Wandering Spleen in a 47-year-old female treated by non-operative conservative management. Case report and literature review.

INTRODUCTION: Wandering spleen (WS) is a rare clinical condition found in less than 0.5 % of splenectomies and is characterized by ectopic location of the spleen within the abdomen or pelvis. It is always caused by excessive mobility brought on by the ligamentous laxity of its peritoneal attachments. Abdominal ultrasonography and computed tomography are the key imaging modalities for inquiry of WS. CASE PRESENTATION: We report the case of a 47-year-old woman who presented with painless abdominal swelling since the age of 6 years. An abdominal examination revealed a palpable, firm, mobile mass in the right lower abdomen approximately 15 × 15 cm in dimensions. A contrast CT scan of the abdomen revealed the absence of the spleen in the left upper quadrant. The patient was managed conservatively and followed for five years with favourable outcome. DISCUSSION: Failure of the dorsal mesogastrium to merge with the posterior abdominal wall in the second month of embryonic development is one of the reasons for WS. The nonsurgical conservative approach is limited to patients who are high-risk surgical candidates and have minimal symptoms and no complications. CONCLUSION: The good clinical outcome of our patient suggests that conservative non-surgical approach may be a reasonable alternative to unwarranted surgical intervention in selected clinically stable patients who have no evidence of splenic torsion or infarction, avoiding the possible complications of surgery.

Multivariate mixed-effects ordinal logistic regression models with difference-in-differences estimator of the impact of WORTH Yetu on household hunger and socioeconomic status among OVC caregivers in Tanzania.

BACKGROUND: Although most of the livelihood programmes target women, those that involve women and men have been evaluated as though men and women were a single homogenous population, with a mere inclusion of gender as an explanatory variable. This study evaluated the impact of WORTH Yetu (an economic empowerment intervention to improve livelihood outcomes) on household hunger, and household socioeconomic status (SES) among caregivers (both women and men) of orphaned and vulnerable children (OVC) in Tanzania. The study hypothesized that women and men respond to livelihood interventions differently, hence a need for gender-disaggregated impact evaluation of such interventions. METHODS: This is a secondary analysis of longitudinal data, involving caregivers' baseline (2016-2019) and follow-up (2019-2020) data from the USAID Kizazi Kipya project in 25 regions of Tanzania. Two dependent variables (ie, outcomes) were assessed; household hunger which was measured using the Household Hunger Scale (HHS), and Socioeconomic Status (SES) using the Principal Component Analysis (PCA). WORTH Yetu, a livelihood intervention implemented by the USAID Kizazi Kipya project was the main independent variable whose impact on the two outcomes was evaluated using multivariate analysis with a multilevel mixed-effects, ordinal logistic regression model with difference-in-differences (DiD) estimator for impact estimation. RESULTS: The analysis was based on 497,293 observations from 249,655 caregivers of OVC at baseline, and 247,638 of them at the follow-up survey. In both surveys, 70% were women and 30% were men. Their mean age was 49.3 (±14.5) years at baseline and 52.7 (±14.8) years at the follow-up survey. Caregivers' membership in WORTH Yetu was 10.1% at the follow-up. After adjusting for important confounders there was a significant decline in the severity of household hunger by 46.4% among WORTH Yetu members at the follow-up compared to the situation at the baseline (adjusted Odds Ratio (aOR) = 0.536, 95% Confidence Interval (CI) [0.521, 0.553]). The decline was 45.7% among women (aOR = 0.543 [0.524, 0.563]) and 47.5% among men (aOR = 0.525 [0.497, 0.556]). Regarding SES, WORTH Yetu members were 15.9% more likely to be in higher wealth quintiles at the follow-up compared to the situation at the baseline (aOR = 1.159 [1.128, 1.190]). This impact was 20.8% among women (aOR = 1.208 [1.170, 1.247]) and 4.6% among men (aOR = 1.046 [0.995, 1.101]). CONCLUSION: WORTH Yetu was associated with a significant reduction in household hunger, and a significant increase in household SES among OVC caregivers in Tanzania within an average follow-up period of 1.6 years. The estimated impacts differed significantly by gender, suggesting that women and men responded to the WORTH Yetu intervention differently. This implied that the design, delivery, and evaluation of such programmes should happen in a gender responsive manner, recognising that women and men are not the same with respect to the programmes.

Surgical excision of acquired urethral diverticulum and single-stage urethroplasty for a 32-year-old male. Case report and literature review.

INTRODUCTION: Urethral diverticulum (UD) is a saccular dilatation of the urethral wall, continuous with the true urethral lumen. It is categorized etiologically into congenital and acquired. The etiology of an acquired urethral diverticulum is thought to be secondary to trauma. The gold standard imaging modalities for diagnosis of UD are retrograde urethrogram (RGU) and micturating cystourethrogram (MCU). Management options include: nonoperative treatment, minimally invasive and open surgeries. Open surgeries comprise a primary anastomosis or, Substitution urethroplasty after UD excision, with the aim of excising the diverticulum, reestablishing the continuity of the urethra, and prevent urethrocutaneous fistula formation. We present a case of urethral diverticulum and bulbar urethral stricture successfully managed by surgical excision of UD and substitution urethroplasty. CASE PRESENTATION: We report a case of a 32-year-old man who had lower urinary tract symptoms following a traumatic urethral catheterization. Investigations done in a peripheral hospital revealed a short, bulbar urethral stricture and direct visual internal urethrotomy (DVIU) was done. Later he presented to us with urine retention, whereupon emergency suprapubic cystostomy was performed. After serial investigations, urethral diverticulectomy followed by single stage urethroplasty with ventral onlay buccal mucosa graft was done. He was followed for 12 months with good surgical outcome. DISCUSSION: The development of Acquired UD has been attributed to several possible factors: pelvic fractures, urethral strictures, straddle injuries, long-term urethral catheterization, endoscopic direct injuries, lower urinary tract infections, and urethral surgeries. Depending on the presentation and investigation findings, management of UD is planned. Conservative management is possible for uncomplicated asymptomatic UD if the patient consents to follow-up. Surgery to remove the diverticulum and urethral reconstruction are required for complicated symptomatic UD; these procedures vary from patient to patient and are individualized. CONCLUSION: It is important to base the choice to do surgery on the clinical presentation. Whether a concurrent urethral stricture is present is a critical factor in deciding on the best course of surgical treatment. In our case we opted to perform a substitution urethroplasty with ventral onlay buccal mucosa graft as our patient had a long bulbar urethral stricture proximal to the diverticulum.

Successful surgical excision of the accessory urethra in a 13-year-old boy with Effmann Type IIA-2 urethral duplication. Case report and literature review.

INTRODUCTION AND CLINICAL IMPORTANCE: Urethral duplication is a congenital anomaly characterized by the partial or full development of an auxiliary urethra as a second urethral channel varying in extent and location. The course of treatment for urethral duplication should be individualized for each patient based on the type of anomaly and the existence of symptoms. In most cases, if the ventral orthotopic urethra is normal, excision of the dorsal auxiliary urethra is almost always curative. CASE PRESENTATION: We report a case of a 13-year-old boy who presented with recurrent urinary tract infection, occasionally having drops of urine at an external pin hole meatal opening on the dorsum of the penile shaft. Several investigations were performed to confirm the presence of the dorsal accessory urethra. The patient underwent complete excision of the accessory urethra, and 12 weeks post-surgery the patient was completely asymptomatic. DISCUSSION: Urethral duplications are rare anomalies. These anomalies have been classified in various ways in the literature, including sagittal and lateral duplications, dorsal and ventral duplications. The sagittal plane is where the majority of urethral duplications occur. Based on the anatomic variation, clinical presentation and severity of the anomaly, urethral duplication treatment should be customized for each patient. An asymptomatic child may require no specific treatment. Total surgical excision of the dorsal accessory urethra appears to offer the best curative solution. CONCLUSION: Excision of the dorsal accessory urethra is usually curative when the ventral orthotopic urethra is normal. Thorough investigation before surgery is mandatory to determine the type of urethral duplication. The most common diagnostic procedures for urethral duplications include cystoscopy, KUB ultrasonography, and micturating cystourethrography. These procedures can help plan surgery, prevent complications such as neurovascular bundle injuries and urine incontinence, and improve patient self-esteem and quality of life.

Advanced prostate cancer with brain metastasis presenting with isolated severe headache without urinary symptoms.: Case report and literature review.

INTRODUCTION AND CLINICAL IMPORTANCE: Brain metastases from prostate cancer are uncommon, occurring in fewer than 1 % of cases of metastatic prostate cancer. Brain metastasis can cause cerebral edema, neurologic symptoms, and may be misdiagnosed as primary brain tumors on imaging if thorough investigations are not done. It is difficult to identify and diagnose brain metastasis from prostate cancer since the intracranial metastatic process and presentation are poorly understood and limited to case studies. Most patients with brain metastases from prostate cancer exhibit a variety of metastatic symptoms; however, this patient's presentation was defined by only isolated intense headache. Our goal is to draw attention to the uncommon instance of brain metastases from prostate cancer in addition to reviewing the literature on the advances in treatment for prostatic cancer with metastasis to the brain. CASE PRESENTATION: We report the case of a 67-year-old male with metastatic prostate adenocarcinoma into the brain, presenting with isolated severe headache with no prostate cancer symptoms. Following extensive radiologic examination, metastatic deposits were detected in the left side of the brain with multiple intracerebral and cerebellar vermis lesions. Multiplanar T2 weighted abdominal pelvic MRI visualized the primary lesion in the prostate which was confirmed by histology. After a month following surgical castration, the patient reported resolved headache and resumed his daily activities. The patient's serum PSA decreased from 7.8 ng/ml to 0.3 ng/ml during a 12-months follow-up with no neurological symptoms. CLINICAL DISCUSSION: Prostate cancer rarely causes brain metastases, and the percentage of all brain metastases that originate from prostate cancer is seldom updated. It can be difficult to distinguish between primary brain lesions and metastatic brain prostate cancer, particularly when there is just one lesion present. Despite the recently developed diagnostic approaches, symptomatic patients exhibit a variety of clinical manifestations that vary depending on the location of the metastatic focus. These manifestations include headache, seizures, and focal neurological deficits, in addition to some common non-focal manifestations like confusion and memory deficits. Our patient had a PSA of 7.8 ng/ml at the beginning and the DRE results were normal, clinically prostate cancer was not thought to be the main cause of brain metastasis. Abdominal pelvic MRI was performed to investigate the primary lesion and confirmed the presence of prostate cancer with extra prostatic extensions. Adenocarcinoma prostate cancer was found to be the main cause when histopathology was done. CONCLUSION: This report reviews the literature on brain metastases from prostate cancer and points out that while very rare, brain metastases from prostatic cancer do occur and should not be overlooked, particularly in light of the recent advancements in prostatic cancer therapies that may extend the patient's survival. Gadolinium-enhanced MRI is necessary to confirm or rule out brain metastases if it is suspected, as well as to monitor prostate cancer patients.

Isolated testicular tuberculosis mimicking testicular malignancy in a 45-year-old male treated at a tertiary hospital. Case report and literature review.

INTRODUCTION AND IMPORTANCE: Tuberculosis is prevalent in African countries especially in sub-Saharan Africa where HIV/AIDS is common. While Testicular tuberculosis is uncommon in the young as well as the elderly, pulmonary tuberculosis is commonly observed in these populations. History, physical examination, scrotal ultrasonography, and fine needle biopsy are important in diagnosis of suspected cases of testicular tuberculosis. Anti-TB therapy is the mainstay of treatment to ensure complete resolution of the lesion. However, in a few cases, orchidectomy is required for both diagnosis and treatment. When treating testicular tuberculosis, it is crucial to do a thorough assessment and investigations to exclude testicular malignancy because tuberculosis can present similarly to a testicular tumor. CASE PRESENTATION: We report a rare case of right sided isolated testicular tuberculosis in a 45-year-old male who came with right sided testicular pain and swelling. Blood workups and testicular tumor markers were all normal, scrotal ultrasound reported right heterogenous testicular mass with avascular areas of necrosis and septated fluid collections in the tunica vaginalis with features suggestive of testicular tumor. Right orchiectomy through inguinal approach was done, findings included testicular mass with pus pockets and caseous necrosis occupying the whole testis. Specimen was sent for histopathology which revealed chronic granulomatous inflammation, most likely tuberculosis, and ZN stain confirmed the diagnosis of testicular tuberculosis. In accordance with national TB guidelines, the patient had anti-TB medication for six months, and after 12-months serial follow-up, the patient had completely recovered. CLINICAL DISCUSSION: Genitourinary tuberculosis is the second most common form of extrapulmonary TB after lymph node tuberculosis. 0.5 % of genitourinary TB involves the testes; On the other hand, isolated testicular TB as presented in our patient, is extremely uncommon, thus may mimic other testicular conditions including testicular tumor, so the diagnosis is challenging. It is important to accurately diagnose testicular TB and differentiate it from other scrotal pathologies especially testicular malignancy as the management is totally different. Testicular tuberculosis is diagnosed by tissue Cytology using FNAC or after an orchidectomy. It requires early, regular, full course combined anti-tuberculosis treatment. The drug treatment method uses three to four anti-tuberculosis drugs for 6-9 months. Surgical treatment is necessary if there is no response to drug treatment or in cases of abscess formation. CONCLUSION: Testicular TB is a curable disease, but its diagnosis remains challenging. It is often missed owing to its non- specific symptoms. Thus, testicular TB should be suspected in patients with a notion of contagion or history of tuberculosis. Some of the radiological features are highly suggestive of testicular TB. FNAB could prevent unnecessary orchidectomy. In our case, the presentation was typically mimicking a testicular cancer and the patient underwent trans inguinal orchiectomy, and histology and ZN stain confirmed the diagnosis followed by subsequent six-month anti TB therapy.

A rare case report of ectopic-adrenal paraganglioma with inferior vena cava infiltration. Case report and literature review.

INTRODUCTION AND IMPORTANCE: Phaeochromocytomas are neuroendocrine neoplasms arising from chromaffin cells of the adrenal medulla and are known as intra-adrenal paragangliomas. On the contrary, paragangliomas are non-epithelial neuroendocrine neoplasms that produce other peptide hormones such as norepinephrine, epinephrine, and dopamine. In a setting with limited resources, such a condition may result in inaccurate diagnosis and treatment, which may lose a patient life if left untreated. In addition, PPGLs present a surgical challenge to many surgeons who are not thoroughly prepared. CASE PRESENTATION: We describe a case of extra-adrenal paraganglioma in a 27-year-old female who presented with symptoms of heartbeat awareness for almost a year and abdominal swelling for three months. Physical examination revealed a palpable mass around the umbilicus. Abdominal pelvic CT scan revealed a well-circumscribed mass in the central retroperitoneum displacing the IVC laterally and abdominal aorta medially with no invasion of surrounding structures. Results for pheochromocytoma workup showed elevated levels of 24-h urine Vanillylmandelic acid (VMA), and 24-h metanephrine excretion. Laparotomy through extended midline incision was done with successful excision of the tumor. The blood pressure, which was initially high normalized after surgery. DISCUSSION: The diagnosis of a malignant EAP is commonly made based on recurrence and the development of metastasis to lymph nodes or to other organs. Our patient presented with similar symptoms as pheochromocytoma. Compared to the commonly stated 10 % risk for pheochromocytomas, people with EAPs have been observed to have a 20 % to 50 % incidence of malignancy. EAPs account for at least 15 % of adult and 30 % of pediatric pheochromocytomas and are frequently found in the Zuckerkandl organ. Pheochromocytoma symptoms may manifest asymptomatically in patients with EAPs, or they may occur because of compression of nearby tissues. Surgical excision of the tumor is always the best option in managing EAP. CONCLUSION: Extra-adrenal paragangliomas can be successfully managed surgically, provided there is a multidisciplinary team, and the tumor location is well recognized and can reduce the chance of tumor metastasis.

Impacts of sustainable management on the spatial distributions of erosion susceptibility and probable sediment yield in a mixed-forested watershed.

Forest management practices play multifaceted roles in enhancing the geophysical properties that affect raindrop erosion in the watershed, and consequently, sediment deposition in the reservoir. The current work attempts to integrate empirical and physically-based modeling approaches to quantify the impacts of forest conservation on erosion risk and potential sediment accumulation in the mixed-forested Ogouchi Dam watershed in Japan. The reliability of the empirical model for estimating the total erodibility coefficient (TEr), as a function of various forest properties, was evaluated by applying the mathematical expression to multiple forest conditions and comparing the values to field-measured soil erosion rates. The spatial distribution of the empirically derived values showed that about 25.8% of the Government-managed forests and 45.1% of the private forests have higher risks of raindrop splash erosion compared to natural forests. The TEr value in each small Government-divided forest land (less than 5 ha) was then corresponded to the MUSLE management practice factor (MUSLE P) input in each hydrologic response unit (HRU) in the Soil and Water Assessment Tool (SWAT) model to create a sediment yield distribution map and to predict the amounts of sediment accumulation for different management scenarios. The spatial distribution of sediment yield for the base condition showed that 20.9% of the Government-managed forests and 61.6% of the private forests have higher probable amounts of sediment yield relative to the value simulated in the natural forest. A maximum cumulative sediment reduction of about 14.4% is likely attainable upon the complete control of the Government in the entire planted forest area. Overall, this study effectively utilized the field survey datasets to develop a robust empirical model for quantifying erosion risk and was able to couple the results to a GIS-based model that predicts the amounts of sediment yield under varying environmental conditions.

"A successful reconstruction of remnants of corporal bodies and penile urethra after Total Glans Penis amputation following surgical circumcision in a 5-year-old boy". A case report and literature review.

INTRODUCTION AND IMPORTANCE: Circumcision is the most common surgical procedure done in boys. Its complication varies from minor to severe. In most of African countries circumcision is often performed by traditional circumcisers. The management of penile glans amputation depends on the duration before presentation with auto-transplantation being the favorable management in acute phase of presentation. The amputation of the glans is a serious complication of circumcision because it can derange the urinary and sexual functions of a patient and may lead into psychological instability and low self-esteem. CASE PRESENTATION: We report a case of total glansectomy in a 5-year old boy who presented 12 months after surgical circumcision which was done by inexperienced medical personnel at his house. Patient presented with a pinhole urethra opening, missing glans, buried phallus with remnants of corporal bodies. Penile exploration was done, with successful significant phallus stump of about 5 cm, phallus reconstruction and meatoplasty was achieved. Partial Skin thickness grafting of the phallus stump was performed. At six- month follow up, the patient had both satisfactory cosmetic and functional outcomes. CLINICAL DISCUSSION: Total glansectomy is a rare surgical emergency with auto transplantation being the best option in acute management however successful outcome for a delayed glansectomy depends on proficient surgical penile exploration and comprehensive post operative care. Based on the clinical presentation, the goals of management for our patient were to achieve a largely patent urethral opening in the long term and to prevent further urethral meatal stenosis as well as achieving adequate phallus stump for sexual function. CONCLUSION: The amputation of the glans is a serious complication of circumcision because it can derange the urinary and sexual functions of a patient if neglected. Findings on this case report highlight the importance of raising awareness among traditional health care workers to prevent urinary and sexual function disabilities. Prevention of penile amputation can be prevented by providing proper training for circumcisers and providing public education for hospital circumcision.

Characterizing Non-governmental Organizations And Local Government Collaborations In Urban Forest Management Across Canada.

Urban forests are being threatened by rapid urbanization, biodiversity crises, and climate variability. In response, governments are increasingly collaborating with the public for solutions to these mounting challenges. Non-governmental organizations (NGOs) are dominant players in these collaborations because of their ability to supplement governments' expertize and resources and bring social and ecological issues to the forefront of civic agendas. Despite their growing visibility in urban forest management, there is a lack of attention directed to the forms and range of NGO relationships. This study focuses on addressing this gap and examining collaborations between local governments and NGOs in urban forest programming by characterizing their components including mandates, relationship ties, accountability, resource exchange, and power dynamics. We collected data using semi-structured interviews with three groups: leaders of NGOs, municipal government officials in an urban forest or public works departments, and urban-forest experts who have observed their interactions. The participants represent 32 individuals in nine Canadian cities. Our results indicate that NGO-government collaborations have relational ties and accountability processes that are both formal and informal in nature. Formality in collaborations is often associated with the amount of funding, proximity to government, or size of the NGO. In addition, our findings suggest that NGOs present an opportunity for local governments to supplement their resources and capacity. While the strength and formality of collaborations may be a product of NGO size and budgets, public servants should not hesitate to engage smaller, grassroots NGOs to realize their public service mandates. Characterizing the components of these governance processes provides a benchmark for practitioners participating in similar public-civic interactions and arms them with the knowledge to navigate collaborative decision-making.

Factors affecting caregivers' participation in support groups for people living with HIV in Tanzania.

Introduction: Support groups for people living with HIV (PLHIV) are essential for increasing adherence, retention, addressing their psychosocial needs and improving patient literacy. However, factors that influence participation of caregivers living with HIV (LHIV) in these groups are scarcely documented, particularly for those caring for orphans and vulnerable children (OVC). Methods: This study used baseline data collected between 1st October 2021 and 30th September 2022 from the PEPFAR/USAID-funded Adolescents and Children HIV Incidence Reduction, Empowerment and Virus Elimination (ACHIEVE) project in Tanzania to investigate factors that affect participation of caregivers LHIV in support groups for PLHIV. A total of 74,249 HIV-positive OVC caregivers who were already receiving antiretroviral therapy (ART) and had a confirmed care and treatment centre identification number were included in the analysis. Factors affecting group participation were identified through multilevel analysis using multivariable mixed-effects logistic regression. Results: Results showed that 84.2% of the caregivers were participants in the support groups for PLHIV. Their mean age was 36 years, and the majority (82.1%) were female. Multivariable analysis revealed that participation in the groups was more likely among caregivers living in urban areas (aOR = 1.39 [1.24, 1.55]), with primary education (aOR = 1.17 [1.07, 1.28]), and without disabilities (aOR = 0.62 [0.47, 0.82]). However, participation was less likely among widowed (aOR = 0.91 [0.84, 0.999]), single or unmarried (aOR = 0.86 [0.78, 0.95]), and those with secondary education or higher levels than never attended (aOR = 0.69 [0.60, 0.80]), moderate hunger (aOR = 0.86 [0.79, 0.93]), and those aged 30 years or older (p< 0.001). Discussion: A sizeable proportion (15.8%) of the caregivers were not in support groups for PLHIV, ranging from 12.3% among those in households with severe hunger to 29.7% among disabled ones. The study highlights the need for tailored interventions to increase participation in support groups for PLHIV, particularly for caregivers who are disabled, live in rural areas, are older, widowed, and/or unmarried, and those in poor households.

Drivers of inappropriate antibiotic use in low- and middle-income countries.

Antimicrobial resistance (AMR) is a global security threat that accounts for about 700 000 deaths annually. Studies have shown that antimicrobial resistance could result in a 2% to 3.5% reduction in global Gross Domestic Product by 2050 and a loss of between 60 and 100 trillion US dollars, worth of economic output resulting in significant and widespread human suffering. Low- and middle-income countries (LMICs) will be worse hit by an unchecked rise of AMR. For example, it is predicted that AMR could kill about 4.1 million people in Africa by 2050 if it is not curbed. Similarly rising rates of AMR will lead to increased treatment costs and an inability to attain universal health coverage, in LMICs with fragile health systems. Sadly, AMR is driven by the inappropriate use of antimicrobials, especially antibiotics. Inappropriate antibiotic use is a pertinent problem in LMICs where regulatory frame works are weak. Inappropriate antibiotic use in LMICs is a multifaceted problem that cuts across clinical and veterinary medicine and agriculture. Therefore, efforts geared at curbing inappropriate antibiotic use in LMICs must identify the factors that drive this problem (i.e. inappropriate antibiotic use) in these countries. A clear knowledge of these factors will guide effective policy and decision making to curb inappropriate antibiotic use and ultimately AMR. The focus of this review is to discuss the factors that drive inappropriate antibiotic use in LMICs.

Antivenom access impacts severity of Brazilian snakebite envenoming: A geographic information system analysis.

BACKGROUND: Snakebite envenoming (SBE) is a neglected tropical disease capable of causing both significant disability and death. The burden of SBE is especially high in low- and middle-income countries. The aim of this study was to perform a geospatial analysis evaluating the association of sociodemographics and access to care indicators on moderate and severe cases of SBE in Brazil. METHODS: We conducted an ecological, cross-sectional study of SBE in Brazil from 2014 to 2019 using the open access National System Identification of Notifiable Diseases (SINAN) database. We then collected a set of indicators from the Brazil Census of 2010 and performed a Principal Component Analysis to create variables related to health, economics, occupation, education, infrastructure, and access to care. Next, a descriptive and exploratory spatial analysis was conducted to evaluate the geospatial association of moderate and severe events. These variables related to events were evaluated using Geographically Weighted Poisson Regression. T-values were plotted in choropleth maps and considered statistically significant when values were <-1.96 or >+1.96. RESULTS: We found that the North region had the highest number of SBE cases by population (47.83/100,000), death rates (0.18/100,000), moderate and severe rates (22.96/100,000), and proportion of cases that took more than three hours to reach healthcare assistance (44.11%). The Northeast and Midwest had the next poorest indicators. Life expectancy, young population structure, inequality, electricity, occupation, and more than three hours to reach healthcare were positively associated with greater cases of moderate and severe events, while income, illiteracy, sanitation, and access to care were negatively associated. The remaining indicators showed a positive association in some areas of the country and a negative association in other areas. CONCLUSION: Regional disparities in SBE incidence and rates of poor outcomes exist in Brazil, with the North region disproportionately affected. Multiple indicators were associated with rates of moderate and severe events, such as sociodemographic and health care indicators. Any approach to improving snakebite care must work to ensure the timeliness of antivenom administration.

Determinants of viral load suppression among orphaned and vulnerable children living with HIV on ART in Tanzania.

Introduction: In Tanzania, only 66% children 0-14 years living with HIV know their HIV status, 66% are on treatment while 47% of children on ART are virally suppressed. Although retention on ART and poor adherence remain a challenge for children living with HIV, orphans and vulnerable children (OVC) face a greater limitation of access to and utilization of comprehensive HIV care and treatment. In response to this, the current study assessed the determinants of viral load suppression (VLS) among OVC aged 0-14 years living with HIV enrolled in HIV interventions. Methods: This was a cross-sectional study that used secondary data collected by the USAID Kizazi Kipya project in 81 district councils of Tanzania. Included in this study are 1,980 orphans and vulnerable children living with HIV (OVCLHIV) (0-14 years) enrolled and served by the project for 24 months. Data analysis involved multivariable logistic regression, with viral load suppression as the outcome of interest and HIV interventions as the main independent variables. Results: The overall VLS rate among the OVCLHIV was 85.3%. This rate increased from 85.3, 89.9, 97.6 to 98.8% after 6, 12, 18, and 24 months of retention on ART, respectively. Similar rates were observed as the duration of adherence to ART increased. In the multivariable analysis, OVCLHIV attending people living with HIV (PLHIV) support groups were 411 times more likely to be virally suppressed than those not attending (aOR = 411.25, 95% CI 168.2-1,005.4). OVCLHIV with health insurance were 6 times more likely to achieve viral suppression than those without (aOR = 6.05, 95% CI 3.28-11.15). OVCLHIV with >95% adherence to ART were 149 times more likely to be virally suppressed than those not adherent to ART (aOR = 148.96, 95% CI 42.6-520.6, p < 0.001). Other significant factors included food security and family size. OVCLHIV reached by the different HIV community-based interventions were more likely to be virally suppressed than those who were not. Discussion: To advance viral suppression, efforts should be made to ensure that all OVCLHIV are reached by community-based interventions as well as integrating food support in HIV treatment interventions.

River dataset as a potential fluvial transportation network for healthcare access in the Amazon region.

Remote areas, such as the Amazon Forest, face unique geographical challenges of transportation-based access to health services. As transportation to healthcare in most of the Amazon Forest is only possible by rivers routes, any travel time and travel distance estimation is limited by the lack of data sources containing rivers as potential transportation routes. Therefore, we developed an approach to convert the geographical representation of roads and rivers in the Amazon into a combined, interoperable, and reusable dataset. To build the dataset, we processed and combined data from three data sources: OpenStreetMap, HydroSHEDS, and GloRiC. The resulting dataset can consider distance metrics using the combination of streets and rivers as a transportation route network for the Amazon Forest. The created dataset followed the guidelines and attributes defined by OpenStreetMap to leverage its reusability and interoperability possibilities. This new data source can be used by policymakers, health authorities, and researchers to perform time-to-care analysis in the International Amazon region.

River dataset as a potential fluvial transportation network for healthcare access in the amazon region

Remote areas, such as the Amazon Forest, face unique geographical challenges of transportation-based access to health services. As transportation to healthcare in most of the Amazon Forest is only possible by rivers routes, any travel time and travel distance estimation is limited by the lack of data sources containing rivers as potential transportation routes. Therefore, we developed an approach to convert the geographical representation of roads and rivers in the Amazon into a combined, interoperable, and reusable dataset. To build the dataset, we processed and combined data from three data sources: OpenStreetMap, HydroSHEDS, and GloRiC. The resulting dataset can consider distance metrics using the combination of streets and rivers as a transportation route network for the Amazon Forest. The created dataset followed the guidelines and attributes defined by OpenStreetMap to leverage its reusability and interoperability possibilities. This new data source can be used by policymakers, health authorities, and researchers to perform time-to-care analysis in the International Amazon region.

Rates and Determinants of Retention on ART Among Orphans and Vulnerable Children Living With HIV in Tanzania.

Despite the global progress in response to HIV and AIDS, notable challenges remain for children, especially identification, linkage, and retention in HIV care and treatment services. To succeed in pediatric HIV programming requires the linkage and retention of the children in those services over time. This study assessed the level of retention to antiretroviral therapy (ART) and its associated factors among orphans and vulnerable children living with HIV (OVCLHIV) in Tanzania. Data were obtained from the USAID Kizazi Kipya project that collected pediatric ART data from October 2017 to October 2019 in 81 district councils of Tanzania. Community-based volunteers supported the linkage and retention of the OVCLHIV on ART. Analysis of on-ART status was conducted in a cohort of OVCLHIV aged 0-20 years enrolled in the project and monitored for 24 months. OVCLHIV who remained on ART until the end of the follow-up period were referred to as "retained," otherwise, "not retained". Multivariable analysis was conducted using logistic regression, adjusting for baseline characteristics. Of the 5,304 OVCLHIV analyzed, the mean age was 13.1 years, 51.5% were female, and 72.2% were living with female caregivers. Their overall rate of retention on ART over the 24 months was 86.7%. Multivariable analysis showed that as the higher frequency of home visit by the project staff increased, the likelihood of retention increased by 8% [adjusted odds ratio (aOR) = 1.08, 95% CI 1.06-1.11, p < 0.001]. Membership in people living with HIV (PLHIV) support groups was associated with a higher likelihood of retention compared to nonmembership (aOR = 3.31, 95% CI 2.60-4.21, p < 0.001). Children in larger family size were 22% less likely to sustain ART (aOR = 0.78, 95% CI 0.72-0.84, p < 0.001). Urban OVCLHIV were 18% less likely to remain on ART than their rural counterparts (aOR = 0.82, 95% CI 0.69-0.98, p = 0.030). Remaining on ART was 49% more likely for OVC in economically better-off households than those in destitute households (aOR = 1.49, 95% CI 1.22-1.81, p < 0.001). Male OVC were 17% less likely to be retained on ART than their female counterparts (aOR = 0.83, 95% CI 0.71-0.99, p = 0.033). Community-based OVC support resulted in a high pediatric retention rate over the 24 months of follow-up. While key enablers of retention were higher frequency of home visits by the project volunteer, participation in PLHIV support groups, and better economic status, large family sizes, urban place of residence, and male gender of the OVC were barriers. This study brings useful evidence to inform strategies for advancing retention of OVCLHIV on ART for their better health outcomes and overall wellbeing.

Real-time luminescence enables continuous drug-response analysis in adherent and suspension cell lines.

The drug-induced proliferation (DIP) rate is a metric of in vitro drug response that avoids inherent biases in commonly used metrics such as 72 h viability. However, DIP rate measurements rely on direct cell counting over time, a laborious task that is subject to numerous challenges, including the need to fluorescently label cells and automatically segment nuclei. Moreover, it is incredibly difficult to directly count cells and accurately measure DIP rates for cell populations in suspension. As an alternative, we use real-time luminescence measurements derived from the cellular activity of NAD(P)H oxidoreductase to efficiently estimate drug response in both adherent and suspension cell populations to a panel of known anticancer agents. For the adherent cell lines, we collect both luminescence reads and direct cell counts over time simultaneously to assess their congruency. Our results demonstrate that the proposed approach significantly speeds up data collection, avoids the need for cellular labels and image segmentation, and opens the door to significant advances in high-throughput screening of anticancer drugs.