Development of alcohol control law, Sao Tome and Principe.

The World Health Organization (WHO) African Region is struggling with increasing harm associated with alcohol consumption. Legislators of Sao Tome and Principe, concerned about this harm and the high prevalence of alcohol use disorders, designed a comprehensive alcohol control bill to tackle this situation. Input into the design of the bill was obtained through interviews involving many stakeholders. The process had five phases: (i) scoping the problem to understand the social burden of the harm caused by alcohol consumption; (ii) updating the evidence on alcohol policies and identifying areas for legislative interventions; (iii) drafting the bill; (iv) aligning the legislative framework of the bill; and (v) initiating the parliamentary procedure. The new bill scored 92/100 using a standardized alcohol control policy scale. The bill covers all domains of WHO's 2010 global strategy to reduce the harmful use of alcohol, and includes the three most cost-effective interventions for reducing alcohol consumption: increased excise taxes on alcohol; bans or comprehensive restrictions on exposure to alcohol advertising; and restrictions on the availability of retailed alcohol through reduced hours of sale. The National Assembly plenary session upheld the bill, which is now under evaluation of the specialized First Commission on Political, Legal, Constitutional and Ethical Affairs. Approval of the bill requires the final voting once it is back with the National Assembly and its promulgation by the President. Drafting an alcohol control bill which is country-led, inclusive, evidence-based and free of interference by the alcohol industry helps prioritize public health objectives over other interests.

La Région africaine de l'Organisation mondiale de la Santé (OMS) fait face à une hausse des dégâts causés par l'alcool. Préoccupés par la situation et par la forte prévalence des troubles liés à cette consommation, les législateurs de Sao Tomé-et-Principe ont élaboré un projet de loi détaillé afin d'y remédier. À l'origine de sa conception, plusieurs entretiens avec différentes parties prenantes. Le processus s'est divisé en cinq phases: (i) définir l'étendue du problème pour évaluer le fardeau que les dégâts provoqués par l'alcool font peser sur la société; (ii) actualiser les données probantes relatives aux politiques en matière d'alcool et identifier les domaines nécessitant une intervention législative; (iii) rédiger le projet de loi; (iv) aligner le cadre législatif du projet de loi; et enfin, (v) initier la procédure parlementaire. Le nouveau projet de loi a obtenu un score de 92/100 sur une échelle d'évaluation standard des mesures de lutte contre l'alcool. Il couvre tous les thèmes repris dans la Stratégie mondiale de l'OMS visant à réduire l'usage nocif de l'alcool, publiée en 2010. Il prévoit également les trois interventions les plus rentables en termes de diminution de la consommation d'alcool: l'augmentation des taxes d'accise sur l'alcool; l'interdiction ou l'instauration de conditions strictes en matière d'exposition à la publicité pour l'alcool; et une disponibilité restreinte des boissons alcoolisées dans le commerce en limitant les heures de vente. L'Assemblée nationale a soutenu le projet de loi en séance plénière. Il est désormais en cours d'évaluation au sein de la première Commission spécialisée en affaires politiques, juridiques, constitutionnelles et éthiques. Pour être adopté, le projet de loi doit revenir à l'Assemblée nationale pour un vote final, puis être promulgué par le président. Une loi globale de lutte contre l'alcool, élaborée par le pays lui-même, fondée sur des faits et n'ayant subi aucune ingérence de la part de l'industrie de l'alcool contribue à faire passer les objectifs de santé publique avant d'autres intérêts.

La Región de África de la Organización Mundial de la Salud (OMS) está tratando de hacer frente a los crecientes daños derivados del consumo de alcohol. Los legisladores de Santo Tomé y Príncipe, preocupados por estos daños y por la alta prevalencia de los trastornos por consumo de alcohol, diseñaron un proyecto de ley integral para el control del alcohol con el fin de solucionar esta situación. Las contribuciones al diseño del proyecto de ley se obtuvieron a través de entrevistas en las que participaron muchas partes interesadas. El proceso constó de cinco fases: (i) la delimitación del problema para comprender la carga social de los daños causados por el consumo de alcohol; (ii) la actualización de los datos sobre las políticas de alcohol y la identificación de las áreas de intervención legislativa; (iii) la redacción del proyecto de ley; (iv) la adaptación del marco legislativo del proyecto de ley; y (v) el inicio del procedimiento parlamentario. El nuevo proyecto de ley obtuvo una puntuación de 92/100 según una escala estandarizada de políticas para el control del alcohol. El proyecto de ley abarca todos los ámbitos de la estrategia mundial que la OMS puso en marcha en 2010 para reducir el uso nocivo del alcohol, e incluye las tres intervenciones más rentables para reducir el consumo de alcohol: el aumento de los impuestos especiales sobre el alcohol; la prohibición o la restricción general de la exposición a la publicidad del alcohol; y la restricción de la disponibilidad del alcohol al por menor mediante la reducción del horario de venta. La sesión plenaria de la Asamblea Nacional respaldó el proyecto de ley, que ahora está bajo evaluación de la Comisión Primera especializada en Asuntos Políticos, Jurídicos, Constitucionales y Éticos. La aprobación del proyecto de ley requiere la votación final una vez que regrese a la Asamblea Nacional y que el Presidente lo promulgue. La elaboración de un proyecto de ley para el control del alcohol que sea liderado por el país, inclusivo, basado en la evidencia y libre de interferencias por parte de la industria del alcohol ayuda a priorizar los objetivos de salud pública sobre otros intereses.

Development of alcohol control law, Sao Tome and Principe

The World Health Organization (WHO) African Region is struggling with increasing harm associated with alcohol consumption. Legislators of Sao Tome and Principe, concerned about this harm and the high prevalence of alcohol use disorders, designed a comprehensive alcohol control bill to tackle this situation. Input into the design of the bill was obtained through interviews involving many stakeholders. The process had five phases: (i) scoping the problem to understand the social burden of the harm caused by alcohol consumption; (ii) updating the evidence on alcohol policies and identifying areas for legislative interventions; (iii) drafting the bill; (iv) aligning the legislative framework of the bill; and (v) initiating the parliamentary procedure. The new bill scored 92/100 using a standardized alcohol control policy scale. The bill covers all domains of WHO's 2010 global strategy to reduce the harmful use of alcohol, and includes the three most cost-effective interventions for reducing alcohol consumption: increased excise taxes on alcohol; bans or comprehensive restrictions on exposure to alcohol advertising; and restrictions on the availability of retailed alcohol through reduced hours of sale. The National Assembly plenary session upheld the bill, which is now under evaluation of the specialized First Commission on Political, Legal, Constitutional and Ethical Affairs. Approval of the bill requires the final voting once it is back with the National Assembly and its promulgation by the President. Drafting an alcohol control bill which is country-led, inclusive, evidence-based and free of interference by the alcohol industry helps prioritize public health objectives over other interests.

Dynamic changes in genetic diversity, drug resistance mutations, and treatment outcomes of falciparum malaria from the low-transmission to the pre-elimination phase on the islands of São Tomé and Príncipe.

BACKGROUND: With effective vector control and case management, substantial progress has been made towards eliminating malaria on the islands of São Tomé and Príncipe (STP). This study assessed the dynamic changes in the genetic diversity of Plasmodium falciparum, the anti-malarial drug resistance mutations, and malaria treatment outcomes between 2010 and 2016 to provide insights for the prevention of malaria rebounding. METHODS: Polymorphic regions of merozoite surface proteins 1 and 2 (msp1 and msp2) were sequenced in 118 dried blood spots (DBSs) collected from malaria patients who had visited the Central Hospital in 2010-2016. Mutations in the multi-drug resistance I (pfmdr1), chloroquine resistance transporter (pfcrt), and kelch 13 (pfk13) genes were analysed by polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) and sequencing in 111 DBSs. A total of 7482 cases that completed a 28-day follow-up were evaluated for treatment outcomes based on the microscopic results. Regression models were used to characterize factors associated with levels of parasite density and treatment failures. RESULTS: Parasite strains in STP showed significant changes during and after the peak incidence in 2012. The prevalent allelic type in msp1 changed from K1 to MAD20, and that in msp2 changed from 3D7/IC to FC27. The dominant alleles of drug-resistance markers were pfmdr1 86Y, 184F, D1246, and pfcrt 76 T (Y-F-D-T, 51.4%). The average parasite density in malaria cases declined threefold from low-transmission (2010-2013) to pre-elimination period (2014-2016). Logistic regression models showed that patients with younger age (OR for age = 0.97-0.98, p < 0.001), higher initial parasite density (log10-transformed, OR = 1.44, p < 0.001), and receiving quinine treatment (compared to artemisinin-based combination therapy, OR = 1.91-1.96, p < 0.001) were more likely to experience treatment failures during follow-up. CONCLUSIONS: Plasmodium falciparum in STP had experienced changes in prevalent strains, and increased mutation frequencies in drug-resistance genes from the low-transmission to the pre-elimination settings. Notably, patients with younger age and receiving quinine treatment were more likely to show parasitological treatment failure during follow-up. Therapeutic efficacy should be carefully monitored to inform future treatment policy in STP.

Seroepidemiological and molecular investigation of spotted fever group rickettsiae and Coxiella burnetii in Sao Tome Island: A One Health approach.

Spotted fever group rickettsiae (SFGR) and Coxiella burnetii are intracellular bacteria that cause potentially life-threatening tick-borne rickettsioses and Q fever respectively. Sao Tome and Principe (STP), small islands located in the Gulf of Guinea, recently experienced a dramatic reduction in the incidence of malaria owing to international collaborative efforts. However, unexplained febrile illnesses persist. A One Health approach was adopted to investigate exposure to SFGR and C. burnetii in humans and examine the diversity of these bacteria in ticks parasitizing domestic ruminants. A cross-sectional human serological study was conducted in Agua Grande district in Sao Tome Island from January to March 2016, and ticks were collected from farmed domestic ruminants in 2012 and 2016. In total, 240 individuals varying in age were randomly screened for exposure to SFGR and C. burnetii by indirect immunofluorescence assay. Twenty of 240 individuals (8.3%) were seropositive for SFGR (4 for Rickettsia africae and 16 for R. conorii) and 16 (6.7%) were seropositive for C. burnetii. Amblyomma astrion were collected exclusively in 2012, as were A. variegatum in 2016 and Rickettsia spp. were detected in 22/42 (52.4%) and 49/60 (81.7%) respectively. Sequence analysis of multiple gene targets from Rickettsia spp. detected in ticks suggests the presence of a single divergent R. africae strain (Sao Tome). While no ticks were found positive for C. burnetii, Coxiella-like endosymbionts were detected in nearly all ticks. This is the first study in STP to provide serological evidence in humans of SFGR and C. burnetii and additional molecular evidence in ticks for SFGR, which may be responsible for some of the unexplained febrile illnesses that persist despite the control of malaria. Future epidemiological studies are needed to confirm the occurrence and risk factors associated with SFG rickettsioses and Q fever in both humans and animals.

Serologic Evidence for Orientia Exposure in the Democratic Republic of Sao Tome and Principe.

Orientia tsutsugamushi is an obligate intracellular bacterium that causes scrub typhus in humans. Formerly thought to be confined to the "tsutsugamushi triangle" within the Asia-Pacific region, scrub typhus was recently identified in the Western Hemisphere. Moreover, a new species of Orientia bacterial genus was isolated from a patient in Dubai. This study investigated Orientia exposure in an African country, the Democratic Republic of Sao Tome and Principe. Two sets of samples were analyzed in the study: 240 dried blood spots (DBSs) collected in 2016 and 863 serum samples from 570 pregnant women in 2003. Antibodies against O. tsutsugamushi were examined by immunofluorescence assay (IFA) and enzyme-linked immunosorbent assay (ELISA). The positive samples were further confirmed by Western blot. The results of IFA showed that 5.8% (14/240) of DBSs and 20.4% (116/570) of the serum samples contained reactive antibodies, whereas IgG ELISA yielded a positive rate of 15.4% (88/570) for the serum samples. These findings provided serologic evidence of potential Orientia exposure even though case of scrub typhus has never been diagnosed in the nation. Further studies are needed to determine the epidemiology and the burden of this neglected tropical disease in Africa.

Seroprevalence of antibodies against dengue virus among pregnant women in the Democratic Republic of Sao Tome and Principe.

Dengue fever has become a worldwide public health concern, threatening an estimated 40% of the world's population. However, most resources and attention are still focused on malaria, while dengue statuses are poorly recognized in many African countries. In this serological survey, dengue virus (DENV) transmission was demonstrated by using serum samples collected from 78 pregnant women in the Democratic Republic of Sao Tome and Principe (DRSTP) during 2003 to 2004. Immunofluorescence assay was performed and 31 samples (39.74%) were found positive for DENV antibodies. Indirect enzyme-linked immunosorbent assay (ELISA) showed that 53 samples (67.95%) were positive for dengue E IgG, and 38 samples (48.72%) were positive for NS1 IgG. A prevalence of 35.90% was therefore determined for dengue IgG by considering samples that yielded positive results by all three tests. Cross-reactions with other flaviviruses were examined by indirect ELISA against Japanese encephalitis virus, West Nile virus, and yellow fever virus. Only one sample exhibited stronger absorbance against Japanese encephalitis virus and West Nile virus. Moreover, one sample was positive for dengue IgM. These results agreed with the previous researches in neighboring countries and suggested DENV exposure. The study contributes to raising public awareness of dengue and supporting future control strategies.

Penile fracture with urethral trauma.

We reported a case of a twenty-nine-year-old male who presented a penile fracture associated with urethral injury caused by a sexual intercourse. An ideal anamnesis and a special physical examination were determinant to correct diagnostics. Ultrasonography and uretrocistography must be performed for confirmation. The treatment is based on the presence of associated urethral injury. The surgical repair of cavernous body and urethra can produce good results, with a favorable prognosis and minimal rate of complications.

Estratégias de controle da malária em São Tomé e Príncipe: 1946-2002 / Strategies of control of the malaria in São Tomé and Príncipe: 1946-2002

O presente trabalho analisa as estratégias de controle da malária em São Tomé e Príncipe, de 1946 aos dias atuais buscando identificar os limites e potencialidades para viabilizar e manter uma situação de controle sustentado ou erradicação. Características geográficas sócio- econômicas e conjunturais fazem de São Tomé e Príncipe um espaço endêmico, propício à produção e transmissão da malária.De acordo com este estudo, no período colonial recente, a redução dos níveis de endemicidade esteve sempre vinculada ao grau de eficácia das estratégias e a sustentabilidade das ações desenvolvidas. Estratégias baseadas na dedetização e na cloroquinazação produziram resultados mais relevantes reduzindo a mortalidade e o nível de endemicidade de hiper-holoendêmico para mesoendêmico.O mesmo estudo revela que após a independência, a implementação de estratégias de erradicação baseadas na pulverização intradomiciliar de DDT e na busca ativa e tratamento de casos tiveram resultados encorajadores. Porém, ambientes institucionais vulneráveis, ações não sustentadas no tempo, mudança no comportamento epidemiológico do vetor, resistência ao inseticida empregue, diminuição da sensibilidade do parasita à cloroquina, não foram capazes de propiciar um controle efetivo nem uma atuação sobre as condições ambientais, impedindo a circulação de parasitos e consequentemente a transmissão da doença. A transmissão da malária colocada em equilíbrio instável antes de se conseguir a interrupção da transmissão, influenciou, de forma negativa a receptividade levando a morbidade e a mortalidade a se instalarem em patamares mais altos.O recrudescimento revelou-se desastroso abrindo caminhos à novas vulnerabilidades. A malária continua sendo a primeira causa de morte e de morbidade em São Tomé e Príncipe. Mobiliza custos enormes com o tratamento e proteção e constitui um sério bloqueio ao progresso econômico do país. Considerando as forças e as fraquezas identificadas no decorrer deste estudo, as particularidades geográfico-ambientais, a complexidade dos fatores epidemiológicos e sócio-econômicos assim como os elementos técnicos em que se baseiam a estratégia mundial, o trabalho discute as estratégias que poderiam viabilizar um controle com sucesso.

Volumetric density of elastic and reticular fibers in transition zone of controls and patients with benign prostatic hyperplasia.

OBJECTIVES: To analyze the volumetric density (Vv) of elastic and reticular fibers in the transition zone of controls and patients with benign prostatic hyperplasia (BPH). METHODS: Prostatic tissue samples were obtained from 25 patients (age range 63 to 79 years, mean 68) with clinical symptoms of bladder outlet obstruction who had undergone open prostatectomy. The control group was composed of 25 transition zone samples from prostates obtained during autopsy of adults aged younger than 30 years (killed in accidents). The Vv of the elastic and reticular fibers was determined in 25 random fields per prostate, using the point-count method with an M-42 grid test system. The data were analyzed using the Kolmogorov-Smirnov, Shapiro-Wilk W, and Mann-Whitney U tests. The Vv of these components was determined by stereologic methods. RESULTS: The Vv in the control and BPH groups was 12.47% +/- 3.6% and 16.55% +/- 9.11% in the elastic system fibers (difference not statistically significant) and 22.75% +/- 1.66% and 29.33% +/- 1.08% in the reticular fibers (difference statistically significant), respectively. CONCLUSIONS: Reticular fibers showed a statistically significant increase in the BPH samples, and this finding suggests that stromal network fibers play a significant role in BPH.