Brucellosis in Sub-Saharan Africa:Current challenges for management, diagnosis and control

Brucellosis is a highly contagious zoonosis caused by bacteria of the genus Brucella and affecting domestic and wild mammals. In this paper, the bacteriological and serological evidence of brucellosis in Sub-Saharan Africa (SSA) and its epidemiological characteristics are discussed. The tools available for the diagnosis and treatment of human brucellosis and for the diagnosis and control of animal brucellosis and their applicability in the context of SSA are presented and gaps identified. These gaps concern mostly the need for simpler and more affordable antimicrobial treatments against human brucellosis, the development of a B. melitensis vaccine that could circumvent the drawbacks of the currently available Rev 1 vaccine, and the investigation of serological diagnostic tests for camel brucellosis and wildlife. Strategies for the implementation of animal vaccination are also discussed.Publishe

Track D Social Science, Human Rights and Political Science

Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/138414/1/jia218442.pd

Clinical characteristics of women captured by extending the definition of severe postpartum haemorrhage with 'refractoriness to treatment': a cohort study

Background: The absence of a uniform and clinically relevant definition of severe postpartum haemorrhage hampers comparative studies and optimization of clinical management. The concept of persistent postpartum haemorrhage, based on refractoriness to initial first-line treatment, was proposed as an alternative to common definitions that are either based on estimations of blood loss or transfused units of packed red blood cells (RBC). We compared characteristics and outcomes of women with severe postpartum haemorrhage captured by these three types of definitions. Methods: In this large retrospective cohort study in 61 hospitals in the Netherlands we included 1391 consecutive women with postpartum haemorrhage who received either ≥4 units of RBC or a multicomponent transfusion. Clinical characteristics and outcomes of women with severe postpartum haemorrhage defined as persistent postpartum haemorrhage were compared to definitions based on estimated blood loss or transfused units of RBC within 24 h following birth. Adverse maternal outcome was a composite of maternal mortality, hysterectomy, arterial embolisation and intensive care unit admission. Results: One thousand two hundred sixty out of 1391 women (90.6%) with postpartum haemorrhage fulfilled the definition of persistent postpartum haemorrhage. The majority, 820/1260 (65.1%), fulfilled this definition within 1 h following birth, compared to 819/1391 (58.7%) applying the definition of ≥1 L blood loss and 37/845 (4.4%) applying the definition of ≥4 units of RBC. The definition persistent postpartum haemorrhage captured 430/471 adverse maternal outcomes (91.3%), compared to 471/471 (100%) for ≥1 L blood loss and 383/471 (81.3%) for ≥4 units of RBC. Persistent postpartum haemorrhage did not capture all adverse outcomes because of missing data on timing of initial, first-line treatment. Conclusion: The definition persistent postpartum haemo

Effects of infused methionine, lysine and rumen-protected methionine derivatives on nitrogen retention and wool growth of Merino wethers

Nitrogen( N) retentiooa ndw ool growthr ate( WGR)r esponsetso variousa minoa cidsa ndd erivativeas s well as protein sourcesw ered eterminedw ith six ruminallya nd six abomasallyfi stulatedM erino wethersin two balancedc rcss-over designe xperimentsT.h e six treatmentosf the first trial consistedo f a control( RC),r uminallyi nfused:m ethionine(R M), maleylm ethionine(R MM) and2 -methyl-malemyl ethionin(eR MMM),a sw ell aso there ssentiaalm inoa cidss uppliedb y a low (RFM: fish meal)a ndh ighd egradabldei etaryp roteins ource(R SOM:s unflower-oilcakmee al),r espectivelyT.h el atter two treatment(sA FM andA SOM,r espectivelya)n da control( AC) werei ncludedin thes econdtr ial asw ell asa bomasally infusiono f methionine(A M) and/orly sine( AL or AML). Six roughage-basdeide tsw erec ompiledto be iso-nutritiouas nd complementartoy thed ifferente atmentsa ndw eref ed at a maintenanclev el.L ive weightw asn ot affected(P > 0.10)b y anyt reatmenwt hereasth e apparenDt M digestibilityw ase nhance(dP < 0.05)w ith the inclusiono f fish meali n the drets (RFM: 56.'l/o; AFM: 5'7.SVoT)h. e percentagNe retained( 1 5.6a nd3 5.870v s. 26.IEo)d eqeased(P = 0.03)b y ruminally infusedm ethionine(R M) andi ncrease(dP = 0.M) by inclusiono f fish meal( RFM).A bomasallyin fusiono f methionine (AM) resultedin an increase(dP = 0.02)p ercentagNe retained(3 9.0%b) utt hei ntusiono flysine( AL) or both( AML) gave no respons(e2 6.5a nd3 6.64ov s.3}.lVo).WGRw ase nhancebdy 0.21! 0.05 mElcm2lda(yP = 0.0002)a nd0 .27t 0.05m g/ cm'?/da(yP = 0.0001)b y ruminallyin fusiono f derivative(sR MM andR MMM) andt hei nclusiono f naturapl roteins ources (RSOMa ndR FM), respectivelAy.b omasallyin fusiono f methionine(A M) anda mixtureo f aminoa cids( AML) asw ell as dietsc ontainingn aturapl roteins ource(sA SOMa ndA FM) increase(dP < 0.0004)W GR with 31, 35, 19a nd3 8%,r espectively, w hereasly sinei nfusion( AL) hadn o effect.M MM (2-methyl-malemyle thioninea)n df ish meals howg reatp otential as a sourceo f bypassm ethioninee,s peciallyto increasew ool growth( 307oa nd3 6-38Vo)w, hercasM M (maleylm ethionine)(127,)a nds unflower-oilcakmee al( 17-19%)appears to be about half as efficient. Stikstof( N)-retensieen wolgroeitemp(oW cTlresponst ot verskeiea minosureen -derivatea sookp roteibnbronnise m ets es ruminale en ses abomasaleg efistuleerdMe erinohamelsin twee gebalanseerdoeo rskakelproefontwerp-eksperimente bepaalD. ie sesb ehandelingvsa nd ie eerstee ksperimenhte tb estaa[u it 'n kontrole( RC),r uminaailn gedruptem; etionien (RM), maleiblmetionie(nR MM) en 2-metielmaleielmetion(ieRnM MM) sowela sa ndere ssensielaem inosurew at onderskeidelikd eur'n laags( RFM:v ismeel)e nh oogsd egradeerbadri€e etproteienbro(RnS OM:s onneblbmoliekoekmeveoro) rsien is. Laasgenoemdtew ee behandelilgs( AFM en ASOM, onderskeidelike)n 'n kontrole (AC) is in die tweede eksperimenint gesluita sooka bomasalien druppelinvga nm etionien(A M) er/of lisien( AL of AML). Sesr uvoergebaseerde di€tei s met inagnemingv and ie verskillendbee handelingosp 'n iso-voedingstofbassaisa mgestelr l teeno nderhoudspeil gevoer.L iggaamsmassias nie deure nigeb ehandelingb eihvloedn ie (P > 0.10) terwyl die skynbarev e.teerbaarheidv an die DM deurd ie insluitingv anv ismee(l RFM:5 6.7%,A FMi 57.57 a)i n die dietev erhoog( P < 0.05)i s. N-retensiea,s p ersentasiev anN ingeneem(1 5.6e n 35.8Vav s.26.17o),1,ste rlaag(P = 0.03)d eurr uminaailn gedruptem etionien(R M) en verhoog( P = 0.04)d eurd iei nsluitingv anv ismeelA. bomasalien druppelinvga nm etionien(A M) hetN -retensiea,s p ersentasie vanN ingeneem(3 9.07o)v,e rhoog( P = 0.02),m aard ie indruppelingva nl isien( AL) of albeia minosure(A ML) het geen respons(2 6.5e n 36.6Vov s.3O.lVog) ehadrt .e.W CT is meto nderskeidel0ik. 21t 0.05m g/cm'z/da(gP = 0.0002)e n 0.27t 0.05m g/cm'?/da(Pg = 0.0001d) eurr uminalein druppelinvga nd ied erivate(R MM enR MMM) end ie insluitingv ann atuurlike proteienbronn(eR SOMe nR FM) verhoogA. bomasalien druppelinvga nm etionien(A M) en 'n mengsevl ana minosure (AML) asookd ietew at natuurlikep roteibnbronn(Ae SOMe nA FM) bevath, etW GT meto nderskeidel3ik1 , 35, 19e t38Vo verhoog( P < 0.0004)t erwyl lisieni ndruppeling(A L) ge€ni nvloedg ehadh et nie.M MM (2-metiel-maleielmetionieenn) vismeelt oon grootp otensiaaal s bron vand eurvloeimetionievn€, ralo m wolgroeit e verhoog( 3O%e n 36-38qa)t,e rsyl maleielmetionie(nM M) (127r)e n sonneblomoliekoekm(e1e7l- 19%)o ngeveedri eh elftes od oeltreff€nwd as.Keywords: Amino acids, methionine, lysine, derivatives, nitrogen retention, wool growth, i nfusion, sheep