Therapeutic efficacy of chloroquine and sulfadoxine/pyrimethamine against Plasmodium falciparum infection in Somalia

Study on the therapeutic efficacy of treatments based on chloroquine and sulfadoxine/pyrimethamine in cases of malaria (Plasmodium falciparum) in Merka and Gabiley, Somalia.Daraasaad ku saabsan waxtarka ku daaweynta chloroquine iyo sulfadoxine/pyrimethamine cudurka duumada, degaannada soomaaliyeed ee Marka iyo Gabiley.Studio sull'efficacia terapeutica di trattamenti a base di clorochina e sulfadossina/pirimetamina nei casi di malaria (Plasmodium falciparum) a Merka e Gabiley, Somalia

Assessment of the Therapeutic Efficacy of Two Artemisinin-Based Combinations in the Treatment of Uncomplicated Falciparum Malaria among Children Under 5 Years in Four District Hospitals in Sierra Leone

Plasmodium falciparum has developed resistance to almost every class of antimalarial compounds. As a result of this, the World Health Organization has recommended artemisinin-based combination therapy as first line treatment for P. falciparum malaria. There is however need for the continuous monitoring of the efficacy of these antimalarials in order to provide timely information on trends of the emergence of resistant strains. We assessed the therapeutic efficacy of oral artesunate – amodiaquine and artemether-lumefantrine combinations in the treatment of uncomplicated P. falciparum malaria in four District Hospitals in Sierra Leone. A total of 320 children under five years partiiccipated in the study sites (Kenema, Rokupa, Bo and Makeni). Oral Artesunate-amodiaquine combination was administered to participants in Kenema and Rokupa whilst Artemetherlumefantrine combination was administered to participants in Bo and Makeni. The new WHO Protocol for recruitment of participants in therapeutic efficacy trials in high transmission zones was adopted for the study with filter paper blood samples taken from each participant on days 0 and 28 to distinguish between treatment failure and new infection. When uncorrected for PCR analysis, 96% (95% CI: 902 – 989) and 100% (95% CI:63.1 – 100) responses were obtained in Kenema and Bo respectively with Artesunate-amodiaquine combination whilst 94.3% (CI 95 : 88.1 – 979) and 100% (95% CI: 96.5 – 100) were obtained with Artemether-lumefantrine combination in Bo and Makeni respectively. When corrected for PCR on the other hand, a 100% (95% CI) Adequate Clinical and Parasitological Response was obtained for the two drugs in all four study sites. Results from this study indicate that both Artesunate-amodiaquine and Artemether-lumefantrine combinations remain highly efficacious in Sierra Leone with presently no observed emergence of resistant strains to both drugs.Keywords: Artemisinin-based combination, uncomplicated falciparum malaria, children, Sierra Leon

Knowledge and exploitation of small ruminant grading and pricing systems among Somaliland livestock producers

This study sought to determine the level of awareness of the informal indigenous livestock grading and pricing system among producers and the exploitation of this knowledge to increase market participation and realise better prices and returns for their animals. Data was collected from 144 small ruminant producers in 3 livelihood zones (West Golis pastoral, Togdheer agro-pastoral and Hawd pastoral regions) in the northern Togdheer region using a structured questionnaire. Descriptive statistics and econometric methods were used in the analysis of data. Results confirmed the importance of small ruminants as sources of income among livestock producers in Somaliland. On average, a household kept 53 sheep and goats with most of the producers (79-85%) having sold some animals (mean=10) during the preceding 12 months. It was also established that producers were generally well versed with the grading and pricing system except for the very fine details. However, this knowledge did not have significant effect on level of market participation, but rather, other supply influencing factors like the number of animals kept by the household, gender of sales decision maker, age of household head and livelihood zone in which the household resided significantly influenced household annual small ruminants sales volumes. Despite level of awareness of grading and pricing having no significant effect on the absolute annual household sales volumes due to other adjunct supply constraints, producers tended to avail more of the superior quality grades for sale. For example, Grades I and II of small ruminants accounted for the largest proportions of animals sold (40% and 29%, respectively) with inferior quality grades (grade III and the local grade) accounting for only 15% and 17% respectively. Furthermore, results of an Ordinary Least Squares (OLS) regression showed that supply of higher grade animals had a positive effect on prices received. In addition, number of animals sold and involvement in other economic activities besides livestock production positively affected the level of prices received by producers. Although a significant number of producers (39%) said that they deliberately fatten animals before sale, the strategy employed simply involved grazing of animals in communal land during the rainy season. Sheep and goats producers in Somalia face formidable constraints of drought and the attendant lack of feed and water for livestock, and also animal health issues. This provides a justification for development agencies and research organisations to continue working to address these problems

Study protocol for evaluation of aid to diagnosis for developmental dysplasia of the hip in general practice: controlled trial randomised by practice

Introduction: In the UK, a compulsory ‘6-week hip check’ is performed in primary care for the detection of developmental dysplasia of the hip (DDH). However, missed diagnoses and infants incorrectly labelled with DDH remain a problem, potentially leading to adverse consequences for infants, their families and the National Health Service. National policy states that infants should be referred to hospital if the 6-week check suggests DDH, though there is no available tool to aid examination or offer guidelines for referral. We developed standardised diagnostic criteria for DDH, based on international Delphi consensus, and a 9-item checklist that has the potential to enable non-experts to diagnose DDH in a manner approaching that of experts. / Methods and analysis: We will conduct a controlled trial randomised by practice that will compare a diagnostic aid against standard care for the hip check. The primary objective is to determine whether an aid to the diagnosis of DDH reduces the number of clinically insignificant referrals from primary care to hospital and the number of late diagnosed DDH. The trial will include a qualitative process evaluation, an assessment of professional behavioural change and a full health economic evaluation. We will recruit 152 general practitioner practices in England. These will be randomised to conduct the hip checks with use of the study diagnostic aid and/or as per usual practice. The total number of infants seen during a 15-month recruitment period will be 110 per practice. Two years after the 6-week hip check, we will measure the number of referred infants that are (1) clinically insignificant for DDH and (2) those that constitute appropriate referrals. / Ethics and dissemination: This study has approval from the Health Research Authority (16/1/2020) and the Confidentiality Advisory Group (18/2/2020). Results will be published in peer-reviewed academic journals, disseminated to patient organisations and the media. / Trial registration number: NCT04101903; Pre-results

Patterns of resistance and DHFR/DHPS genotypes of Plasmodium falciparum in rural Tanzania prior to the adoption of sulfadoxine-pyrimethamine as first-line treatment.

A study was carried out to assess the patterns of resistance and occurrence of DHFR/DHPS genotypes of Plasmodium falciparum prior to the adoption of sulfadoxine-pyrimethamine (SP) as first-line treatment for uncomplicated malaria in Tanzania. Children under five years (n = 117) with clinical, uncomplicated malaria were randomly allocated to standard treatments of either chloroquine (CQ) (25 mg/kg) or SP (25 mg sulfadoxine and 1.25 mg pyrimethamine/kg). Patients were monitored for 28 days. Clinical recovery was achieved in 98% (n = 58) and 90% (n = 59) of the patients in the SP and CQ groups, respectively. Parasitologically, 14% of the patients in the SP group and 51% in the CQ group exhibited RII/RIII resistance. When relating pre-treatment blood drug levels to treatment outcome and the degree of parasite resistance to the number of mutations, no relationships could be detected. There was an overall significant increase in haemoglobin levels from day 0 to day 28 in both patient groups. Sulfadoxine-pyrimethamine produced an acceptable clinical response but the high degree of parasitological resistance (RII/RIII) observed two years prior to the introduction of the drug as first-line treatment is of concern, especially considering the long half-lives of sulfadoxine and pyrimethamine

Modal analysis of novel coronavirus (SARS COV-2) using finite element methodology

Many new engineering and scientific innovations have been proposed to date to passivate the novel coronavirus (SARS CoV-2), with the aim of curing the related disease that is now recognised as COVID-19. Currently, vaccine development remains the most reliable solution available. Efforts to provide solutions as alternatives to vaccinations are growing and include established control of behaviours such as self-isolation, social distancing, employing facial masks and use of antimicrobial surfaces. The work here proposes a novel engineering method employing the concept of resonant frequencies to denature SARS CoV-2. Specifically, “modal analysis” is used to computationally analyse the Eigenvalues and Eigenvectors i.e. frequencies and mode shapes to denature COVID-19. An average virion dimension of 63 nm with spike proteins number 6, 7 and 8 were examined, which revealed a natural frequency of a single virus in the range of 88–125 MHz. The information derived about the natural frequency of the virus through this study will open newer ways to exploit medical solutions to combat future pandemics

Right Ventricular Compression Observed in Echocardiography from Pectus Excavatum Deformity

Pectus excavatum exists as varying anatomic deformities and compression of the right heart by the chest wall can lead to patient symptoms including dyspnea and chest pain with exertion. Echocardiography can be difficult but is critical to the evaluation and diagnosis of this patient population. Modifying standard views such as biplane transthoracic and 3-D transesophageal views may be necessary in some patients due to limitations from the abnormal anatomy of the deformed anterior chest wall. Apical four-chamber views when seen clearly can usually visualize any extrinsic compression to the right ventricle of the heart

Circulating levels of urocortin neuropeptides are impaired in children with overweight

Objective The corticotropin-releasing factor neuropeptides (corticotropin-releasing hormone [CRH] and urocortin [UCN]-1,2,3) and spexin contribute to the regulation of energy balance and inhibit food intake in mammals. However, the status of these neuropeptides in children with overweight has yet to be elucidated. This study investigated the effect of increased body weight on the circulating levels of these neuropeptides. Methods A total of 120 children with a mean age of 12 years were enrolled in the study. Blood samples were collected to assess the circulating levels of neuropeptides and were correlated with various anthropometric, clinical, and metabolic markers. Results Plasma levels of UCNs were altered in children with overweight but less so in those with obesity. Furthermore, the expression pattern of UCN1 was opposite to that of UCN2 and UCN3, which suggests a compensatory effect. However, no significant effect of overweight and obesity was observed on CRH and spexin levels. Finally, UCN3 independently associated with circulating zinc-alpha-2-glycoprotein and UCN2 levels, whereas UCN1 was strongly predicted by TNF alpha levels. Conclusions Significant changes in neuropeptide levels were primarily observed in children with overweight and were attenuated with increased obesity. This suggests the presence of a compensatory mechanism for neuropeptides to curb the progression of obesity.Peer reviewe