The impact of the COVID-19 pandemic on health service use in sub-Saharan Africa.

SETTING: Six hospitals in four sub-Saharan African countries. OBJECTIVE: To examine the indirect effects of COVID-19 on health service utilisation and to explore the risk of bias in studies on prediction models. DESIGN: Monthly data were analysed using interrupted time-series modelling. We used linear mixed-effect models for the analysis of antenatal care visits, institutional deliveries, vaccinations, outpatient visits and hospital admissions, and generalised linear mixed-effect models for hospital mortality. RESULTS: During 2018-2020, the six hospitals recorded a total of 57,075 antenatal care visits, 38,706 institutional deliveries, 312,961 vaccinations, 605,925 out-patient visits and 143,915 hospital admissions. The COVID-19 period was associated with decreases in vacci-nations (- 575 vaccinations, P < 0.0001), outpatient visits (- 700 visits, P < 0.0001) and hospital admission (- 102 admission, P = 0.001); however, no statistically significant effects were found for antenatal care visits (P = 0.71) or institutional deliveries (P = 0.14). Mortality rate increased by 2% per month in the pre-COVID-19 period; however, a decreasing trend (by 2% per month) was observed during the COVID-19 period (P = 0.004). Subgroup and sensitivity analyses broadly confirmed the main findings with only minor inconsistencies. A reduction in outpatient visits was also observed in hospitals from countries with a higher Stringency Index and in urban hospitals. CONCLUSIONS: The pandemic resulted in a reduction in health service utilisation. The decreases were less than anticipated from modelling studies.

CONTEXTE: Six hôpitaux de quatre pays d'Afrique subsaharienne. OBJECTIF: Examiner les effets indirects de la COVID-19 sur l'utilisation des services de santé et analyser le risque de biais dans les études utilisant des modèles de prédiction. MÉTHODES: Des données mensuelles ont été analysées en utilisant une modélisation de séries chronologiques interrompues. L'analyse principale a mis en place des modèles linéaires à effets mixtes (pour les consultations anténatales, les accouchements en institutions, les vaccinations, les consultations ambulatoires et les admissions à l'hôpital) et des modèles linéaires généralisés à effets mixtes (pour la mortalité hospitalière). RÉSULTATS: En 2018­2020, les six hôpitaux ont enregistré un total de 57 075 consultations anténatales, 38 706 accouchements en institutions, 312 961 vaccinations, 605 925 consultations ambulatoires et 143 915 admissions hospitalières. La période de la COVID-19 a été associée à une baisse des vaccinations (− 575 vaccinations, P<0,0001), des consultations ambulatoires (− 700 consultations, P < 0,0001) et des admissions hospitalières (− 102 admissions, P = 0,001). Cependant, aucun effet statistiquement significatif n'a été observé pour les consultations anténatales (P = 0,71) ou les accouchements en institutions (P = 0,14). Le taux de mortalité augmentait de 2% par mois avant la période de la COVID-19, mais nous avons observé une tendance à la baisse (de 2% par mois) pendant la période de la COVID-19 (P = 0,004). Les analyses des sous-groupes et de sensibilité ont globalement confirmé les résultats principaux ; seules des incohérences mineures ont été observées. Une diminution des consultations ambulatoires a également été observée dans les hôpitaux des pays dont l'Indice de sévérité des mesures publiques était plus élevé, ainsi que dans les hôpitaux urbains. CONCLUSIONS: La pandémie a été associée à une utilisation réduite des services de santé. Ces diminutions étaient moindres que celles anticipées par les études de modélisation.

Viral hepatitis, HIV, human herpes virus and Treponema pallidum infection in haemodialysis patients from Kosovo, 2005.

The serological status of hepatitis viruses and other infectious diseases in the 66 dialysed patients of one haemodialysis unit in Kosovo were studied, comparing the data with a large group of blood donors and out-patients. All dialysed patients were hepatitis A virus (HAV) positive. Prevalence of hepatitis B surface antigen (HBsAg), hepatitis B surface antibodies (anti-HBs), and hepatitis B core antibodies (anti-HBc) was 14 of 66, 21% (95% confidence interval (CI): 12-33%), 5 of 66, 8% (95%CI: 5-22%), and 50 of 66, 76% (95%CI: 64-85%), respectively. Antibodies to hepatitis C virus (anti-HCV) prevalence was 57 of 66, 86% (95%CI: 76-94%). No human immunodeficiency virus (HIV) positive case was found. Prevalence of past herpes simplex virus type 2 (HSV-2) infection was 29% (95%CI: 18-41%). Two patients (3%, 95%CI: 0-10%) were positive for Treponema pallidum and 18% (95%CI: 10-30%) were human herpesvirus 8 (HHV-8) antibody positive. Four hundred and fifty-two subjects were recruited for comparison. Markers of past HAV infection was associated with haemodialysis (Fisher s exact test p-value=0.037). Dialysed patients were at a higher risk of being HBsAg positive than others: the sex- and age-adjusted odds ratio (OR) was 5.18 (95%CI: 1.87-14.32). Anti-HBc positivity was strongly associated with haemodialysis: the sex- and age-adjusted OR was 6.43 (95%CI: 3.22-12-85). Anti-HCV positivity was 86% and 1% in presence and absence of haemodialysis, respectively. The Fisher s exact test for association proved a strong association between haemodialysis and HCV (p-value<0.0001). The OR for association between haemodialysis and HSV-2 positivity was 3.20 (95%CI: 1.46-7.00). Significant associations were also observed between haemodialysis status and antibodies to Treponema pallidum (Fisher s exact test p-value=0.044). In Kosovo, the prevalence of viral hepatitis infection and other viral infections and Treponema pallidum among dialysed patients is high, indicating major ongoing nosocomial transmission.

Aortocardiac fistulas complicating infective endocarditis.

This study sought to determine the clinical and echocardiographic features, surgical approach, and outcome of patients with infective endocarditis complicated with aortocardiac fistulas among a series of 346 consecutive cases between 1988 and 1998. Nine patients (2%) were found to have aortocardiac fistulas complicating infective endocarditis caused by highly pyogenic pathogens (4 patients had ruptured abscesses of the right sinus of Valsalva, 3 had fistulous communications from the left coronary sinus, and 1 had a fistulized abscess in the noncoronary sinus). Mortality in these patients was very high (55%), even when surgery was attempted early in the course of the disease and reconstructive procedures were implemented.

Study of 2708 heroin-related deaths in north-eastern Italy 1985-98 to establish the main causes of death.

AIMS: To ascertain the causes of deaths among a very large cohort of heroin injecting drug users (IDUs) who, from 1985 to 1998, attended 36 Public Health Authority Centres for Drug Users (PCDUs) in north-eastern Italy. DESIGN: Retrospective analysis of data, obtained from the Annual Register of each Centre and the Municipal Registry Office of each local health district. SETTING: Thirty-six PCDUs in north-eastern Italy and Medical Service for Addictive Disorders of the University of Verona. PARTICIPANTS: All IDUs who had sought medical care at least once in the PCDUs during the study period. FINDINGS: Of 2708 deaths, overdose was found to be the major cause (37%), followed by AIDS (32.5%) and road accidents (9.4%). The percentage of deaths due to AIDS increased steadily from 2.7% in 1985 to 42.2% in 1996, and then decreased to 16.9% in 1998. Deaths due to overdose remained almost constant. The average age of death per year rose from 26 in the mid eighties to 34 in 1998. The mortality rate among IDUs proved much higher compared to the general population of the same age (13-fold, 95% CI, 11.3-14.6). The proportion of all deaths attributable to regular use of illegal opiates in the 15-34 age group in the general population in 1991 was 16%. HIV prevalence was not a significant factor in suicides and deaths by overdose. CONCLUSIONS: The mortality rate was 13 times greater than in the general population. To be female and to have dropped out of any kind of treatment proved an important risk factor for overdose. The fall in deaths from AIDS enhances the problem to prevent and treat HCV infection. Decisions in drug projects, in research and in training should be influenced by the strikingly high percentage of deaths due to drug use.

Carbamimidothioic acid phenylmethyl ester salts and their N,N'-tetramethyl derivatives as possible antimicrobial agents.

A series of carbamimidothioic acid phenylmethyl ester salts and their N,N'-tetramethyl derivatives were synthesized, many of which exert an interesting inhibiting action on Gram-positive and Gram-negative bacteria and also on fungi. This activity is noteworthy in view of the large number of strains antagonized; the (3,4,5-trichlorophenyl) methyl ester chloride of carbamimidothioic acid appeared to be the best term of the series. The possible influence on this activity of decomposition kinetics to the corresponding mercapto-derivatives was investigated and compared with that of a series of N,N'-tetramethyl derivatives of previously studied carbamimidothioic acid phenyl ester salts.

[Guidelines on drug donations are not sufficient for effective coordination: the case of Mostar in former Yugoslavia]. / Le linee guida sulla donazione di farmaci non sono sufficienti per un coordinamento efficace: il caso di Mostar nella ex Yugoslavia.

This article deals with the problem of restoring and repairing the supply and distribution of drugs, a vital service damaged by long-term conflicts. During the post-war situation in Bosnia the Authors have been actively involved in the implementation of the Drugs Management Programme whose principal aims were as follows: 1) rationalise the arrival and storage of new drugs; 2) utilise efficiently the stocks of drugs and medical materials at hand; 3) cope with the steady post-war decrease of humanitarian aid drug donations; 4) eliminate the large quantities of expired or inappropriate drugs. The experience stresses the need that all EU countries adopt as far as possible the strict WHO guidelines in their donations to countries in emergency situations. However a very flexible organisation should be set up immediately after the conflict in order to tackle all the problems that, no doubt, will appear in the aftermath of a war.

[The significance of the isolated anti-HBc carrier. A study of 1797 drug addicts. The Intersert Group of Scientific Collaboration]. / Significato del portatore dell'anti-HBc isolato. Studio in 1797 tossicodipendenti. Gruppo Intersert di Collaborazione Scientifica.

From 1985 through 1992 the following hepatitis B markers HBsAg, anti-HBs and anti-HBc were evaluated in 1797 injecting drug users (IDUs) attending 8 Centers for drug addicts in the Veneto region (north-east Italy). Among all IDUs, 1004 (56%) proved to be positive for at least one of the above markers. In particular our aim was to study the carriers of only anti-HBc. At entry, among these 1004 IDUs, 294 (29%) showed only the anti-HBc; 141 IDUs of them have been followed for a period of time: 77% remained without any marker change and 23% showed the appearance of anti-HBs. Subsequently, other 75 IDUs became carrier only of the anti HBc, for the following reasons: loss of anti-HBs (57%) or HBsAg (15%) appearance only of anti-HBc (28%). No carrier of only anti-HBc seroconverted for HBsAg. The evaluation of our data supports the hypothesis that the carrier status of the only anti-HBc prevents from reinfection by HBV and therefore these subjects do not need vaccination.

Open access for operational research publications from low- and middle-income countries: who pays?

Open-access journal publications aim to ensure that new knowledge is widely disseminated and made freely accessible in a timely manner so that it can be used to improve people's health, particularly those in low- and middle-income countries. In this paper, we briefly explain the differences between closed- and open-access journals, including the evolving idea of the 'open-access spectrum'. We highlight the potential benefits of supporting open access for operational research, and discuss the conundrum and ways forward as regards who pays for open access.

Les articles de journaux en accès libre visent à assurer la dissémination large de nouvelles connaissances et de rendre leur accès libre de façon à pouvoir être utilisées rapidement pour améliorer la santé des populations, surtout dans les pays à revenu faible ou moyen. Dans cet article, nous expliquons briêvement les différences entre les publications à accès limité et à accès libre, notamment l'idée en gestation de « spectre d'accès libre ¼. Nous soulignons les bénéfices potentiels du soutien à l'accès libre pour la recherche opérationnelle et ensuite discutons la question de qui paye pour cet accès et la recherche de solutions.

El propósito de las publicaciones en las revistas de acceso libre es lograr una amplia difusión de los nuevos conocimientos mediante el acceso libre y oportuno, de manera que los avances se puedan aplicar a fin de mejorar la salud de las personas, sobre todo en los países de bajos y medianos ingresos. En el presente artículo se explican brevemente las diferencias entre las revistas de acceso libre y acceso restringido y se analiza además la idea evolutiva del 'espectro del acceso libre'. Se destacan las ventajas que puede ofrecer el respaldo al libre acceso a la investigación operativa y se analiza luego el dilema y las opciones que pueden permitir progresar con respecto a la fuente de financiamiento del libre acceso.

Prevalence of antibodies to phleboviruses and flaviviruses in Peja, Kosovo.

In order to investigate the current and past activity of phlebovirus and flavivirus in Kosovo, a seroprevalence study among 200 blood donors was performed. Positive results were obtained for the phleboviruses TOSV and SFNV, and for a flavivirus of the Japanese Encephalitis group. No positive results for TBEV were observed.

Association between depressive mood and cigarette smoking in a large Italian sample of smokers intending to quit: implications for treatment.

OBJECTIVE: The aim of the study is to assess the prevalence and degree of depression at baseline of a large cohort of smokers intending to quit. METHODS: A cross-sectional investigation was carried out on a population of 757 smokers attending the Medical Service for Addictive Disorders, at Verona University Hospital. The degree of nicotine addiction was measured by the Fagerstrom Test of Nicotine Dependence (FTND) and current mood tested by the Self-rating Depression Scale (SDS), a commonly used and well validated instrument to assess depressive mood. RESULTS: Two hundred and twenty-two subjects (30.3%) were depressed at baseline (SDS test score > or = 50). Bivariate analysis, using the SDs score dichotomised at the cut-off of 50 as dependent variable, shows that female gender (p=0.01) and widowhood (p<0.001) were correlated to depression. Logistic regression analysis confirms the correlation between depression and female gender (OR=2.03, IC 95%=1.42-2.88, p<0.001) and between depression and widowhood, with the greatest risk of depression among widows and widowers (OR=3.22, IC 95%=1.01-10.27, p<0.048). CONCLUSIONS: The study showed a high degree of pre-treatment depression in smokers intending to quit. Although the association between depression and nicotine dependence has been consistently reported many times, and it is well known that depressed subjects find it more difficult to quit, most guidelines seem not to consider this connection. These findings suggest the need for baseline assessment of depression by screening all smokers seeking assistance in quitting, a priority health objective because smoking is the number one avoidable killer in developed countries.

Staphylococcus lugdunensis infective endocarditis: description of 10 cases and analysis of native valve, prosthetic valve, and pacemaker lead endocarditis clinical profiles.

OBJECTIVE: To evaluate the incidence and the clinical and echocardiographic features of infective endocarditis (IE) caused by Staphylococcus lugdunensis and to identify the prognostic factors of surgery and mortality in this disease. DESIGN: Prospective cohort study. SETTING: Study at two centres (a tertiary care centre and a community hospital). PATIENTS: 10 patients with IE caused by S lugdunensis in 912 consecutive patients with IE between 1990 and 2003. METHODS: Prospective study of consecutive patients carried out by the multidisciplinary team for diagnosis and treatment of IE from the study institutions. English, French, and Spanish literature was searched by computer under the terms "endocarditis" and "Staphylococcus lugdunensis" published between 1989 and December 2003. MAIN OUTCOME MEASURES: Patient characteristics, echocardiographic findings, required surgery, and prognostic factors of mortality in left sided cases of IE. RESULTS: 10 cases of IE caused by S lugdunensis were identified at our institutions, representing 0.8% (four of 467), 1.5% (two of 135), and 7.8% (four of 51) of cases of native valve, prosthetic valve, and pacemaker lead endocarditis in the non-drug misusers. Native valve IE was present in four patients (two aortic, one mitral, and one pulmonary), prosthetic valve aortic IE in two patients, and pacemaker lead IE in the other four patients. All patients with left sided IE had serious complications (heart failure, periannular abscess formation, or shock) requiring surgery in 60% (three of five patients) of cases with an overall mortality rate of 80% (four of five patients). All patients with pacemaker IE underwent combined medical treatment and surgery, and mortality was 25% (one patient). In total 59 cases of IE caused by S lugdunensis were identified in a review of the literature. The combined analysis of these 69 cases showed that native valve IE (53 patients, 77%) is characterised by mitral valve involvement and frequent complications such as heart failure, abscess formation, and embolism. Surgery was needed in 51% of cases and mortality was 42%. Prosthetic valve endocarditis (nine of 60, 13%) predominated in the aortic position and was associated with abscess formation, required surgery, and high mortality (78%). Pacemaker lead IE (seven of 69, 10%) is associated with a better prognosis when antibiotic treatment is combined with surgery. CONCLUSIONS: S lugdunensis IE is an uncommon cause of IE, involving mainly native left sided valves, and it is characterised by an aggressive clinical course. Mortality in left sided native valve IE is high but the prognosis has improved in recent years. Surgery has improved survival in left sided IE and, therefore, early surgery should always be considered. Prosthetic valve S lugdunensis IE carries an ominous prognosis.

The immune response of the chicken to vaccination against Newcastle disease with live virus and killed emulsified virus in relation to the length of time between two vaccinations.

Chicks with no specific antibodies were initially y vaccinated against Newcastle disease at 21 days old with the live 'La Sota' strain or beta-propiolactone-killed virus emulsified in mineral oils. After a second vaccination 15 or 21 days later with the live "La Sota' strain, the interference produced by the first vaccination on the antibody production induced by the second vaccination was investigated. It was found that the live virus vaccine used for the second immunization was affected by the antibodies induced by the first vaccination, as shown in previous work utilizing 1-day-old chicks.

[Antimicrobial effect of derivatives of 1,2,4-benzothiadiazin-1,1-dioxide. VII]. / Azione antimicrobica di derivati dell'1,2,4-benzotiadiazin-1,1-diossido. Nota VII.

Series of alkyl derivatives of the following have been prepared: 5,7-dichloro- [compounds (II leads to V)], 6-methyl- [compounds (VI leads to IX)] and 6-methoxy-3-mercapto-1,2,4-benzothiadiazine-1,1-dioxide [compounds (X leads to XIII)]. The products were tested for antimicrobial activity. Studies were also made of the corresponding 3-mercapto precursors (XIV, XV, XVI) and the relative 3-picolinium salts (XVII, XVIII, XIX) and also of the 3-picolinium salts of 6-chloro-, 7-chloro- and 6,7-dichloro-3-mercapto-1,2,4-benzothiadiazine-1,1-dioxide (XX, XXI, XXII). Some of the 3-alkylmercapto compounds, and especially the 5,7-dichloro derivative, inhibited various strains of Gram-positive bacteria of the genus Staphylococcus, while the same substances proved much less effective against the genera Streptococcus and Diplococcus. Antimicrobial activity appeared to be influenced by the length of the alkyl chain as well as by the nature and position of the substituents on the benzene ring. The compounds proved inactive against the Gram-negative schizomycetes (Salmonella, Shigella, Escherichia, Proteus, Pseudomonas. Enterobacter, Klebsiella, Serratia, Yersinia, Providencia) and against yeasts (Candida) with the exception of compound (V) which showed slight bacteriostatic action against three strains of Candida albicans.

S-Aryl(tetramethyl)isothiouronium salts as possible antimicrobial agents--III.

A series of S-Aryl(tetramethyl)isothiouronium salts were prepared and evaluated in vitro for antimicrobial activity. Some compounds revealed interesting inhibiting action on Gram-positive bacteria which is noteworthy in view of the large number of strains antagonized and of the low MIC values. The possible influence of decomposition kinetics to the corresponding mercaptoderivatives was intestigated and compared with those of salts previously studied.

[Antimicrobial activity of derivatives of 1,2,4-benzothiadiazine-1,1-dioxide. VIII]. / Azione antimicrobica di derivati dell'1,2,4-benzotiadiazin-1,1-diossido. Nota VIII.

The antimicrobial activity of a series of fluoro derivatives of benzothiadiazine and sulfonamides was studied. The compounds tested can be grouped as: a) 3-alkylmercapto derivatives of 6-trifluoromethyl-1,2,4-benzothiadiazine-1,1-dioxide (III leads to VI); the 3-mercapto precursor (VII) and the related 3-picolinic salt (VIII); b) 3-trifluoromethyl derivatives of 1,2,4-benzothiadiazine-1,1-dioxide and of its benzene substituted derivatives (IX leads to XVI); c) trifluoroacetylaminobenzenesulfonamides (XVII leads to XXV). Two of the 3-alkylmercapto compounds [(V) and (VI)] showed marked inhibitory activity against some strains of Staphylococcus, Streptococcus and Diplococcus. None of the compounds tested proved active against Gram-negative schizomycetes (genera Salmonella, Shigella, Escherichia, Proteus, Pseudomonas, Enterobacter, Klebsiella, Serratia, Yersinia, Providencia) or against yeasts (Candida).

Synthesis and antimicrobial activity of monoalkylcarbamic and thiocarbamic esters of 3-mercapto-1,2,4-benzothiadiazine-1,1-dioxide and of its Bz-derivatives.

A new series of monoalkylcarbamic esters of 3-mercapto-1,2,4-benzothiadiazine-1,1-dioxide (I) and of its 6-chloro- and 5,7-dichloroderivatives [compounds (II leads to XVI)] and a series of monoalkylthiocarbamic esters of (I) [compounds (XVII leads to XIX)] were synthesized and evaluated in vitro for antimicrobial activity. All the substances studied have been found to possess an inhibiting action on one or more strains of mycetes of the genus Candida and on some strains of Gram-positive bacteria belonging to the genus Staphylococcus. Moreover, some compounds have shown a bacteriostatic effect on a strain belonging to the genus Streptococcus. None of the substances tested was active on Gram-negative schizomycetes.