Challenges and Outcomes of the First Stem Cell Transplant Program in Tanzania, East Africa.

Introduction: Due to the significant resources involved in creating HSCT programs there is a significant disparity in the availability of this treatment modality between the developed and developing countries. This manuscript details the process and the outcomes of the first HSCT program in East Africa which was started at Muhimbili National Hospital (MNH) in Dar-es-Salaam, Tanzania. Materials and Methods: Information and data were collected on the processes which had been implemented for starting the HSCT program at MNH. The details of the collaborations, training, infrastructure development, and acquisition of the biomedical equipment, as well as the actual process for HSCT, as well as the outcomes of treatment are described. Observations. The project has been detailed in 4 stages for ease of description: Stage 1: Preparatory work which was performed by the Government of Tanzania, as well as the administrators and clinicians from MNH (July 2017-September 2021). Stage 2: Exploratory gap analysis by the teams from MNH and International Haematology Consortium of HCG Hospital, India (HCG-IHC) in October 2021. Stage 3: Activities for closure of gaps (November 2021). Stage 4: Stem Cell Transplantation Camps (November 2021 to March 2022). 11 peripheral blood stem cell transplants were done in two camps, November 2021 (5 patients), and February 2022 (6 patients). 10 patients underwent autologous peripheral blood stem cell transplantation for multiple myeloma and 1 for lymphoma. The median duration of hospital stay was 19 ± 6 days. The median time for neutrophil engraftment, it was on 8.8 ± 0.8 days, and for platelet engraftment was 9.6 ± 2.4 days. Progression-free survival was 100%, and there was no mortality. Conclusion: Commonalities in the socioeconomic challenges in developing countries can be leveraged to create robust HSCT programs in other developing countries.

Identifying Active Salmonella Infections in Swine Nurseries Using Serology and Bacterial Culture and Evaluating Associated Risk Factors.

The objectives of this study were: to identify nursery cohorts with an active Salmonella infection using combined serological and bacteriological methods, and to try to identify risk factors associated with swine nurseries with active Salmonella spread. Twenty pigs from each of 50 cohorts of weaned pigs from 44 different nursery barns were sampled about the time of weaning and near the end of the nursery stage. Information regarding farm management and biosecurity practices were collected using a questionnaire. Blood samples were obtained at both visits, while rectal swabs were collected at the second visit. An enzyme-linked immunosorbent assay (ELISA) was used to test sera for Salmonella antibodies and rectal samples were cultured for Salmonella. A nursery cohort was identified as having an active Salmonella infection if Salmonella was cultured from one or more of the 20 pigs or if serological evidence suggested exposure to Salmonella. The association between farm-level management covariates and active Salmonella infection was assessed in 46 cohorts using a logistic regression model. Nine of 46 (20%) cohorts produced Salmonella-free pigs. The remaining 37 (80%) cohorts were classified as having an active infection. Examination of risk factors failed to identify how negative and positive nurseries differed.

Effect of flavophospholipol on fecal microbiota in weaned pigs challenged with Salmonella Typhimurium.

BACKGROUND: The heightened prevalence of Salmonella Typhimurium remains a public health and food safety concern. Studies have reported antibiotic, flavophospholipol, may have the ability to reduce Salmonella in swine, as well as alter the gut microbiota in favour of beneficial bacteria by inhibiting pathogenic bacteria. Thus, the objective of this study was to investigate the fecal microbiota of weaned pigs receiving in-feed flavophospholipol and challenged with Salmonella Typhimurium. RESULTS: Twenty-one weaned pigs were fed either a diet containing 4 ppm of flavophospholipol (treatment group) or a non-medicated feed (control group) for 36 days post-weaning (Day 1 to Day 36). The pigs were orally challenged with a 2 mL dose of 108 CFU/mL of S. Typhimurium at Day 7 and Day 8. Community bacterial DNA extracted from fecal samples collected at Day 6 (before challenge) and Day 36 (28 days after challenge) were used to assess the fecal microbiota using the V4 region of the 16S rRNA gene with Illumina MiSeq next-generation sequencing. Sequencing data were visualized using mothur and analyzed in JMP and R software. The fecal microbiota of pigs in the treatment group had differences in abundance of phyla (Firmicutes, Proteobacteria) and genera (Lactobacillus, Roseburia, Treponema, unclassified Ruminococcaceae, Blautia, Streptococcus, Megasphaera, Dorea, Sporobacter, Peptococcus, unclassified Firmicutes, Clostridium IV and Campylobacter) when compared to pigs that were controls, 28 days after challenge with Salmonella (P < 0.05). Specifically, results demonstrated a significant increase in phylum Proteobacteria (P = 0.001) and decrease in Firmicutes (P = 0.012) and genus Roseburia (P = 0.003) in the treated pigs suggestive of possible microbial dysbiosis. An increased abundance of genera Lactobacillus (P = 0.012) was also noted in the treated group in comparison to the control. CONCLUSION: Based on these findings, it is difficult to conclude whether treatment with 4 ppm of flavophospholipol is promoting favorable indigenous bacteria in the pig microbiota as previous literature has suggested.

An in vitro study of comparative evaluation of efficacy of electrochemically activated water as a root canal irrigant in smear layer removal.

AIM: The aim was to compare and evaluate the efficacy of electrochemically activated water (ECA) against maleic acid, Mixture of tetracycline, acid and detergent. ie; 3% doxycycline, 4.25% citric acid, and 0.5% Tween 80 detergent (MTAD), Sodium hypochlorite (NaOCl), and saline as root canal irrigants in removing the smear layer. MATERIALS AND METHODS: Twenty single canal mandibular premolars were randomly divided into five groups (n = 4), decoronated, prepared to working length, and instrumented till F3 using protaper gold rotary files. Each group was assigned a different irrigant. Saline-negative control and NaOCl-positive control. Teeth were sectioned and subjected to Scanning Electron Microscopic analysis. ECA was prepared using a custom-made apparatus having two chambers of capacity 50 ml each separated by a polymer membrane. About 40 ml of tap water was collected in each chamber. Two graphite electrodes were connected to the top of the compartments, linked to a power supply which initiates electrolysis, and the solutions obtained in anodic and cathodic compartments were collected. Statistical analysis was done using one-way ANOVA and Post hoc Tukey analysis. RESULTS: NaOCl, maleic acid, and ECA had similar smear layer removal efficacy. MTAD was less efficient than the other irrigants tested. Saline did not remove the smear layer. CONCLUSION: Electrochemically activated water has promising smear layer removal efficacy and is comparable with conventional root canal irrigants.

Salmonella shedding and seropositivity and its association with in-feed flavophospholipol in nursery pigs.

The objective of this study was to assess the impact of in-feed flavophospholipol on Salmonella shedding and antibody response in nursery pigs. Weaned pigs were fed either a diet containing 4 ppm flavophospholipol (n = 16) or a non-medicated feed (n = 16) for 36 d. All pigs were orally challenged with a 2-mL dose of 108 colony-forming units (CFUs)/mL of Salmonella Typhimurium on Days 7 and 8 of the trial. On Day 36, all pigs were euthanized and samples were collected from the liver, spleen, and ileocecal lymph nodes. Fecal and tissue samples were quantitatively cultured for Salmonella and serum samples were tested for the presence of the Salmonella antibody by enzyme-linked immunosorbent assay (ELISA). There was no difference between the 2 groups in antibody response and the presence of Salmonella in feces and tissue (P > 0.05). Medicating nursery diets with flavophospholipol at 4 ppm did not appear to reduce Salmonella infection in nursery pigs.

L'objectif de la présente étude était d'évaluer l'impact de l'ajout de flavophospholipol dans l'aliment sur l'excrétion de Salmonella et la réponse en anticorps chez des porcs en pouponnière. Des porcs sevrés ont été nourris avec soit une diète contenant 4 ppm de flavophospholipol (n = 16) ou une diète non-médicamentée (n = 16) pendant 36 j. Tous les porcs ont reçu oralement une dose de 2 mL de 108 unités formatrices de colonies (UFC)/mL de Salmonella Typhimurium aux Jours 7 et 8 de l'essai. Au Jour 36, tous les porcs ont été euthanasiés et on préleva des échantillons de foie, rate, et noeuds lymphatiques iléo-caecaux. Des échantillons de fèces et de tissus ont été cultivés pour quantifier le nombre de Salmonella et des échantillons de sérum furent testés pour la présence d'anticorps contre Salmonella par épreuve immunoenzymatique (ELISA). Il n'y avait pas de différence entre les deux groupes quant à la réponse en anticorps et la présence de Salmonella dans les fèces et les tissus (P > 0,05). L'ajout de 4 ppm de flavophospholipol à la diète en pouponnière ne semble pas réduire l'infection par Salmonella chez les porcs en pouponnière.(Traduit par Docteur Serge Messier).

What Factors Contribute to Falls-Related Distal Radius Fracture?

Objective: This mixed methods study analyzed the factors that led to a fall in a cohort of patients with distal radius fracture (DRF). Methods: A sample of 1,453 patients (430 men; 1,023 women; age range: 18-89 years) supplemented by new interview data from 29 patients (19 women) were examined. Chi-square and descriptive analysis of quantitative data and descriptive thematic analysis of qualitative data were compared to determine data convergence and divergence. Results: A higher number of DRF were observed in the 45- to 64-year-old group (44%), employed people (48%), in winter months (41%), and in low-energy fractures (75%). Themes emerged from qualitative data on the cause of the fracture, including environmental factors, behavioral factors, physical factors, and sports activities. Conclusion: Reasons for DRF are multifactorial. Preventive strategies with an emphasis on environmental and behavioral factor modifications are likely to decrease the number of DRF.

Time course of Salmonella shedding and antibody response in naturally infected pigs during grower-finisher stage.

A longitudinal trial was conducted to determine the course of Salmonella shedding and antibody response in naturally infected grower-finisher pigs. Ten-week-old pigs (n = 45) were transferred from a farm with history of salmonellosis and housed at a research facility. Weekly fecal samples (weeks 1 to 11) as well as tissue samples at slaughter were cultured for Salmonella. Serum samples were tested for presence of Salmonella antibody by enzyme-linked immunosorbent assay (ELISA). Data were analyzed using a multilevel mixed-effects logistic regression model. Over 10 wk, 91% and 9% of pigs shed Salmonella ≤ 4 and > 5 times, respectively. The estimated median of Salmonella shedding duration was 3 to 4 wk but some pigs shed Salmonella for up to 8 wk. Salmonella shedding increased 1 wk post-arrival but followed a decreasing pattern afterwards up to week 11 (P < 0.05). Salmonella isolates (n = 29), which were recovered from 18 pigs at different occasions, were S. Typhimurium (28%), S. Livingstone (21%), S. Infantis (14%), S. Montevideo (7%), S. Benfica (3%), S. Amsterdam (3%), S. Senftenberg (17%), and S. I:Rough-O (7%). Of 11 pigs from which the first and last isolates were serotyped, 10 pigs were reinfected with a different serotype. At slaughter, Salmonella was isolated from 7 pigs, of which 5 (71%) had not tested positive for at least 7 wk prior to slaughter. Antibody response peaked 4 wk after the peak of Salmonella infection; Salmonella shedding reduced as antibody response elevated (P < 0.05). These findings indicate that pigs may shed Salmonella into the mid-point of the grower-finisher stage and may be reinfected with different serotypes.

Un essai longitudinal a été réalisé afin de déterminer la progression de l'excrétion de Salmonella et la réponse en anticorps chez des porcs en période de croissance-finition naturellement infectés. Des porcs âgés de 10 semaines (n = 45) ont été transférés d'une ferme avec une histoire de salmonellose et hébergés dans une installation de recherche. Des échantillons de fèces ont été prélevés à chaque semaine (semaines 1 à 11) de même que des échantillons de tissus lors de l'abattage et ont été cultivés pour Salmonella. Des échantillons de sérum ont été testés pour la présence d'anticorps contre Salmonella par une épreuve immunoenzymatique (ELISA). Les résultats ont été analysés par un modèle de régression logistique multiniveaux à effets mixtes. Au-delà de 10 semaines, 91 % et 9 % des porcs excrétaient Salmonella ≤ 4 et > 5 fois, respectivement. La médiane estimée de la durée d'excrétion de Salmonella était de 3 à 4 sem mais quelques porcs ont excrété Salmonella jusqu'à 8 sem. L'excrétion de Salmonella augmenta 1 sem après l'arrivée mais fut suivie par la suite d'un patron de diminution jusqu'à la semaine 11 (P < 0,05). Les isolats de Salmonella (n = 29) qui ont été obtenus de 18 porcs à différentes occasions, étaient S. Typhimurium (28 %), S. Livingstone (21 %), S. Infantis (14 %), S. Montevideo (7 %), S. Benfica (3 %), S. Amsterdam (3 %), S. Senftenberg (17 %) and S. I :Rough-O (7 %). De 11 porcs pour lesquels les premiers et les derniers isolats furent sérotypés, 10 porcs étaient réinfectés avec un sérotype différent. Lors de l'abattage, Salmonella a été isolé de sept porcs, parmi lesquels cinq (71 %) n'avaient pas eu de culture positive pour au moins 7 sem avant l'abattage. La réponse en anticorps a présenté un pic 4 sem après le pic d'infection par Salmonella; l'excrétion de Salmonella a diminué alors que la réponse en anticorps augmentait (P < 0,05). Ces résultats indiquent que les porcs peuvent excréter Salmonella jusqu'au milieu de leur période de croissance-finition et peuvent être réinfectés avec un sérotype différent.(Traduit par Docteur Serge Messier).

A clinical trial investigating the impact of in-feed flavophospholipol on Salmonella shedding and antimicrobial resistance in pigs.

A clinical trial was conducted to assess the effectiveness of in-feed flavophospholipol in reducing Salmonella shedding and antimicrobial resistance (AMR) associated with Salmonella and generic Escherichia coli in naturally infected grower-finisher pigs. Pigs were obtained from a farm with a history of salmonellosis and were housed at a research facility. Over the span of 10 weeks the pigs received either a feed containing 4 ppm of flavophospholipol (treatment, n = 25) or a non-medicated feed (control, n = 20). Weekly fecal samples were collected and cultured for Salmonella and generic E. coli. A subset of Salmonella and E. coli isolates were tested for antimicrobial susceptibility. A multilevel mixed-effects logistic regression model was used to compare the prevalence of Salmonella shedding and AMR in Salmonella and E. coli isolates in treatment and control groups. Overall, the prevalence of Salmonella shedding (P > 0.05) and AMR in Salmonella (P > 0.01) and E. coli (P > 0.005) isolates was not different between the treatment and control groups.

Essai clinique étudiant l'impact du flavophospholipol dans les aliments sur l'excrétion de Salmonellaet l'antibiorésistance chez les porcs. Un essai clinique a été réalisé pour évaluer l'efficacité du flavophospholipol dans les aliments pour réduire l'excrétion de Salmonella et l'antibiorésistance associée à Salmonella et à Escherichia coli générique chez les porcs d'engraissement naturellement infectés. Les porcs obtenus provenaient d'une ferme ayant des antécédents de salmonellose et ils ont été logés à un établissement de recherche. Pendant 10 semaines, les porcs ont reçu soit des aliments contenant 4 ppm de flavophospholipol (traitement, n = 25) ou des aliments non médicamentés (témoin, n = 20). Des échantillons fécaux hebdomadaires ont été prélevés et soumis à des cultures pour Salmonella et E. coli générique. Un sous-groupe d'isolats de Salmonella et d'E. coli ont été testés pour la susceptibilité antimicrobienne. Un modèle de régression logistique à effets contrastés à plusieurs niveaux a été utilisé pour comparer la prévalence d'excrétion de Salmonella et de l'antibiorésistance dans les isolats de Salmonella et d'E. coli dans le groupe de traitement et le groupe témoin. Dans l'ensemble, la prévalence d'excrétion de Salmonella (P > 0,05) et de l'antibiorésistance des isolats de Salmonella (P > 0,01) et d'E. coli (P > 0,005) n'était pas différente entre le groupe de traitement et le groupe témoin.(Traduit par Isabelle Vallières).