founded. Originality/Value: Seasons and oases climate significantly affected the physical and biochemical quality characteristics of date palm fruits. This engendered in the longest maturity period recorded in TCO. MPP where we recorded the highest spring temperatures, showed the shorted development cycle