Sterilization of gowns: making the most of a scarce commodity during the COVID-19 pandemic.

Baylor Clinic in Mbabane, Eswatini, convened a crisis meeting to tackle critical shortages of long-sleeved disposable gowns that resulted from COVID-19 pandemic constraints on available personal protective equipment (PPE). A strategy deemed safe, affordable and sustainable was adopted to autoclave and re-use gowns based on a risk-stratified approach. Key objectives were to ensure essential infection control and prevention (ICP) for medical doctors, nurses, and laboratory teams. Administrative, environmental and personal protective measures for ICP were enhanced through regular staff training. This strategy for gown re-use has been invaluable in motivating responsible stewardship and maximization of available gowns during the COVID-19 pandemic.

La Baylor Clinic de Mbabane, Eswatini, a convoqué une réunion de crise pour remédier à la grave pénurie de blouses jetables à manches longues due au manque d'équipements de protection individuelle (PPE) lié à la pandémie de COVID-19. Une stratégie jugée sûre, abordable et durable a été adoptée pour stériliser par autoclave et réutiliser les blouses en prenant appui sur une approche stratifiée des risques. Les objectifs clés étaient de garantir la prévention et le contrôle des infections (ICP) pour les médecins, les infirmiers et les équipes de laboratoire. Les mesures ICP d'ordre administratif, environnemental et de protection individuelle ont été renforcées par le biais de formations régulières du personnel. Cette stratégie de réutilisation des blouses a permis de promouvoir une gestion responsable et de tirer au maximum profit des blouses disponibles pendant la pandémie de COVID-19.

Surgical treatment of post-infectious hydrocephalus in infants.

The management of post-infective hydrocephalus in infants remains a challenging task for the pediatric neurosurgeon. The decision-making curve is often complex in that appropriate temporizing measures need to be implemented to properly clear any infection within the CSF before any decision can be made regarding a permanent solution. The etiology differs at varying stages of neonatal development, and the weight of the child, skin fragility, and relevant surgical treatment options are often important limiting factors. Deciding on the optimal treatment option involves assessing the etiology, age, and clinical and radiological features of the individual case and selecting the most appropriate surgical option.

Development of a web-based application to improve data collection of antimicrobial utilization in the public health care system in South Africa.

OBJECTIVE: Determining antimicrobial utilization patterns in hospitals can be a challenge given personnel and resource constraints with paper-based systems. A web-based application (APP) was developed in South Africa to address this, building on a recent point prevalence survey (PPS) using a paper-based system. Consequently, there was a need to test and evaluate the ease of use of a newly developed app and potential time saving versus paper-based methods for PPS. The findings can be used to further refine the APP. METHODS: The developed app was tested in a large academic public hospital in a PPS in South Africa. During data collection, the app was evaluated for functionality on 35 variables and subsequently refined. After data collection, the app was evaluated in terms of its time-saving potential and ease of use. RESULTS: 181 patient's files were surveyed across 13 wards in the hospital, with the antimicrobial usage findings similar to the previous paper-based study in the same hospital. The median age for males was 45.5 years and 42 years for females. Overall 80 out of 181 (44%) patients received antibiotics. Whilst 38% (12 out of 31) of patients in the adult surgical ward received antimicrobials, the prevalence was the highest (78%) in the pediatric medical wards. All the data collectors were confident in using the app after training and found the tool is not complex at all to use. In addition, the time taken to plan for the study and to collect data was considerably reduced. Reduced time spent in data collection and analysis is important for timely instigation of quality improvement programs in resource limited settings. CONCLUSIONS: All data collectors would recommend the app for future PPSs. Several concerns with data entry were identified, which have now been addressed. The app development has been successful and is now being deployed across South Africa as part of a national PPS as well as wider.

Bedaquiline and delamanid result in low rates of unfavourable outcomes among TB patients in Eswatini.

SETTING: Since 2015, Eswatini has been scaling up bedaquiline (BDQ) and delamanid (DLM) based drug-resistant TB treatment regimens under programmatic conditions.OBJECTIVE: Identification of factors associated with treatment outcomes in patients receiving BDQ and/or DLM either as a new treatment initiation or drug substitution.DESIGN: This is a retrospective cohort study of patients receiving BDQ and/or DLM in Eswatini between March 2015 and October 2018. We describe factors associated with unfavourable treatment outcomes (death, lost to follow-up, treatment failure and amplification of resistance) and culture conversion using multivariable flexible parametric survival and competing-risks regression analyses.RESULTS: Of 352 patients receiving BDQ and/or DLM, 7.8% and 21.2% had an unfavourable treatment outcome at 6 and 24 months, respectively. Predictors were age ≥ 60 years (adjusted hazard ratio aHR 4.49, 95%CI 1.61-12.57) vs. age 20-39 years, and a treatment regimen combining both drugs (aHR 4.49, 95%CI 1.61-12.57) vs. BDQ only. The probability of culture conversion was increased for two health facilities and patients with a poly resistance profile (adjusted sub-hazard ratio 2.01, 95%CI 1.13-3.59) vs. multidrug resistance.CONCLUSION: Single use of BDQ or DLM was associated with low rates of unfavourable outcomes, suggesting that these medications may be effectively adopted at scale under routine programmatic conditions. Combined use of BDQ and DLM was a risk factor for unfavourable outcomes and should prompt for collection of more data on the combined use of these medications.

Fractional Flow on TOF-MRA as a Measure of Stroke Risk in Children with Intracranial Arterial Stenosis.

BACKGROUND AND PURPOSE: Conventional angiography is the criterion standard for measuring intracranial arterial stenosis. We evaluated signal intensity ratios from TOF-MRA as a measure of intracranial stenosis and infarct risk in pediatric stroke. MATERIALS AND METHODS: A retrospective study was undertaken in children with intracranial arterial stenosis, who had TOF-MRA and conventional angiography performed within 6 months. Arterial diameters were measured for percentage stenosis. ROI analysis on TOF-MRA measured signal intensity in pre- and poststenotic segments, with post-/pre-signal intensity ratios calculated. The Pearson correlation was used to compare percentage stenosis on MRA with conventional angiography and signal intensity ratios with percentage stenosis; the point-biserial correlation was used for infarcts compared with percentage stenosis and signal intensity ratios. Sensitivity, specificity, and positive and negative predictive values were calculated for determining severe (≥70%) stenosis from MRA and signal intensity ratios against the criterion standard conventional angiography. P < .05 was considered statistically significant. RESULTS: Seventy stenotic segments were found in 48 studies in 41 children (median age, 11.0 years; range, 5 months to 17.0 years; male/female ratio, 22:19): 20/41 (48.8%) bilateral, 11/41 (26.8%) right, and 10/41 (24.4%) left, with the most common site being the proximal middle cerebral artery (22/70, 31%). Moyamoya disease accounted for 27/41 (65.9%). Signal intensity ratios and conventional angiography stenosis showed a moderate negative correlation (R = -0.54, P < .001). Receiver operating characteristic statistics showed an area under the curve of 0.86 for using post-/pre-signal intensity ratios to determine severe (≥70%) carotid stenosis, yielding a threshold of 1.00. Sensitivity, specificity, and positive and negative predictive values for severe stenosis were the following-MRA: 42.8%, 58.8%, 30.0%, and 71.4%; signal intensity ratio >1.00: 97.1%, 77.8%, 71.7%, and 97.4%; combination: 75.5%, 100%, 100%, and 76.8%, respectively. Signal intensity ratios decreased with increasing grade of stenosis (none/mild-moderate/severe/complete, P < .001) and were less when associated with infarcts (0.81 ± 0.52 for arteries associated with downstream infarcts versus 1.31 ± 0.55 for arteries without associated infarcts, P < .001). CONCLUSIONS: Signal intensity ratios from TOF-MRA can serve as a noninvasive measure of intracranial arterial stenosis and allow identification of high-risk lesions in pediatric stroke.

Predicting Ischemic Risk Using Blood Oxygen Level-Dependent MRI in Children with Moyamoya.

BACKGROUND AND PURPOSE: Moyamoya is a progressive steno-occlusive arteriopathy. MR imaging assessment of cerebrovascular reactivity can be performed by measuring the blood oxygen level-dependent cerebrovascular reactivity response to vasoactive stimuli. Our objective was to determine whether negative blood oxygen level-dependent cerebrovascular reactivity status is predictive of ischemic events in childhood moyamoya. MATERIALS AND METHODS: We conducted a retrospective study of a consecutive cohort of children with moyamoya who underwent assessment of blood oxygen level-dependent cerebrovascular reactivity. The charts of patients with written informed consent were reviewed for the occurrence of arterial ischemic stroke, transient ischemic attack, or silent infarcts. We used logistic regression to calculate the OR and 95% CI for ischemic events based on steal status. Hazard ratios for ischemic events based on age at blood oxygen level-dependent cerebrovascular reactivity imaging, sex, and moyamoya etiology were calculated using Cox hazards models. RESULTS: Thirty-seven children (21 female; median age, 10.7 years; interquartile range, 7.5-14.7 years) were followed for a median of 28.8 months (interquartile range, 13.7-84.1 months). Eleven (30%) had ischemic events, 82% of which were TIA without infarcts. Steal was present in 15 of 16 (93.8%) hemispheres in which ischemic events occurred versus 25 of 58 (43.1%) ischemic-free hemispheres (OR = 19.8; 95% CI, 2.5-160; P = .005). Children with idiopathic moyamoya were at significantly greater risk of ischemic events (hazard ratio, 3.71; 95% CI, 1.1-12.8; P = .037). CONCLUSIONS: Our study demonstrates that idiopathic moyamoya and the presence of steal are independently associated with ischemic events. The use of blood oxygen level-dependent cerebrovascular reactivity could potentially assist in the selection of patients for revascularization surgery and the direction of therapy in children with moyamoya.

Synthesis, characterization, kinetic drug release and anticancer activity of bisphosphonates multi-walled carbon nanotube conjugates.

The statistical proof that most forms of cancer metastasize to bone tissue has redirected research focus to the development of efficient secondary bone cancer treatment regimens. Bisphosphonates (BPs) have been earmarked as a drug of choice for bone metastasis. However, they have a shortcoming of being released before reaching targeted sites due to their low molecular weight. In haste to attain increased efficacy, there is a tendency for drug overdose to occur, resulting in systemic toxicity. One way to curb this is by employing drug delivery systems for targeted and controlled release of the drugs. Having been explored as versatile and innovative drug carriers, multi-walled carbon nanotubes (MWCNTs) have emerged as potential drug delivery systems. Hence, in the present study, alendronate, neridronate and pamidronate are three classes of bisphosphonates that were conjugated onto multi-walled carbon nanotubes. Conjugation was confirmed by characterization techniques including SEM, TEM, EDX, FTIR, Raman and TGA. Drug release studies were also conducted at pH 1.2, 5.5 and 7.4 to study the mechanism of release for neridronate. Results obtained were fitted into Zero order (42.6%), Higuchi (26%) and Korsmeyer-Peppas (22%). The best models describing the release of neridronate from MWCNTs were Zero order, Higuchi and Korsmeyer-Peppas at pH 1.2, 5.5 and 7.4, respectively. A tetrazolium cell viability assay was performed to assess the anticancer activity of the MWCNTs conjugated BPs.

Breath-Hold Blood Oxygen Level-Dependent MRI: A Tool for the Assessment of Cerebrovascular Reserve in Children with Moyamoya Disease.

BACKGROUND AND PURPOSE: There is a critical need for a reliable and clinically feasible imaging technique that can enable prognostication and selection for revascularization surgery in children with Moyamoya disease. Blood oxygen level-dependent MR imaging assessment of cerebrovascular reactivity, using voluntary breath-hold hypercapnic challenge, is one such simple technique. However, its repeatability and reliability in children with Moyamoya disease are unknown. The current study sought to address this limitation. MATERIALS AND METHODS: Children with Moyamoya disease underwent dual breath-hold hypercapnic challenge blood oxygen level-dependent MR imaging of cerebrovascular reactivity in the same MR imaging session. Within-day, within-subject repeatability of cerebrovascular reactivity estimates, derived from the blood oxygen level-dependent signal, was computed. Estimates were associated with demographics and intellectual function. Interrater reliability of a qualitative and clinically applicable scoring scheme was assessed. RESULTS: Twenty children (11 males; 12.1 ± 3.3 years) with 30 MR imaging sessions (60 MR imaging scans) were included. Repeatability was "good" on the basis of the intraclass correlation coefficient (0.70 ± 0.19). Agreement of qualitative scores was "substantial" (κ = 0.711), and intrarater reliability of scores was "almost perfect" (κ = 0.83 and 1). Younger participants exhibited lower repeatability (P = .027). Repeatability was not associated with cognitive function (P > .05). However, abnormal cerebrovascular reactivity was associated with slower processing speed (P = .015). CONCLUSIONS: Breath-hold hypercapnic challenge blood oxygen level-dependent MR imaging is a repeatable technique for the assessment of cerebrovascular reactivity in children with Moyamoya disease and is reliably interpretable for use in clinical practice. Standardization of such protocols will allow further research into its application for the assessment of ischemic risk in childhood cerebrovascular disease.

Cost and cost-effectiveness of transitioning to universal initiation of lifelong antiretroviral therapy for all HIV-positive pregnant and breastfeeding women in Swaziland.

OBJECTIVES: To assess the costs and cost-effectiveness of transitioning from antiretroviral therapy (ART) initiation based on CD4 cell count and WHO clinical staging ('Option A') to universal ART ('Option B+') for all HIV-infected pregnant and breastfeeding women in Swaziland. METHODS: We measured the total costs of prevention of mother-to-child HIV transmission (PMTCT) service delivery at public sector facilities with empirical cost data collected at three points in time: once under Option A and again twice after transition to the Option B+ approach. The cost per woman treated per month includes recurrent costs (personnel, overheads, medication and diagnostic tests) and capital costs (buildings, furniture, start-up costs and training). Cost-effectiveness was estimated from the health services perspective as the cost per woman retained in care through 6 months postpartum. This analysis is nested within a larger stepped-wedge evaluation, which demonstrated a 26% increase in maternal retention after the transition to Option B+. RESULTS: Across the five sites, the total cost for PMTCT during the study period (from August 2013 to October 2015, in 2015 US$) was $868,426 for Option B+ and $680 508 for Option A. The cost per woman treated per month was $183 for a woman on ART under Option B+, and $127 and $118 for a woman on ART and zidovudine (AZT), respectively, under Option A. The weighted average cost per woman treated on Option B+ was $826 compared to $525 under Option A. The main cost drivers were the start-up costs, additional training provided and staff time spent on PMTCT tasks for Option B+. The incremental cost-effectiveness ratio was estimated at $912 for every additional mother retained in care through six months postpartum. CONCLUSIONS: The cost and cost-effectiveness outcomes from this study indicate that there is a robust economic case for pursuing the Option B+ approach in Swaziland and similar settings such as South Africa. Furthermore, these costs can be used to aid decision making and budgeting, for similar settings transitioning to test and treat strategy.

From diagnosis to case investigation for malaria elimination in Swaziland: is reporting and response timely?

Background: Swaziland is one of the southern African countries that aim to eliminate malaria by 2020. In 2010, the country introduced an Immediate Disease Notification System (IDNS) for immediate reporting of notifiable diseases, including malaria. Health facilities are to report malaria cases within 24 h through a toll-free telephone number (977), triggering an alert for case investigation at the patient's household within 48 h. We assessed the completeness of reporting in the IDNS, the subsequent case investigation, and whether it was done within the stipulated timelines. Methods: A cross-sectional study using routine country-wide data. Results: Of 1991 malaria cases notified between July 2011 and June 2015, 76% were reported in the IDNS, of which 68% were investigated-a shortfall of 24% in reporting and 32% in case investigations. Of the 76% of cases reported through the IDNS, 62% were reported within 24 h and 20% were investigated within 48 h. These shortcomings were most pronounced in hospitals and private facilities. Investigated cases (n = 1346) were classified as follows: 60% imported, 35% local and 5% undetermined. Conclusion: The utilisation of the IDNS for case reporting to trigger investigation is crucial for active surveillance. There is a need to address the reporting and investigation gaps identified to ensure that malaria cases receive appropriate interventions.

Contexte: Le Swaziland est l'un des pays d'Afrique australe visant à éliminer le paludisme d'ici 2020. En 2010, le pays a introduit un système de déclaration immédiate des maladies notifiables (IDNS), dont le paludisme. Les structures de santé doivent déclarer les cas de paludisme dans les 24 h grâce à un numéro de telephone gratuit (977), qui déclenche une alerte pour l'investigation des cas dans leur domicile dans les 48 h. Nous avons évalué la complétude des déclarations dans l'IDNS, l'investigation qui a suivi et si elle a eu lieu dans les délais impartis.Méthodes : Une étude transversale basée sur des données de routine nationales.Résultats : Il y a eu 1991 cas de paludisme entre juillet 2011 et juin 2015, dont 76% ont été déclarés dans l'IDNS et 68% d'entre eux ont fait l'objet d'une investigation­un déficit de 24% dans la déclaration et 32% pour l'investigation des cas. Sur les 76% déclarés à travers l'IDNS, 62% ont été déclarés dans les 24 h et 20% ont eu une investigation dans les 48 h. Ces lacunes ont été plus prononcées dans les hôpitaux et les structures privées. Des 1346 patients qui ont eu une investigation, 60% étaient classifies comme cas importés, 35% comme cas locaux et 5% indéterminés.Conclusion : L'utilisation de l'IDNS pour la déclaration des cas afin de déclencher l'investigation est cruciale pour la surveillance active. Il est nécessaire d'examiner les lacunes identifiées en termes de déclaration et d'investigation afin de s'assurer que les cas bénéficient des interventions appropriées.

Marco de referencia: Swazilandia es uno de los países del sur de África que se proponen eliminar el paludismo hacia el 2020. En el 2010, se introdujo en el país un Sistema de Notificación Inmediata de Enfermedades (IDNS, por Immediate Disease Notification System) con el objeto de notificar de inmediato las enfermedades de declaración obligatoria como el paludismo. Los centros de atención de salud deben notificar los casos de paludismo en las primeras 24 h, por conducto de una llamada telefónica sin costo (977), que desencadena una alarma para la investigación del caso en su domicilio en menos de 48 h. En el presente estudio se evaluó el carácter integral de las notificaciones al IDNS, la posterior investigación de los casos y el cumplimiento del cronograma estipulado.Métodos: Un estudio transversal a partir de los datos corrientes de ámbito nacional.Resultados: De julio del 2011 a junio del 2015 se presentaron 1991 casos de paludismo, de los cuales se notificó el 76% al IDNS y se investigó el 68% de ellos, es decir una deficiencia de 24% en la notificación y de 32% en la investigación de casos. Del 76% de casos notificados al IDNS, el 62% se informó en las primeras 24 h y el 20% se investigó en las primeras 48 h. Las deficiencias fueron más marcadas en los hospitales y los establecimientos privados. Los casos investigados (n = 1346) se clasificaron en 60% importados, 35% locales y 5% indeterminados.Conclusión: La utilización del IDNS en la notificación de los casos con el objeto de desencadenar la investigación es un aspecto fundamental de la vigilancia activa. Es necesario actuar frente a las fallas detectadas en la notificación y la investigación, de manera que todos los casos reciban las intervenciones apropiadas.

Low uptake of preventive interventions among malaria cases in Swaziland: towards malaria elimination.

Settings: Swaziland is striving to achieve sustainable malaria elimination. Three preventive interventions are vital for reaching this goal: 1) effective household utilisation of long-lasting insecticide nets (LLINs), 2) indoor residual spraying (IRS), and 3) provision of chemoprophylaxis for those travelling to malaria-endemic areas. Objectives: To assess the uptake of preventive intervention among confirmed malaria cases. Design: A longitudinal study using nation-wide programme data from 2010 to 2015. Data on malaria cases from health facilities were sourced from the Malaria Surveillance Database System. Results: Of a total 2568 confirmed malaria cases in Swaziland, 2034 (79%) had complete data on case investigations and were included in the analysis. Of 341 (17%) individuals who owned LLINs, 169 (8%) used them; 338 (17%) had IRS and 314 (15%) slept in sprayed structures. Of 1403 travellers to areas at high malaria risk, 59 (4%) used any form of malaria prevention, including chemoprophylaxis. Conclusion: The uptake of all three key malaria prevention interventions is low, and could threaten the progress made thus far toward malaria elimination. Efforts to improve this situation, including qualitative research to understand the reasons for low uptake, are urgently needed.

Contextes : Le Swaziland s'efforce de parvenir à l'élimination pérenne du paludisme. Trois interventions préventives sont vitales pour atteindre ce but : l'utilisation efficace de moustiquaires imprégnées d'insecticide rémanent (LLIN) ; la pulvérisation d'insecticide à effet rémanent (IRS) ; et la fourniture de chimioprophylaxie pour les personnes voyageant en zone d'endémie palustre.Objectifs : Evaluer la couverture des interventions préventives parmi les cas confirmés de paludisme.Schéma : Une étude longitudinale basée sur les données du programme national de 2010 à 2015. Les données des cas de paludisme des structures de santé proviennent de la base de données du système de surveillance du paludisme.Résultats : Il y a eu un total de 2568 cas confirmés de paludisme au Swaziland, dont 2034 (79%) ont eu une investigation complète et ont été inclus dans l'analyse. Parmi eux, 341 (17%) disposaient de LLIN et 169 (8%) les utilisaient; 338 (17%) avaient bénéficié d'une IRS et 314 (15%) dormaient dans des structures vaporisées. Il y a eu 1403 voyageurs dans des zones à risque de paludisme, dont 59 (4%) ont utilisé une forme de prévention du paludisme incluant la chimioprophylaxie.Conclusion : La couverture des trois interventions clés de prévention du paludisme est faible et peut menacer les progrès réalisés à ce jour vers l'élimination du paludisme. Les efforts visant à améliorer cette situation, notamment l'utilisation de recherche qualitative pour comprendre les raisons de cette faible couverture, sont requises d'urgence.

Marco de referencia: Swazilandia se esfuerza por alcanzar una eliminación sostenible del paludismo. Existen tres intervenciones preventivas esenciales con miras a cumplir esta meta, a saber: 1) la utilización efectiva de mosquiteros impregnados de insecticidas de larga duración (LLIN); 2) la fumigación de interiores con insecticidas de efecto residual (IRS); y 3) la provisión de quimioprofilaxis a las personas que se desplazan hacia las zonas donde el paludismo es endémico.Objetivos: Apreciar la aceptación de la intervención preventiva en los casos confirmados de paludismo.Método: Un estudio longitudinal a partir de los datos del programa nacional del 2010 al 2015. Los datos sobre los casos de paludismo de los centros de atención de salud se obtuvieron de la Base de Datos del Sistema de Vigilancia del Paludismo.Resultados: Ocurrieron 2568 casos confirmados de paludismo en Swazilandia, de los cuales 2034 (79%) contaban con datos completos sobre las investigaciones del caso y se incluyeron en el análisis. De estas personas, 341 poseían LLIN (17%) y 169 lo utilizaban (8%); el domicilio de 338 personas había sido fumigado con un IRS (17%) y 314 dormían en estructuras fumigadas (15%). Se contabilizaron 1403 viajeros a zonas con riesgo de transmisión del paludismo, de los cuales 59 utilizaron alguna forma de prevención, incluida la quimioprofilaxis (4%).Conclusión: La utilización de las tres intervenciones esenciales de prevención del paludismo es muy baja y podría poner en peligro los logros alcanzados hasta ahora, en materia de eliminación de la enfermedad. Es urgente ejecutar medidas que mejoren esta situación, entre otras, la realización de investigaciones cualitativas que ayuden a comprender las razones de la baja utilización.

Carbon nanospheres conjugated bisphosphonates: synthesis, characterization and in vitro antimalarial activity.

About 40% of the world's population lives in malaria zones where it presents a challenging health problem. Malaria treatment and prevention have been hindered by drug resistance. Bisphosphonates have been found to be active against Trypanosoma cruzi and Plasmodium falciparum that cause Chaga's disease and malaria respectively. However, bisphosphonates have a shortcoming of being rapidly removed from the bloodstream through the kidneys before reaching the target sites due to their low molecular weight. In the current study, increased bisphosphonates' efficacy for malaria treatment was attempted by conjugating bisphosphonates onto carbon nanospheres (CNSs). The synthesis of the target compounds was confirmed by SEM, TEM, EDX, FTIR, Raman and TGA. The target CNSs containing bisphosphonates were evaluated for antimalarial activity against a chloroquine-resistant strain of P. falciparum. From the free bisphosphonates to the conjugates, the results obtained revealed that there were improvements in percentage parasite kill (from -10.71% to 18%, -18.93% to 28.09% and 10.47% to 28.33% for alendronate, pamidronate and neridronate, respectively). The haemolysis assays revealed that the synthesized compound did not have a toxic impact on healthy red blood cells. The results indicate that bisphosphonates conjugated CNSs are said to be promising P. falciparum blood stage inhibitors.

Childhood tuberculosis in Mauritania, 2010-2015: diagnosis and outcomes in Nouakchott and the rest of the country.

Setting: The National Tuberculosis Programme, Mauritania. Objective: To compare the diagnosis and treatment outcomes of childhood tuberculosis (TB) cases (aged <15 years) registered between 2010 and 2015 inside and outside Nouakchott, the capital city. Design: This was a retrospective comparative cohort study. Results: A total of 948 children with TB were registered. The registration rate was 10 times higher in Nouakchott. The proportion of children among all TB cases was higher inside than outside Nouakchott (7.5% vs. 4.6%, P < 0.01). Under-fives represented 225 (24%) of all childhood TB cases, of whom 204 (91%) were registered in Nouakchott. Extra-pulmonary TB was more common in Nouakchott, while smear-negative TB was less common. Treatment success was similar inside and outside Nouakchott (national rate 61%). The principal unsuccessful outcomes were loss to follow-up outside Nouakchott (21% vs. 11%, P < 0.01) while transfers out were more common in the city (25% vs. 14%, P = 0.01). Being aged <5 years (OR 1.2, 95%CI 1.1-1.5) was associated with an unsuccessful outcome. Conclusion: This study indicates problems in the diagnosis and treatment of childhood TB in Mauritania, especially outside the city of Nouakchott. We suggest strengthening clinical diagnosis and management, improving communications between TB treatment centres and health services and pressing the TB world to develop more accurate and easy-to-use diagnostic tools for children.

Contexte : Programme National Tuberculose, Mauritanie.Objectif : Comparer les résultats en termes de diagnostic et de traitement des cas de tuberculose (TB) de l'enfant (<15 ans) enregistrés entre 2010 et 2015 dans la capitale, Nouakchott, et à l'extérieur de la capitale.Schéma : Une étude rétrospective comparative de cohorte.Résultats : Au total, 948 enfants atteints de TB ont été enregistrés. Le taux d'enregistrement a été 10 fois plus élevé à Nouakchott. La proportion des enfants parmi tous les cas de TB a été plus élevée à Nouakchott qu'à l'extérieur (7,5% contre 4,6% ; P < 0,01). Les enfants âgés de <5 ans ont constitué 225 cas, soit 24% de tous les cas de TB de l'enfant, dont 204 (91%) ont été enregistrés à Nouakchott. La TB extra-pulmonaire a été plus fréquente à Nouakchott, tandis que la TB à frottis négatif a été moins fréquente. Le taux de réussite du traitement a été similaire à Nouakchott et à l'extérieur (taux national de 61%). Les principaux résultats défavorables ont été les pertes de vue à l'extérieur de Nouakchott (21% vs. 11% ; P < 0,01), tandis que les transferts ont été plus fréquents dans la capitale (25% vs. 14% ; P = 0,01). L'âge inférieur à 5 ans a été associé à un résultat défavorable (OR 1,2 ; IC95% 1,1­1,5).Conclusion : Cette étude a mis en évidence les problèmes de diagnostic et de traitement de la TB de l'enfant en Mauritanie, surtout hors de Nouakchott. Nous suggérons de renforcer le diagnostic clinique et la prise en charge, d'améliorer la communication entre les centres de traitement de la TB et les services de santé et de pousser le milieu de la TB à élaborer des outils de diagnostic plus précis et faciles à utiliser pour les enfants.

Marco de referencia: El Programa Nacional contra la Tuberculosis de Mauritania.Objetivo: Comparar los diagnósticos y los desenlaces terapéuticos de los casos de TB en los niños (<15 años de edad) registrados del 2010 al 2015 en la capital Nouakchot y fuera de esta ciudad.Método: Estudio de cohortes retrospectivo comparativo.Resultados: En general, se registraron 948 niños con TB. La tasa de registro fue 10 veces más alta en Nouakchot. La proporción de niños en todos los casos de TB fue más alta en Nouakchot que fuera de la capital (7,5% contra 4,6%; P < 0,01). De todos los casos de TB en la infancia, 225 fueron niños <5 años de edad (24%), de los cuales 204 se registraron en Nouakchot (9%). La TB extrapulmonar fue más frecuente en la capital y se observó allí una menor frecuencia de casos con baciloscopia negativa. La tasa de éxito terapéutico fue equivalente en Nouakchot y fuera de la ciudad (tasa nacional 61%). Fuera de la capital, el principal desenlace desfavorable fue la pérdida durante el seguimiento (21% contra 11%; P < 0,01) y en Nouakchot fueron las transferencias a otros centros (25% contra 14%; P = 0,01). La edad <5 años se asoció con un desenlace desfavorable (cociente de posibilidades 1,2; IC95% 1,1­1,5).Conclusión: El presente estudio pone de manifiesto los problemas del diagnóstico y el tratamiento de la TB en Mauritania, sobre todo fuera de la capital Nouakchot. Se recomienda fortalecer el diagnóstico clínico y el tratamiento, con una mejor comunicación entre los centros de tratamiento de la TB y los servicios de salud y urgir en el mundo de la TB el desarrollo de medios diagnósticos dirigidos a los niños que sean más exactos y de utilización sencilla.

Mutations in RYR1 are a common cause of exertional myalgia and rhabdomyolysis.

Mutations in the skeletal muscle ryanodine receptor (RYR1) gene are a common cause of neuromuscular disease, ranging from various congenital myopathies to the malignant hyperthermia (MH) susceptibility trait without associated weakness. We sequenced RYR1 in 39 unrelated families with rhabdomyolysis and/or exertional myalgia, frequent presentations in the neuromuscular clinic that often remain unexplained despite extensive investigations. We identified 9 heterozygous RYR1 mutations/variants in 14 families, 5 of them (p.Lys1393Arg; p.Gly2434Arg; p.Thr4288_Ala4290dup; p.Ala4295Val; and p.Arg4737Gln) previously associated with MH. Index cases presented from 3 to 45 years with rhabdomyolysis, with or without exertional myalgia (n=12), or isolated exertional myalgia (n=2). Rhabdomyolysis was commonly triggered by exercise and heat and, less frequently, viral infections, alcohol and drugs. Most cases were normally strong and had no personal MH history. Inconsistent additional features included heat intolerance, and cold-induced muscle stiffness. Muscle biopsies showed mainly subtle changes. Familial RYR1 mutations were confirmed in relatives with similar or no symptoms. These findings suggest that RYR1 mutations may account for a substantial proportion of patients presenting with unexplained rhabdomyolysis and/or exertional myalgia. Associated clinico-pathological features may be subtle and require a high degree of suspicion. Additional family studies are paramount in order to identify potentially MH susceptible relatives.

Good outcome following emergency decompressive craniectomy in a case of malignant middle cerebral artery infarction in a 14-month-old infant.

We report the case of a 14-month-old infant presenting with unresponsiveness and seizure following thoracic surgery. Imaging showed full territory left middle cerebral artery infarct and signs of raised intracranial pressure (ICP) that required emergency decompressive craniectomy (DC). The child made a good functional recovery. We discuss the case.

A simple route to triethanolamine (TEA) and cysteine capped ZnSe nanoparticles.

Water soluble triethanolamine (TEA) and cysteine capped ZnSe nanoparticles have been synthesized via simple solution based route. The method involves the reduction of selenium followed by the addition of the metal salt and capping group. The pH and metal salts were varied to study their effect on the optical properties and morphology of the particles. The as-synthesised ZnSe nanoparticles properties were studied by UV-Vis, photoluminescence, FTIR spectroscopy, powder X-ray diffraction, transmission electron microscopy (TEM) and high resolution TEM.

Testing the effectiveness of existing psycho-educational material (The Alliance Programme) for patients suffering from schizophrenia in the South African context.

OBJECTIVE: The objective of this study was to test the effectiveness of the existing psycho-educational material (The Alliance Programme) for patients suffering from schizophrenia in the South African context. METHOD: A qualitative research approach was used. Fifteen Setswana speaking participants, with a diagnosis of schizophrenia were exposed to the programme. Semi-structured and screening interviews were used to collect demographic and clinical data. The participants were divided into two groups and were exposed to either the Alliance Programme or on adapted version of the programme. Participatory communication instruments including focus groups, were used to assess comprehension and knowledge retention of the material over time. RESULTS: Participants who were exposed to the original Alliance Programme experienced the contents of the programme to be technical, difficult to read or recall. They were unable to relate their previous symptoms to the psycho-education given. Participants who were exposed to the adapted version faired much better, gained more insight and were able to relate better to their illnesses. Participants preferred booklets with examples and illustrations, video clips and films over formal lectures. CONCLUSION: Psycho-education material given to people suffering from schizophrenia and their caregivers has to be adapted to their context to be effective.

Testing the effectiveness of existing psycho-educational material (The Alliance Programme) for patients suffering from schizophrenia in the South African context

The objective of this study was to test the effectiveness of the existing psycho-educational material (The Alliance Programme) for patients suffering from schizophrenia in the South African context. Method: A qualitative research approach was used. Fifteen Setswana speaking participants, with a diagnosis of schizophrenia were exposed to the programme. Semi-structured and screening interviews were used to collect demographic and clinical data. The participants were divided into two groups and were exposed to either the Alliance Programme or on adapted version of the programme. Participatory communication instruments including focus groups; were used to assess comprehension and knowledge retention of the material over time. Results: Participants who were exposed to the original Alliance Programme experienced the contents of the programme to be technical, difficult to read or recall. They were unable to relate their previous symptoms to the psycho-education given. Participants who were exposed to the adapted version faired much better; gained more insight and were able to relate better to their illnesses. Participants preferred booklets with examples and illustrations; video clips and films over formal lectures. Conclusion: Psycho-education material given to people suffering from schizophrenia and their caregivers has to be adapted to their context to be effective