Barriers to uptake of antenatal maternal screening tests in Senegal.

BACKGROUND: Evidence exists that selective antenatal maternal screening tests contribute to the reduction of maternal morbidity and mortality. However, data are lacking on coverage with the complete set of recommended tests. The study aimed to identify barriers to uptake of the complete set of tests recommended by the Ministry of Health in Senegal. METHODS: Data were collected in communities, antenatal care (ANC) clinics and the laboratories of 11 public health care facilities across Senegal. Mixed-methods included ethnography (observations and informal conversations), in-depth interviews and workshops at the health facilities; structured interviews with 283 women receiving antenatal tests ("women in the lab"); in-depth interviews with 81 women in communities who were pregnant or had recently delivered ("community women"). RESULTS: Only 13% of community women and 22% of women in the lab had received the complete set of tests. For various social, financial and antenatal care-related reasons 38% of community women who visited antenatal care facilities did not access a laboratory. The lowest test uptake was in women receiving antenatal care at health posts. Barriers at the laboratory level were the cost of the test, stock-outs of reagents, and broken equipment. Midwives were the main gatekeepers of the laboratory, not requesting (all) tests because of assumptions about women's financial problems and reliance on clinical symptoms. CONCLUSION: In Senegal, recommended antenatal maternal screening tests are substantially underutilized. Efforts to increase test uptake should include accessible testing guidelines, reducing the cost of tests, raising awareness about the reasons for tests, and making the complete test set in point-of-care format accessible in peripheral health posts. National and international antenatal care policies and programs should facilitate access to maternal screening tests as a contribution to reducing maternal and infant morbidity and mortality.

Urinary tract infection with Corynebacterium aurimucosum after urethroplasty stricture of the urethra: a case report.

INTRODUCTION: Corynebacteria have an important place among the commensal flora of the skin and mucous membranes. Except for Corynebacterium diphtheriae, they were once considered contaminants of mucosa. Recent publications in medical bacteriology have highlighted the importance of several species, such as C. aurimucosum. To the best of our knowledge, we report the first isolation of this strain from urine. CASE PRESENTATION: We report a case of a patient with a urinary tract infection with C. aurimucosum. We isolated this bacterium from a 52-year-old man of Wolof ethniticity (an ethnic group in Senegal, West Africa) at the regional hospital of Saint Louis, Senegal. Microscopic examination of his total urine sample showed coryneform Gram-positive bacilli associated with a high leukocyte reaction. After repeated isolation of the corynebacteria in three samples from the patient's urine, it was identified by matrix-assisted laser desorption/ionization time-of-flight mass spectrometry. The strain was susceptible to antibiotics, except for penicillin and co-trimoxazole. The potential infectious role of these commensal species in several infections should be taken into consideration. CONCLUSIONS: This case highlights the significant proportion of species in the genus Corynebacterium other than dyphteriae in the infectious process. The use of mass spectrometry for identification highlights the originality of this work and the importance of these new diagnostic tools that are unavailable in most health facilities of countries with limited resources. We share the results of our method of identification of the isolated bacteria. This case should prompt attention to these rare bacteria, which can cause severe infections.

Tumor necrosis factor-á signaling cascades in apoptosis, necrosis, necroptosis and cell proliferation

Tumor necrosis factor-á (TNF-á) is a multifunctional cytokine involved in host defense, inflammation, apoptosis, autoimmunity, organogenesis and lymphoid microarchitecture. Many of these activities may be explained by the ability of this cytokine to induce distinct signal transduction pathways that recruit regulatory proteins involved in differentiation, cell death or cell proliferation. In this review, we discuss the contribution of caspases -3, -6, -7 and -8, and of cyclin-dependent kinases (CDKs), cyclin B and cyclin-dependent kinase inhibitors (CKI p21 and p27), as well as retinoblastoma tumor suppressor in the signaling cascades triggered by TNF-á to induce apoptosis, necrosis and cellular proliferation in the murine cell lines NIH3T3 and WEHI-164 and the human cervical carcinoma cell line HeLa-S3. Based on the findings of many literature reports and our own data, we discussed a model in which caspases are continuously activated throughout the cell cycle and kept at a critical threshold level by IAP (inhibitor of apoptosis) antagonists. Following the release of Smac/Diablo and HtrA2/OMI from mitochondria in response to diverse stimuli, this threshold is overcome and results in amplified caspase activation and cell death. An alternative, caspase-independent mechanism of cell death is induced in NIH3T3 fi broblasts by a combination of TNF and the pan-caspase inhibitor z-VADfmk. This cell death phenotype, known as necroptosis, displays some morphological features of apoptosis and necrosis. Although caspases are critical regulators of the TNF signaling pathway during cellular life and death, the mechanisms involved in the fine regulation of their dual effects remain to be fully elucidated.