Factors associated with severity and anatomical distribution of diabetic foot ulcer in Uganda: a multicenter cross-sectional study.

BACKGROUND: Diabetic foot ulcer (DFU) is a devastating complication of diabetes mellitus (DM) that is associated with increased mortality, morbidity, amputation rate and economic burden. This study aimed at identifying the anatomical distribution and factors associated with severity of DFU in Uganda. METHODOLOGY: This was a multicenter cross-sectional study conducted in seven selected referral hospitals in Uganda. A total of 117 patients with DFU were enrolled in this study between November 2021 and January 2022. Descriptive analysis and modified Poisson regression analysis were performed at 95% confidence interval; factors with p-value < 0.2 at bivariate analysis were considered for multivariate analysis. RESULTS: The right foot was affected in 47.9% (n = 56) of patients, 44.4% (n = 52) had the DFU on the plantar region of the foot and 47.9% (n = 56) had an ulcer of > 5 cm in diameter. The majority (50.4%, n = 59) of patients had one ulcer. 59.8% (n = 69) had severe DFU, 61.5% (n = 72) were female and 76.9% had uncontrolled blood sugar. The mean age in years was 57.5 (standard deviation 15.2 years). Primary (p = 0.011) and secondary (p < 0.001) school educational levels, moderate (p = 0.003) and severe visual loss (p = 0.011), 2 ulcers on one foot (p = 0.011), and eating vegetables regularly were protective against developing severe DFU (p = 0.03). Severity of DFU was 3.4 and 2.7 times more prevalent in patients with mild and moderate neuropathies (p < 0.01), respectively. Also, severity was 1.5 and 2.5 higher in patients with DFU of 5-10 cm (p = 0.047) and in those with > 10 cm diameter (p = 0.002), respectively. CONCLUSION: Most DFU were located on the right foot and on the plantar region of the foot. The anatomical location was not associated with DFU severity. Neuropathies and ulcers of > 5 cm diameter were associated with severe DFU but primary and secondary school education level and eating vegetables were protective. Early management of the precipitating factors is important to reduce the burden of DFU.

In Vitro Antibacterial Activity of Crude Extracts of Artocarpus heterophyllus Seeds against Selected Diarrhoea-Causing Superbug Bacteria.

The current upsurge in resistance to conventional antibiotics, as well as high cost of orthodox medical treatment, called for the use of medicinal plants as an alternative therapy. This research was aimed at determining the antibacterial activity of Artocarpus heterophyllus seed extracts (Jackfruit as it is locally called) in the treatment of diarrhoea. Ethanolic and hexanolic seed crude extracts of the plant were screened for antidiarrhoeal activity against bacteria isolated from clinical samples (methicillin-resistant and susceptible Staphylococcus aureus, multidrug-resistant Pseudomonas aeruginosa, ciprofloxacin-resistant Salmonella typhimurium, and third-generation cephalosporin-resistant Escherichia coli). Plant phytochemical screening was conducted using standard methods. The antibacterial activity was carried out using the agar well diffusion method and compared to the standard antibiotics ceftriaxone and vancomycin. The minimum inhibitory concentration was determined by the microbroth dilution method, whereas the minimum bactericidal concentration was determined by plating out from microtitre plates with no visible growth. The results of phytochemical screening revealed the presence of tannins, flavonoids, reducing sugars, cardiac glycosides, saponins, and steroids from the prepared crude extracts. The ethanolic and hexanolic extracts had activity on multidrug-resistant Pseudomonas aeruginosa, methicillin-resistant Staphylococcus aureus, and methicillin-susceptible Staphylococcus aureus with the mean and standard error zone of inhibition that ranged from 8.5 ± 0.5 to 16.5 ± 0.25 mm; however, the extracts were found not to have activity on resistant E. coli and Salmonella typhimurium. The ethanolic crude extract had the lowest MIC and MBC values of 31.25 and 125 mg/ml, respectively, compared to the hexane extract which had the MIC and MBC values of 62.50 and 250 mg/ml, respectively. This provides the evidence for its usage as an alternative herbal remedy for the treatment of diarrhoea caused by susceptible and methicillin-resistant Staphylococcus aureus and multidrug resistant Pseudomonas aeruginosa.

Effect of storage on the quality of processed palm oil collected from local milling points within Ile-Ife, Osun State, Nigeria.

The influence of storage practices on physicochemical and microbial changes in crude palm oil (CPO) from milling points in Ile-Ife, Nigeria were investigated. Freshly milled CPO samples were collected from four traditional milling points, dispensed in 150 mL portions in sterile bottles and stored under two different conditions (sunlight reflection and in the dark, both at room temperature) for 4 months. Samples were obtained periodically during the storage period for microbiological and physicochemical analysis following established methods. The aerobic mesophilic (2.16 × 106 cfu/mL) and Enteric bacterial (1.6 × 106 cfu/mL) counts of the fresh CPO samples decreased during storage with those exposed to sunlight reflections having very high significant difference (P < 0.00) compared to those stored in the dark at P ≤ 0.05. The bacterial isolates were identified as Bacillus pasteurii (29%), Staphylococcus aureus (22%), Enterobacter aerogenes (17%), Micrococcus sp. (12%), Escherichia coli (8%), Pseudomonas aeruginosa (7%) and Serratia marcescens (5%). Of the physicochemical parameters studied, moisture content (MC) reduced significantly from between 2.55 and 5.50% in fresh sample to between 0.1 and 0.5% at the end of storage while the free fatty acids (FFA) increased from between 0.5 and 1.0% to between 2.2 and 3.1% respectively. Storage under the influence of sunlight resulted in significant increase in iodine value of CPO from Mills 1, 2 and 4, indicating oxidative instability of the palm oil. It could be concluded that storage of freshly milled palm oil at room temperature (in the dark or exposure to sunlight) for a period of 4 months resulted in reduced bacterial load, decrease in MC and stable peroxide value and FFA.

Microbiological quality of water samples obtained from water sources in Ishaka, Uganda.

Objectives: This study aimed to evaluate the microbiological quality of water sources in Ishaka division, Bushenyi district. Methods: Water from taps, wells and springs were sampled for the cross-sectional investigation. The enumeration and identification of microbes (Escherichia coli, Salmonella, Shigella, Proteus, Staphylococcus aureus and total coliforms) in water samples were carried out using a variety of methods. Escherichia coli was enumerated using the membrane filtration method; Salmonella, Shigella and Proteus using a two-step enrichment method; Staphylococcus aureus using the surface spread method and total coliforms using the most probable number technique. Mannitol salt agar was used for enumeration of Staphylococcus Aureus and violet red bile agar was used for enumeration of total coliforms and Escherichia coli; xylose lysine deoxycholate agar was used for both Salmonella spp. and Shigella spp. API-20E was used to phenotypically identify the Enterobacteriaceae contaminants in water. These included Escherichia coli, Proteus mirabilis, Proteus vulgaris, Salmonella spp. and Staphylococcus aureus. Results: Escherichia coli counts in the water from springs and wells ranged from 0 to 314 cfu/mL (p = 0.173) and 0 to 3 cfu/mL (p = 0.269), respectively, while tap water had no incidence of Escherichia coli. Highest level of bacterial contamination in water sources, beyond acceptable WHO (0 cfu/100 mL) limits for drinking water, was reported: Proteus spp., 34 (54.8%), followed by total coliforms, 24 (38.7%), Shigella spp., 22 (35.5%) and least were Salmonella spp. (8.1%) and Staphylococcus aureus spp. (8.1%). Conclusion: It is therefore concluded that spring and well community water sources in Ishaka division, Uganda, are significantly contaminated with pathogenic bacteria and thus unsafe for drinking without adequate water treatment (disinfection and filtration).

Detection of Mycobacterium tuberculosis multiple strains in sputum samples from patients with pulmonary tuberculosis in south western Uganda using MIRU-VNTR.

Infections with multiple strains of Mycobacterium tuberculosis are now widely recognized as a common occurrence. Identification of patients infected with multiple strains provides both insight into the disease dynamics and the epidemiology of tuberculosis. Analysis of Mycobacterial Interspersed Repetitive Unit-Variable-Number Tandem Repeats (MIRU-VNTR) has been shown to be highly sensitive in detecting multiple M. tuberculosis strains even in sputum. The goal of this study was to identify cases of multiple M. tuberculosis strain infections among patients diagnosed with pulmonary tuberculosis in Southwestern Uganda and assessment of factors associated with multiple strain infections. DNA extracted directly from 78 sputum samples, each from an individual patient, was analyzed using the standard 24 loci MIRU-VNTR typing. Five (6.4%) of the 78 patients were infected with multiple strains of M. tuberculosis with all of them being the newly diagnosed cases while two-thirds of them were co-infected with HIV. Exact regression analysis projected that the natives were more likely to harbor multiple strains (OR; 0.981, 95% CI 0-7.926) as well as those with a high microbial load (OR; 0.390, 95% CI 0-3.8167). Despite these findings being not statistically significant due to the small sample size, this points to a critical component of disease dynamics that has clinical implications and emphasizes a need for a study using a larger cohort. It is also essential to study the potential factors associated with higher risk of exposure to newly diagnosed and HIV positive patients at the community level. In addition, our ability to detect multiple M. tuberculosis strains using the standard 24 loci MIRU-VNTR typing especially with allelic diversity in loci 2059 and 3171, which are excluded from the 15-locus MIRU-VNTR, lead us to recommend the use of this genotyping technique, especially in areas with tuberculosis endemicity similar to this study.

An Update on African Trypanocide Pharmaceutics and Resistance.

African trypanosomiasis is associated with Trypanosoma evansi, T. vivax, T. congolense, and T. brucei pathogens in African animal trypanosomiasis (AAT) while T. b gambiense and T. b rhodesiense are responsible for chronic and acute human African trypanosomiasis (HAT), respectively. Suramin sodium suppresses ATP generation during the glycolytic pathway and is ineffective against T. vivax and T. congolense infections. Resistance to suramin is associated with pathogen altered transport proteins. Melarsoprol binds irreversibly with pyruvate kinase protein sulfhydryl groups and neutralizes enzymes which interrupts the trypanosome ATP generation. Melarsoprol resistance is associated with the adenine-adenosine transporter, P2, due to point mutations within this transporter. Eflornithine is used in combination with nifurtimox. Resistance to eflornithine is caused by the deletion or mutation of TbAAT6 gene which encodes the transmembrane amino acid transporter that delivers eflornithine into the cell, thus loss of transporter protein results in eflornithine resistance. Nifurtimox alone is regarded as a poor trypanocide, however, it is effective in melarsoprol-resistant gHAT patients. Resistance is associated with loss of a single copy of the genes encoding for nitroreductase enzymes. Fexinidazole is recommended for first-stage and non-severe second-stage illnesses in gHAT and resistance is associated with trypanosome bacterial nitroreductases which reduce fexinidazole. In AAT, quinapyramine sulfate interferes with DNA synthesis and suppression of cytoplasmic ribosomal activity in the mitochondria. Quinapyramine sulfate resistance is due to variations in the potential of the parasite's mitochondrial membrane. Pentamidines create cross-links between two adenines at 4-5 pairs apart in adenine-thymine-rich portions of Trypanosoma DNA. It also suppresses type II topoisomerase in the mitochondria of Trypanosoma parasites. Pentamidine resistance is due to loss of mitochondria transport proteins P2 and HAPT1. Diamidines are most effective against Trypanosome brucei group and act via the P2/TbAT1 transporters. Diminazene aceturate resistance is due to mutations that alter the activity of P2, TeDR40 (T. b. evansi). Isometamidium chloride is primarily employed in the early stages of trypanosomiasis and resistance is associated with diminazene resistance. Phenanthridine (homidium bromide, also known as ethidium bromide) acts by a breakdown of the kinetoplast network and homidium resistance is comparable to isometamidium. In humans, the development of resistance and adverse side effects against monotherapies has led to the adoption of nifurtimox-eflornithine combination therapy. Current efforts to develop new prodrug combinations of nifurtimox and eflornithine and nitroimidazole fexinidazole as well as benzoxaborole SCYX-7158 (AN5568) for HAT are in progress while little comparable progress has been done for the development of novel therapies to address trypanocide resistance in AAT.

Systematic Review and Meta-Analysis on Knowledge Attitude and Practices on African Animal Trypanocide Resistance.

BACKGROUND: African trypanocide resistance is an emerging public health emergency whose control requires a revisit on farmer's knowledge, attitudes, and practices in developing countries. African animal trypanocide resistance (AATr) is rife in an environment where drug use and policy decisions are disjointed. The objective of the study was to identify community factors responsible for the development of AATr. This was important since diminazene aceturate (DA), isometamidium chloride (ISM), and homidium bromide (HB) have existed for over 30 years and no new drugs have been provided to farmers. METHODS: An electronic keyword search across 12 databases was conducted using a search criterion from 1806 to June 2022. This generated a total of 24 publications, but after removing duplicates, review articles, and nonrelated articles, a total of eight papers were included in the analysis by following the PRISMA checklist. A meta-analysis was conducted on the data extracted and the risk ratio and inverse variance at 95% confidence interval were calculated using RevMan®. RESULTS: All the eight articles in the study showed that DA was the most preferred trypanocide in both West and Eastern Africa. Poor farmer knowledge of AATr and limited drug options were major drivers for trypanocide resistance. In addition, farmer treatments, use of untrained personnel, poor administration, poor dosing, and preparation of trypanocides were major drivers for the development of AATr and similarities were identified in DA and ISM practices (P = 0.13). CONCLUSIONS: AATr is spread in developing countries due to a lack of community knowledge, attitudes, and drug-use practices. This situation could be reversed through interdisciplinary collaborations in endemic communities by promoting effective treatments and responsible drug handling.

Trend of Malaria Burden Among Residents of Kisii County, Kenya After More Than a Decade Usage of Artemisinin Combined Therapies, 11-Year Laboratory Based Retrospective Study.

Background: Malaria remains a major vector borne disease globally, with the majority of the casualties reported in Africa. Despite this fact, there is drastic reduction in malaria infection using Artemisinin combined therapies (ACTs). Malaria is characterized by significant inconsistency in different geographical locations due to different confounding factors. There is need to identify zone-specific malaria trends and interventions to completely eliminate the disease. Thus the study was aimed at assessing the 11-year trend of microscopically confirmed malaria cases in Kisii County, Kenya, so as to devise area-specific evidence-based interventions, informed decisions, and to track the effectiveness of malaria control programs. Methods: This was a retrospective study carried out to determine 11-year malaria trend rates centered on the admission and laboratory records from health facilities located at four Sub-Counties in Kisii County, Kenya. Parasitological positivity rates of malaria were determined by comparing with the register records in health facilities which recorded confirmed malaria cases with the total number of monthly admissions over the entire year. Data was analyzed by using descriptive tools and chi-square test. Results: There were 36,946 suspect cases, with 8449 (22.8%) confirmed malaria cases reported in this study. The overall malaria slide positivity rate over the last 11 years in the study area was 22.6%. The months of April and August showed the largest number of malaria cases (63%). The age group of ≥18 years contained the most positive confirmed cases, having a prevalence rate of 2953 (35.45%). Out of the confirmed malaria cases, 2379 (28.1%) were males and 6070 (71.9%) were females The highest malaria prevalence rate was recorded in 2014, with Marani Sub-County recording the highest positivity rate of 37.94%. Conclusion: From the observed trends, malaria prevalence and transmission still remains stable in the study area. Thus more interventions need to be scaled up.

Rifampicin and isoniazid drug resistance among patients diagnosed with pulmonary tuberculosis in southwestern Uganda.

Multidrug-resistant tuberculosis (MDR-TB) has become a major threat to the control of tuberculosis globally. Uganda is among the countries with a relatively high prevalence of tuberculosis despite significant control efforts. In this study, the drug resistance of Mycobacterium tuberculosis to rifampicin (RIF) and isoniazid (INH) was investigated among patients diagnosed with pulmonary tuberculosis in Southwestern Uganda. A total of 283 sputum samples (266 from newly diagnosed and 17 from previously treated patients), collected between May 2018 and April 2019 at four different TB diagnostic centres, were assessed for RIF and INH resistance using high-resolution melt curve analysis. The overall prevalence of monoresistance to INH and RIF was 8.5% and 11% respectively, while the prevalence of MDR-TB was 6.7%. Bivariate analysis showed that patients aged 25 to 44 years were at a higher risk of developing MDR-TB (cOR 0.253). Furthermore, among the newly diagnosed patients, the prevalence of monoresistance to INH, RIF and MDR-TB was 8.6%, 10.2% and 6.4% respectively; while among the previously treated cases, these prevalence rates were 5.9%, 23.5% and 11.8%. These rates are higher than those reported previously indicating a rise in MTB drug resistance and may call for measures used to prevent a further rise in drug resistance. There is also a need to conduct frequent drug resistance surveys, to monitor and curtail the development and spread of drug-resistant TB.

Diversity of Mycobacterium tuberculosis Complex Lineages Associated with Pulmonary Tuberculosis in Southwestern, Uganda.

Uganda is among the 22 countries in the world with a high burden of tuberculosis. The southwestern region of the country has consistently registered a high TB/HIV incidence rate. This study is aimed at characterizing the Mycobacterium tuberculosis complex (MTBC) genotypic diversity in southwestern Uganda. A total of 283 sputum samples from patients with pulmonary tuberculosis were genotyped using specific single nucleotide polymorphism markers for lineages 3 and 4. Most of the patients were males with a mean age of 34. The lineage 4 Ugandan family was found to be the most dominant strains accounting for 59.7% of all cases followed by lineage 3 at 15.2%. The lineage 4 non-Ugandan family accounted for 14.5% of all cases while 4.2% showed amplification for both lineage 4 and lineage 3. Eighteen samples (6.4%) of the strains remained unclassified since they could not be matched to any lineage based on the genotyping technique used. This study demonstrates that a wide diversity of strains is causing pulmonary tuberculosis in this region with those belonging to the lineage 4 Ugandan family being more predominant. However, to confirm this, further studies using more discriminative genotyping methods are necessary.

Fluoroquinolone resistant bacterial isolates from the urinary tract among patients attending hospitals in Bushenyi District, Uganda.

INTRODUCTION: bacterial resistance to fluoroquinolones is on the rise globally, bacteria causing urinary tract infections (UTIs) are no exception to this fact. Judicious use of the current antibiotics by clinicians is therefore deemed necessary to combat development of resistance. This study determined fluoroquinolone resistant profiles, multiple antibiotic resistance indices (MARI), factors associated with fluoroquinolone resistance and their strength among patients attending hospitals in Bushenyi District, Uganda. METHODS: this was a cross-sectional study in which a total of 86 bacterial uropathogens isolated previously by standard microbiological methods were subjected to antibiotic susceptibility testing using Kirby Bauer disk diffusion method. Data for factors suspected to be associated with fluoroquinolone resistant UTI were obtained by use of questionnaires. RESULTS: the most resisted fluoroquinolone was ofloxacin with 29/83 (34.9%), followed by moxifloxacin 27/83 (32.5%), levofloxacin 24/86 (27.9%) and ciprofloxacin 23/86 (26.7%). The bacterial uropathogens that exhibited the highest frequency of fluoroquinolone resistant strains were P. mirabilis with 2/3 (66.7%) and E. faecalis with 2/3 (66.7%), followed by E. coli 19/36 (52.8%), S. aureus 13/27 (48.1%), K. oxytoca 2/6 (33.3%), K. pneumoniae 2/10 (20.0%) and P. vulgaris 0/1 (0.0%). All the bacterial uropathogens tested showed MARI of ≥ 0.2. Hospitalization, history of fluoroquinolones use in the last 12 months and wrong prescription of antibiotics were found to bear statistically significant relationships (p < 0.05) with fluoroquinolone resistant UTI. CONCLUSION: antibiotic susceptibility testing of the first generation quinolones such as nalidixic acid in hospitalized patients, patients with history of fluoroquinolones' use in the last 12 months and wrong prescription of antibiotics should be adopted to avoid fluoroquinolone abuse. For empiric treatment of UTIs in Bushenyi District, ciprofloxacin still remains the first line of choice among the fluoroquinolone class of antibiotics.

Superbugs-related prolonged admissions in three tertiary hospitals, Kano State, Nigeria.

INTRODUCTION: Superbugs are pathogenic micro-organism and especially a bacterium that has developed resistance to the medications normally used against it. As the superbug family increases, the need for appropriate diagnostic, treatment, prevention and control strategies cannot be over emphasized. Therefore, this work determined the distribution of superbug bacteria among patients on prolonged hospital admissions in three tertiary hospitals of Kano state, Nigeria. METHODS: A descriptive cross sectional study was undertaken among 401 patients from medical, surgery, orthopedic and burn centre wards in a three tertiary hospitals in Kano state. A sample collected comprises wound/pus, urine, urine catheter and nasal intubation and were analysed using standard microbiological methods for Acinetobacter spp and other related nosocomial bacterial pathogens. Antibiotic susceptibility testing was done using Kirby-Bauer disc diffusion method. RESULTS: One hundred and thirty eight (138) isolates were recovered, from the studied participants. More than 80% of the nosocomial infections (NIs) were caused by Gram-negative bacteria, predominantly Escherichia coli, Klebseilla spp, Proteus spp, Pseudomona spp and Acinetobacter spp. In-vitro antibiotic susceptibility test revealed that acinetobacter were 100% resistant to amoxicillin, co-trimoxazole, perfloxacin and imipenem. CONCLUSION: Superbugs (Acinetobacter species) significantly contributed to delayed hospital admissions through observed 100% resistance to used antibiotics. The healthcare managers of these hospitals and the ministry of health need to take measures against this resistant bacteria (Acinetobacter spp) especially on prescribing antibiotics that showed 100% resistant from these studied hospitals.

Prevalence of Dermatophytosis and Antifungal Activity of Ethanolic Crude Leaf Extract of Tetradenia riparia against Dermatophytes Isolated from Patients Attending Kampala International University Teaching Hospital, Uganda.

Dermatophyte infections are a global health problem but neglected in Uganda. This work aimed at determining prevalence of dermatophytosis and antifungal activity of ethanolic crude leaf extract of Tetradenia riparia against dermatophytes isolated from patients attending Kampala International University Teaching Hospital (KIU-TH), Uganda. A total of 100 samples of skin and nail scrapings were collected and processed using standard microscopy (KOH) and cultural methods. T. riparia leaves were collected and processed with 95% ethanol using standard extraction method. The crude leaves ethanolic extract was tested against three dermatophytes: Trichophyton tonsurans, T. mentagrophyte, and Microsporum audouinii using modified agar well diffusion method. Minimum inhibitory concentration (MIC) and minimum fungicidal concentration (MFC) of the ethanolic leaves crude extract were also determined using broth tube dilution and culture, respectively. Out of 100 samples collected, 49 (49%, 95%CI: 0.3930-0.5876) were found positive for microscopy. The prevalence of dermatophytosis was significantly (p=0.001) associated with age groups of participants with higher infection among those aged 11-20 and 21-30 years with 75.0% each. Out of the 49 that were positive by microscopy, 28 (57.15%, 95% CI: 0.1987-0.3739) were positive by culture. Thirty-one (31) fungal isolates were obtained which included both dermatophyte and non-dermatophyte fungi. T. verrucosum had highest distribution 6 (19.35%) among dermatophytes species while Aspergillus spp. were found to have highest distribution 7 (22.58%) among non-dermatophyte species. The result of the antidermatophytic test showed that T. riparia ethanolic crude leaves extract had activity against tested dermatophytes at 1 g/ml. MIC and MFC of the crude extract of T. riparia against tested dermatophytes ranged from 62.5 to 250 mg/ml and 125 to 500 mg/ml, respectively. The findings of this study reported the presence of dermatophytes causing dermatophytosis among patients attending KIU-TH. The results of the current study showed that T. riparia leaves ethanolic crude extract has antidermatophytic activity against tested dermatophytes.

Low concentrations of Lactobacillus rhamnosus GG (Yoba®) are safe in male Drosophila melanogaster.

OBJECTIVE: The purpose of the study was to generate information on the safety of probiotics, thus the study objectives were to evaluate the effects of Yoba® on basic physiochemical properties. The study assessed male w1118 Drosophila melanogaster which were provided food supplemented with Yoba® at 1%, 3%, 6%, and 12% on motor function, total protein, catalase activity, and hydrogen peroxide scavenging activity and lifespan. RESULTS: Yoba® at high concentration (≥ 6%) increased locomotor activity in Drosophila melanogaster, however, total protein, catalase, and hydrogen peroxide scavenging activity were significantly higher at 1% Yoba® compared to 3%, 6%, and 12% Yoba®. Yoba consumed at 1% was associated with greater physiological benefits in Drosophila melanogaster. Findings in the study offer a rationale for the consumption of Yoba® at 1% in humans as is currently being promoted by the Yoba for Life consortium, however, high concentrations of Yoba® would disrupt physiological function as shown by this study.