Forensic parameters and genetic structure analysis of 30 autosomal InDels of the population in Freetown, Sierra Leone.

As the origin of modern humanity, African populations show high genetic diversity and are attracting increasing academic attention. However, populations living in West Africa have so far received less study and exploration. In this study, we analyze 30 insertion/deletion (InDel) loci of 516 samples from Freetown, Sierra Leone, to evaluate the forensic properties and reveal the genetic structure in Freetown, Sierra Leone, West Africa. No significant linkage disequilibrium (LD) between 30 InDels was observed after the Bonferroni correction. The random match probability (RMP), the combined power of exclusion for duos (CPE duos), and the combined power of exclusion for trios (CPE trios) were 6.823 × 10-11, 0.9168, and 0.9731, respectively. Null alleles and off-ladder alleles were observed, suggesting that we should be cautious when using this kit for forensic caseworks in African populations. In the population comparison study, we found that the Freetown population is genetically closer to geographically distinct West Africans and has a closer genetic relationship with the Bantu-speaking populations than other African populations.

Cerebral and Plasmodium ovale Malaria in Rhode Island.

We report two cases of malaria diagnosed in Rhode Island. First, a 21-year-old female who presented with 5 days of fevers, chills, headache, and myalgias after returning from a trip to Liberia, found to have uncomplicated malaria due to P. ovale which was treated successfully with atovaquone/proguanil and primaquine. Second, a chronically ill 55-year-old male presented with 3 days of headache followed by altered mental status, fever, and new-onset seizures after a recent visit to Sierra Leone, found to have P. falciparum malaria requiring ICU admission and IV artesunate treatment. The diagnosis and management of malaria in the United States (US), as well as its rare association with subdural hemorrhage are subsequently reviewed.

Genetic characterization of 19 X-STRs in Sierra Leone population from Freetown.

A total of 550 individuals (265 males and 285 females) from Sierra Leone, a west-African coastal country, were genotyped using the Microreader™ 19X ID System kit. No significant deviations from the Hardy-Weinberg equilibrium were observed. A total of 250 alleles were identified with corresponding allele frequencies spanning from 0.0012 to 0.6762. PIC of the loci ranged from 0.4615 to 0.9481. The CPE, CPDF, and CPDM were 0.9999997856, 0.999999999999999999995774, and 0.999999999998997, respectively. The highly combined MECKruger, MECKishida, MECDesmarais, and MECDesmarais Duo were achieved as 0.99999992508, 0.999999999990802, 0.999999999990836, and 0.99999998412, respectively. Genetic comparisons revealed that genetic homogeneity existed in similar ethno origin or geographic origin populations. This is a pioneering genetic investigation using the Microreader™ 19X ID System kit in the population of Sierra Leone.

Caregiving in Crisis: Fatherhood Refashioned by Sierra Leone's Ebola Epidemic.

In much of the literature on Sierra Leone, young men have been recognized for perpetrating violence or resisting authority. This characterization extended into the Ebola crisis, as young men were depicted as "resisting" public health measures. In contrast, little scholarship has focused on men's roles as caregivers during the epidemic. This article draws on ethnographic research conducted between 2014 and 2016 in eastern Sierra Leone to demonstrate how men contributed to caregiving. Findings reveal that when men were unable to care via established means, they improvised new ways to care for their families, which included: paid labor in Ebola treatment facilities; protecting their families from risk of infection; and hands-on nurturing. By focusing on these diverse types of male caregiving, this article challenges the ways in which "care" and "women" are often neatly linked and calls for a rethinking of stereotypes associating African men with violence.

Severe malaria.

Malaria represents a medical emergency. Without rapid diagnosis and treatment, it can progress and lead to severe complications and, eventually, death. Severe malaria is almost always caused by Plasmodium falciparum. Here, we present an image showing a set of hematological findings associated with severe malaria, highlighting the importance of a correct morphological diagnosis.

Conjuring Biosecurity in the Post-Ebola Kissi Triangle: The Magic of Paperwork in a Frontier Clinic.

This article considers the increasing centrality of biosecurity and epidemiological surveillance as key priorities for the Sierra Leonean health care system after the 2014-2016 Ebola outbreak. Amid this broad shift from conceiving of clinics as sites primarily for the provision of therapeutics to instead sites for disease surveillance and threat mitigation, paperwork regimes have proliferated within remote facilities that are out of stock of nearly all supplies and unable to address even the most basic of infectious diseases. Drawing on fieldwork in one such clinic in the region in which Ebola first emerged, I describe one nurse whose endless paperwork tasks seem to have transformed into a type of magical therapeutic practice, resonant with other forms of local text-based healing. Thus, I reflect on the ways that the logics of the fetish-and the emergent ambiguities and perils therein-come to operate through paperwork for local healing practices and biosecuritization efforts alike.

Ebola and Public Authority: Saving Loved Ones in Sierra Leone.

It is unclear how public authorities shaped responses to Ebola in Sierra Leone. Focusing on one village, we analyze what happened when "staff, stuff, space, and systems" were absent. Mutuality between neighbors, linked to secret societies, necessitated collective care for infected loved ones, irrespective of the risks. Practical learning was quick. Numbers recovering were reported to be higher among people treated in hidden locations, compared to those taken to Ebola Treatment Centres. Our findings challenge positive post-Ebola narratives about international aid and military deployment. A morally appropriate people's science emerged under the radar of external scrutiny, including that of a paramount chief.

Caracterización clínico epidemiológica de pacientes con ébola en un centro de tratamiento de Sierra Leona / Clinical-epidemiological characterization of Ebola disease in patients at a treatment center in Sierra Leone

Introducción: La enfermedad del ébola se dio a conocer por primera vez en 1976, con una letalidad muy elevada en todos los brotes detectados. Objetivo: Caracterizar clínica y epidemiológicamente a los pacientes portadores de la enfermedad por el virus del Ébola. Métodos: Se realizó un estudio observacional, descriptivo y transversal en 424 pacientes ingresados en un centro de tratamiento de ébola en la República de Sierra Leona, África occidental, con el diagnóstico confirmado mediante la técnica de reacción en cadena de la polimerasa para virus Ébola, durante el período de noviembre de 2014 hasta marzo de 2015. Resultados: Se muestra que el grupo etario más afectado fue el de 25 a 34 con un 25,9 por ciento. La mayor letalidad se presentó en los pacientes con más de 65 años de edad con un 44,4 por ciento. El síntoma que prevaleció fue la fiebre para un 61,8 por ciento, y el hipo se presentó en el 88,8 por ciento de los fallecidos. Conclusión: Se concluye que la enfermedad no tuvo distinción significativa con el sexo. La mayor letalidad se presentó en las edades geriátricas. Los síntomas más frecuentes fueron la fiebre, diarrea y el decaimiento. El hipo fue el signo que más se presentó en los pacientes que fallecieron(AU)

Introduction: Ebola disease was first reported in 1976 with a very high lethality in all outbreaks. Objective: To clinically and epidemiologically characterize the patients carriers of Ebola virus disease. Methods: we conducted an observational, descriptive and cross-sectional study in 424 patients admitted to an Ebola Treatment Center in the Republic of Sierra Leone, West Africa from November 2014 to March 2015. The polymerase chain reaction technique for Ebola virus confirmed the diagnosis. Medical records provided all data. Results: The age group most affected was 25 to 34 (25.9 percent). The highest lethality occurred in those over 65 years of age (44.4 percent ). Fever was the prevailing symptom (61.8 percent) and hiccups occurred in 88.8 percent of the deceased. Conclusion: Clinical manifestations were variable, although fever was the main symptom. Hiccup was a sign of poor prognosis when associated with a higher percentage of mortality. Lethality was high(AU)

Ebola's Would-be Refugees: Performing Fear and Navigating Asylum During a Public Health Emergency.

Chronic and acute illnesses sit uncomfortably with asylum claiming and refugee mobilities. The story of a Sierra Leonean, an athlete who feared Ebola and sought refuge in the UK, provides an opening to examine protection discourses that invoke fear, trauma, and crisis metaphors, to understand how asylum claims are performed, and how related petitions are adjudicated during public health emergencies of international concern. Ebola is revealed as a novel claim strategy, and thus a useful subject matter to investigate the shifting modalities of migrant agency, the unstable fabric of medical humanitarianism, and knowledge production in moments of exceptionality.

Genetic variants associated with fetal hemoglobin levels show the diverse ethnic origin in Colombian patients with sickle cell anemia / Las variantes genéticas asociadas con niveles de hemoglobina fetal señalan diversos orígenes étnicos en pacientes colombianos con anemia falciforme.

Introduction: Fetal hemoglobin is an important factor in modulating the severity of sickle cell anemia. Its level in peripheral blood underlies strong genetic determination. Associated loci with increased levels of fetal hemoglobin display population-specific allele frequencies. Objective: We investigated the presence and effect of known common genetic variants promoting fetal hemoglobin persistence (rs11886868, rs9399137, rs4895441, and rs7482144) in 60 Colombian patients with sickle cell anemia. Materials and methods: Four single nucleotide polymorphisms (SNP) were genotyped by restriction fragment length polymorphisms (RFLP) and the use of the TaqMan procedure. Fetal hemoglobin (HbF) from these patients was quantified using the oxyhemoglobin alkaline denaturation technique. Genotype frequencies were compared with frequencies reported in global reference populations. Results: We detected genetic variants in the four SNPs, reported to be associated with higher HbF levels for all four SNPs in the Colombian patients. Genetic association between SNPs and HbF levels did not reach statistical significance. The frequency of these variants reflected the specific ethnic make-up of our patient population: A high prevalence of rs7482144-'A' reflects the West-African origin of the sickle cell mutation, while high frequencies of rs4895441-'G' and rs11886868-'C' point to a significant influence of an Amerindian ethnic background in the Colombian sickle cell disease population. Conclusion: These results showed that in the sickle cell disease population in Colombia there is not a unique genetic background, but two (African and Amerindian). This unique genetic situation will provide opportunities for a further study of these loci, such as fine-mapping and molecular-biological investigation. Colombian patients are expected to yield a distinctive insight into the effect of modifier loci in sickle cell disease.

Introducción. La hemoglobina fetal es un importante factor modulador de la gravedad de la anemia falciforme, cuya expresión está muy condicionada por el factor genético. Los loci asociados con el incremento de la hemoglobina fetal pueden presentar frecuencias alélicas específicas para cada población. Objetivo. Investigar la presencia y el efecto de las variantes genéticas rs11886868, rs9399137, rs4895441 y rs7482144 asociadas con la persistencia de hemoglobina fetal, en 60 pacientes colombianos con anemia falciforme. Materiales y métodos. Se hizo la genotipificación de los polimorfismos de nucleótido simple ( Single Nucleotide Polymorphisms, SNP) mediante la técnica de polimorfismos de longitud de fragmentos de restricción ( Restriction Fragment Length Polymorphisms, RFLP) y el procedimiento TaqMan. La hemoglobina fetal (HbF) se cuantificó utilizando la técnica de desnaturalización alcalina de la oxihemoglobina. Las frecuencias genotípicas se compararon con las reportadas en poblaciones de referencia global. Resultados. Se observaron variantes genéticas ya reportadas para aumento de HbF en los cuatro SNP. La asociación genética entre los SNP y el incremento de la HbF no alcanzó significancia estadística. La frecuencia de estos alelos reflejó la siguiente composición específica en esta muestra de pacientes colombianos: una gran prevalencia de rs7482144-'A', lo que indica que el origen de la mutación para la anemia falciforme es África occidental, y una gran frecuencia de rs4895441-'G' y rs11886868-'C', lo que denota la influencia significativa del origen genético amerindio. Conclusión. Los resultados evidenciaron que la población con anemia falciforme de Colombia no tiene un único origen genético, sino que existen dos (africano y amerindio). Esta situación genética única ofrece la oportunidad de llevar a cabo un estudio más amplio de estos loci a nivel molecular. Se espera que el estudio de pacientes colombianos permita una visión diferente del efecto de los loci modificadores en esta enfermedad.

Characterization of imported malaria, the largest threat to sustained malaria elimination from Sri Lanka.

Sri Lanka has reached zero indigenous malaria cases in November 2012, two years before its targeted deadline for elimination. Currently, the biggest threat to the elimination efforts are the risk of resurgence of malaria due to imported cases. This paper describes two clusters of imported malaria infections reported in 2013 and 2014, one among a group of Pakistani asylum-seekers resident in Sri Lanka, and the other amongst local fishermen who returned from Sierra Leone. The two clusters studied reveal the potential impact of imported malaria on the risk of reintroducing the disease, as importation is the only source of malaria in the country at present. In the event of a case occurring, detection is a major challenge both amongst individuals returning from malaria endemic countries and the local population, as malaria is fast becoming a "forgotten" disease amongst health care providers. In spite of a very good coverage of diagnostic services (microscopy and rapid diagnostic tests) throughout the country, malaria is being repeatedly overlooked by health care providers even when individuals present with fever and a recent history of travel to a malaria endemic country. Given the high receptivity to malaria in previously endemic areas of the country due to the prevalence of the vector mosquito, such cases pose a significant threat for the reintroduction of malaria to Sri Lanka. The challenges faced by the Anti Malaria Campaign and measures taken to prevent the resurgence of malaria are discussed here.

Genetic variants associated with fetal hemoglobin levels show the diverse ethnic origin in Colombian patients with sickle cell anemia.

INTRODUCTION: Fetal hemoglobin is an important factor in modulating the severity of sickle cell anemia. Its level in peripheral blood underlies strong genetic determination. Associated loci with increased levels of fetal hemoglobin display population-specific allele frequencies. OBJECTIVE: We investigated the presence and effect of known common genetic variants promoting fetal hemoglobin persistence (rs11886868, rs9399137, rs4895441, and rs7482144) in 60 Colombian patients with sickle cell anemia. MATERIALS AND METHODS: Four single nucleotide polymorphisms (SNP) were genotyped by restriction fragment length polymorphisms (RFLP) and the use of the TaqMan procedure. Fetal hemoglobin (HbF) from these patients was quantified using the oxyhemoglobin alkaline denaturation technique. Genotype frequencies were compared with frequencies reported in global reference populations. RESULTS: We detected genetic variants in the four SNPs, reported to be associated with higher HbF levels for all four SNPs in the Colombian patients. Genetic association between SNPs and HbF levels did not reach statistical significance. The frequency of these variants reflected the specific ethnic make-up of our patient population: A high prevalence of rs7482144-'A' reflects the West-African origin of the sickle cell mutation, while high frequencies of rs4895441-'G' and rs11886868-'C' point to a significant influence of an Amerindian ethnic background in the Colombian sickle cell disease population. CONCLUSION: These results showed that in the sickle cell disease population in Colombia there is not a unique genetic background, but two (African and Amerindian). This unique genetic situation will provide opportunities for a further study of these loci, such as fine-mapping and molecular-biological investigation. Colombian patients are expected to yield a distinctive insight into the effect of modifier loci in sickle cell disease.

Assessment on the knowledge and reported practices of women on maternal and child health in rural Sierra Leone: a cross-sectional survey.

BACKGROUND: Globally, Sierra Leone is ranked among the countries with the worst maternal and child health indicators. The mortality of women and children is significantly higher compared with other developing countries. The death of women and children can be prevented by simple cost-effective community-based interventions. The aim of this present study was to learn the knowledge levels of women on maternal and child health, and treatment-seeking and preventive behaviours in rural Sierra Leone and provide appropriate suggestions for policy makers. Moreover, the study also aimed to evaluate the effect of a husband's involvement on health knowledge and practices of women in rural Sierra Leone. METHODS: Women with at least a child of five years or below were interviewed in their households through a structured questionnaire. Characteristics of the households and of the respondents were collected and the number of correct answers given to the health knowledge and practice questions and their percentage distributions were tabulated and an overall health knowledge score was calculated. RESULTS: The mean score of the derived overall health-related knowledge was 61.6% (maximum of 91% and a minimum of 18%) with a standard deviation of 14.7% and a median of 63.3%. Multivariable regression analyses showed education and number of pregnancies are associated with knowledge score, with significantly improved health knowledge scores amongst those who accessed higher education. There were some inappropriate practices in hygiene and sanitation. However, vaccination coverage was high with almost 100% coverage for BCG. CONCLUSIONS: Based on the findings of this study, women's knowledge on maternal and child health care are inadequate in rural Sierra Leone. Health promotion activities focusing on prevention of diarrhoea, malaria and pneumonia, improvement in health-related knowledge on pregnancy, delivery, neonatal care and environmental sanitation would be invaluable.

War's enduring effects on the development of egalitarian motivations and in-group biases.

In suggesting that new nations often coalesce in the decades following war, historians have posed an important psychological question: Does the experience of war generate an enduring elevation in people's egalitarian motivations toward their in-group? We administered social-choice tasks to more than 1,000 children and adults differentially affected by wars in the Republic of Georgia and Sierra Leone. We found that greater exposure to war created a lasting increase in people's egalitarian motivations toward their in-group, but not their out-groups, during a developmental window starting in middle childhood (around 7 years of age) and ending in early adulthood (around 20 years of age). Outside this window, war had no measurable impact on social motivations in young children and had only muted effects on the motivations of older adults. These "war effects" are broadly consistent with predictions from evolutionary approaches that emphasize the importance of group cooperation in defending against external threats, though they also highlight key areas in need of greater theoretical development.

Transference-focused psychotherapy with former child soldiers: meeting the murderous self.

This article describes the application of transference-focused psychotherapy (TFP) to the treatment of former child soldiers suffering from dissociative identity disorder. It focuses on the problems with aggression faced in psychotherapy. TFP provides a psychodynamic, object relations model to understand the aggression arising in psychotherapy, focusing on the transference and countertransference in the here and now of the therapeutic relationship. Aggression is considered an essential and vital inner dynamic aimed at autonomy, distancing, and the prevention of injury and dependency. In extremely traumatized patients there may be aggressive and oppressive inner parts that want total control-identifying with childhood aggressors-thus avoiding vulnerability. According to TFP it is vital that this aggression is addressed as belonging to the patients themselves in order to reach some form of integration, balance, and health. This is illustrated in a case description.

Peripheral blood stem cell transplant-related Plasmodium falciparum infection in a patient with sickle cell disease.

BACKGROUND: Although transmission of Plasmodium falciparum (Pf) infection during red blood cell (RBC) transfusion from an infected donor has been well documented, malaria parasites are not known to infect hematopoietic stem cells. We report a case of Pf infection in a patient 11 days after peripheral blood stem cell transplant for sickle cell disease. STUDY DESIGN AND METHODS: Malaria parasites were detected in thick blood smears by Giemsa staining. Pf HRP2 antigen was measured by enzyme-linked immunosorbent assay on whole blood and plasma. Pf DNA was detected in whole blood and stem cell retention samples by real-time polymerase chain reaction using Pf species-specific primers and probes. Genotyping of eight Pf microsatellites was performed on genomic DNA extracted from whole blood. RESULTS: Pf was not detected by molecular, serologic, or parasitologic means in samples from the recipient until Day 11 posttransplant, coincident with the onset of symptoms. In contrast, Pf antigen was retrospectively detected in stored plasma collected 3 months before transplant from the asymptomatic donor. Pf DNA was detected in whole blood from both the donor and the recipient after transplant, and genotyping confirmed shared markers between donor and recipient Pf strains. Lookback analysis of RBC donors was negative for Pf infection. CONCLUSIONS: These findings are consistent with transmission by the stem cell product and have profound implications with respect to the screening of potential stem cell donors and recipients from malaria-endemic regions.

Football and post-war reintegration: exploring the role of sport in DDR processes in Sierra Leone.

Growing enthusiasm for 'Sport for development and peace' (SDP) projects around the world has created a much greater interest among critical scholars seeking to interrogate potential gains, extant limitations and challenges of using sport to advance 'development' and 'peace' in Africa. Despite this interest, the role of sport in post-conflict peace building remains poorly understood. Since peace building, as a field of study, lends itself to practical approaches that seek to address underlying sources of violent conflict, it is surprising that it has neglected to take an interest in sport, especially its grassroots models. In Africa, football (soccer) in particular has a strong appeal because of its popularity and ability to mobilise individuals and communities. Through a case study on Sierra Leone, this paper focuses on sports in a particularly prominent post-civil war UN intervention­the disarmament, demobilisation and reintegration (DDR) process­to determine how ex-youth combatants, camp administrators and caregivers perceive the role and significance of sporting activities in interim care centres (ICCS) or DDR camps. It argues that sporting experiences in ddr processes are fruitful microcosms for understanding nuanced forms of violence and healing among youth combatants during their reintegration process.