The Epidemiology of Cholera in Zanzibar: Implications for the Zanzibar Comprehensive Cholera Elimination Plan.

Background: Cholera poses a public health and economic threat to Zanzibar. Detailed epidemiologic analyses are needed to inform a multisectoral cholera elimination plan currently under development. Methods: We collated passive surveillance data from 1997 to 2017 and calculated the outbreak-specific and cumulative incidence of suspected cholera per shehia (neighborhood). We explored the variability in shehia-specific relative cholera risk and explored the predictive power of targeting intervention at shehias based on historical incidence. Using flexible regression models, we estimated cholera's seasonality and the relationship between rainfall and cholera transmission. Results: From 1997 and 2017, 11921 suspected cholera cases were reported across 87% of Zanzibar's shehias, representing an average incidence rate of 4.4 per 10000/year. The geographic distribution of cases across outbreaks was variable, although a number of high-burden areas were identified. Outbreaks were highly seasonal with 2 high-risk periods corresponding to the annual rainy seasons. Conclusions: Shehia-targeted interventions should be complemented with island-wide cholera prevention activities given the spatial variability in cholera risk from outbreak to outbreak. In-depth risk factor analyses should be conducted in the high-burden shehias. The seasonal nature of cholera provides annual windows of opportunity for cholera preparedness activities.

COMMUNITY ACQUIRED METHICILLIN SENSITIVE STAPHYLOCCUS AUREUS CEREBRAL ABSCESS IN A PREVIOUSLY HEALTH GENTLEMAN MIMICKING SIGNS OF CAVERNOUS SINUS THROMBOSIS-A UNIQUE PRESENTATION.

Central Nervous System (CNS) infections like meningitis and cerebral abscess caused by Staphylococcus aureus are usually seen in patients with neurosurgical interventions or immune compromised patients or patients with cardiac vegetation's. They are extremely rare in healthy patients. We report a case of a 44 year old Indian gentleman who was perfectly healthy with no known co morbidities, which presented with fever, neck stiffness and altered mental status. He had fulminant staph bacteraemia (as evidenced by persistently positive blood cultures) with meningitis and cerebral abscess. Extensive search was made to find the source of infection, but it was inconclusive. Isolated CNS Methicillin Sensitive Staphylococcus aureus (MSSA) infection in an apparently healthy patient is very rare. This gentleman presented with altered mental status, asymmetrical exophthalmos and multiple cranial nerve palsies. This case highlights the challenge of making early diagnoses of a brain abscess; since it has symptomology mimicking cavernous sinus thrombosis .This is due to the involvement of the cerebellopontine angle and extensive brain oedema and oedema of the retro bulbar tissues.

Linezolid induced black hairy tongue: a rare side effect.

Linezolid induced black hairy tongue is a rare benign reversible side effect of linezolid therapy. We report a case of a 61 year old diabetic lady who developed thrombocytopenia and black hairy discoloration of the tongue after being prescribed linezolid for foot osteomyelitis by the orthopaedic surgeon. Patient was encouraged to practice good oral dental hygiene, advised to use a soft tooth brush, regular mouth wash and baking soda containing tooth paste. The condition resolved four weeks after cessation of the antibiotic therapy.

Exenatide induced acute kidney injury.

Exenatide is an incretin mimetic. It was approved by the federal drug authority in 2005 for the treatment of type-2 diabetes. Since it is a relatively new medicine clinicians have limited experience with regards to its side effects and safety profile. We report a 47 year old lady who presented with exenatide associated acute kidney injury. She had type-2 diabetes for 10 years with mild micro albuminuria and normal renal functions. She was also taking a stable dose of metformin, gliclazide, angiotensin converting enzyme inhibitor and diuretic for over a year and there was no history of any recent use of non-steroid anti-inflammatory medications. One week after starting exenatide, she developed severe vomiting, followed by hypotension. She presented with acute renal insufficiency and severe lactic acidosis and had to be dialyzed on emergency basis. To our knowledge this is probably the first case reported in the local United Arab Emirate (U.A.E) population.

Risk assessment of combined photogenotoxic effects of sunlight and food additives.

The presence of flavored colorants (peach and raspberry), flavors (caramel, citric acid and vanilla) and food preservatives (sodium nitrite, sodium nitrate, sodium benzoate, benzoic acid, potassium sorbate and sodium chloride) in Escherichia coli suspension during exposure to sunlight did not change the extent of cell survival. No effect on viability and mutation induction (kanamycin resistant) was also seen when cells were kept in contact with any of the additives for 80 min in the dark. However, when the relevant additive was present in cell suspension during sunlight exposure the number of induced mutations was increased to varying extents over that seen with sunlight alone. Raspberry and peach increased the number of mutations in a dose dependent manner, while vanilla produced mutations in an additive fashion. Nitrite, nitrate, benzoate, sorbate and benzoic acid increased mutation somewhat additively over that of sunlight. Sodium chloride and citric acid were not effective. The impact of this investigation reflects the significance of combination of sunlight and chemical food additives as potential risk, which requires special attention and necessitates further investigations to evaluate the risk.

Odontoonychodermal dysplasia: a previously apparently undescribed ectodermal dysplasia.

Seven affected individuals in a total of 24 belonging to three inbred Lebanese sibships are presented as having a previously apparently undescribed pure ectodermal dysplasia. For this condition, probably owing to the homozygous state of an autosomal recessive gene, we suggest the name trichoodontodermal dysplasia.

Formulation of a mathematical model to predict solar water disinfection.

A mathematical model was formulated that will facilitate the prediction of solar disinfection by analyzing the effect of sunlight exposure (x(1)) and the load of bacterial contamination (x(2)), as predictor variables, on the efficiency of solar disinfection (y). Aliquots of 0.1 ml containing average numbers of E. coli, ranging between 1 and 5 x 10(3)cells/ml raw water, were introduced into each of the 96 wells of polystyrene microtitre plates. Plates, with the lid on, were exposed to sunlight for varying exposures ranging between 1.04 x 10(3) and 8.40 x 10(3)kJ m(-2). Double strength nutrient broth was then added. After 48 h incubation wells containing visible contamination were considered as containing one cell or more that survived the exposure. Data showed that disinfection is dependent both on the load of bacterial contamination and sunlight exposure. This relationship is characterized by curves having shoulders followed by a steep decline and then tailing off in an asymptotic fashion. The shoulder size increased with the increase of the contamination load, however, the slope remains the same. Statistical analysis indicates a positive correlation among the variables (R(2) = 0.893); the mathematical model, y=1-(1-e(-kx(1)))(x(2)), represents the relationship, with k being the solar inactivation constant. The exposure required to produce a given decontamination level can be predicted using the equation: x(1)=-1/kln[1-(1-y)(-1/x(2))]e(-micro/rho.m/A), where micro is the linear attenuation coefficient (m(-1)), rho is the density, m is the mass and A is the area of the exposed part of the sample. The predictor variables (x(1), x(2)) strongly influence the efficiency of solar disinfection, which can be predicted using the suggested mathematical model. The present data provides a means to predict the efficiency of solar disinfection as an approach to improve the quality of drinking water mainly in developing countries with adequate sunshine all year-round.

A new sensor for thermometric titrations.

A new thermometric sensor, which is a transistor (OC71), has been introduced to follow thermometric titrations successfully to clear end points. The sensor was suitable in both normal and differential modes of titration. It is possible to titrate down to 1.32micromol of HCl and 26.4micromol of H(3)BO(3)in a final 20ml solution with accuracy and precision of 1%, 2.2% and 1.4%, 2.2%, respectively. The sensor, in association with a pH glass electrode, was used for the determination of pK values of some well established weak acids such as, acetic acid (4.77), phosphoric acid (pK(1)=2.18, pK(2)=7.20 and pK(3)=12.32) as well as for a very weak acid of uncertain pK values H(3)BO(3) (pK(1)=9.20, pK(2)=12.7 and pK(3)=13.80). The sensor was also examined for kinetic catalytic determination of iron(III) in water, milk and pharmaceuticals.

Effect of clothing varieties on solar photosynthesis of previtamin D3: an in vitro study.

BACKGROUND/PURPOSE: Vitamin D3 plays important roles in the absorption of calcium and phosphorus from the gastrointestinal tract and in the treatment of rickets; in addition, it facilitates the deposition of minerals in bones, thus minimizing the possibility of developing osteomalacia. Sunlight naturally induces vitamin D3 photosynthesis. Such a process is affected by a number of factors such as age, geographical location, skin color, sunscreen application and clothing. It is intended in the present investigation to study in vitro the effect of clothing on the solar photoproduction of vitamin D3. METHODS: Fifteen different fabric samples were tested for their effect on the efficiency of the in vitro solar conversion of 7-dehydrocholesterol (7-DHC) to vitamin D3. 7-DHC was dissolved in methanol to give a concentration of 2.6 x 10(-4) M. Solutions were exposed to sunlight in quartz containers for predetermined periods either uncovered or covered with the fabric sample under test. Changes in the concentrations of 7-DHC and the photoproducts were monitored by HPLC. Fabrics were graded as the number of threads per square inch (in(2)), and their sunlight attenuation was determined. RESULTS: 7-DHC is transformed to previtamin D3 upon exposure to sunlight, and the amount generated exhibited an almost linear relationship. When fabric-covered samples of 7-DHC were irradiated, photoproducts were also detected and their concentrations depended on the degree of sunlight attenuation imposed by the fabric. Generally, the higher the number of threads per in(2) the more the light attenuation produced. CONCLUSION: Clothing plays an important role in attenuating sunlight, thus leading to diminished vitamin D3 production to an extent that would require dietary compensation.