Retrospective Analysis of the Outcome of Hospitalized COVID-19 Patients with Coexisting Metabolic Syndrome and HIV Using Multinomial Logistic Regression.

Globally, the coexistence of metabolic syndrome (MetS) and HIV has become an important public health problem, putting coronavirus disease 19 (COVID-19) hospitalized patients at risk for severe manifestations and higher mortality. A retrospective cross-sectional analysis was conducted to identify factors and determine their relationships with hospitalization outcomes for COVID-19 patients using secondary data from the Department of Health in Limpopo Province, South Africa. The study included 15,151 patient clinical records of laboratory-confirmed COVID-19 cases. Data on MetS was extracted in the form of a cluster of metabolic factors. These included abdominal obesity, high blood pressure, and impaired fasting glucose captured on an information sheet. Spatial distribution of mortality among patients was observed; overall (21-33%), hypertension (32-43%), diabetes (34-47%), and HIV (31-45%). A multinomial logistic regression model was applied to identify factors and determine their relationships with hospitalization outcomes for COVID-19 patients. Mortality among COVID-19 patients was associated with being older (≥50+ years), male, and HIV positive. Having hypertension and diabetes reduced the duration from admission to death. Being transferred from a primary health facility (PHC) to a referral hospital among COVID-19 patients was associated with ventilation and less chance of being transferred to another health facility when having HIV plus MetS. Patients with MetS had a higher mortality rate within seven days of hospitalization, followed by those with obesity as an individual component. MetS and its components such as hypertension, diabetes, and obesity should be considered a composite predictor of COVID-19 fatal outcomes, mostly, increased risk of mortality. The study increases our understanding of the common contributing variables to severe manifestations and a greater mortality risk among COVID-19 hospitalized patients by investigating the influence of MetS, its components, and HIV coexistence. Prevention remains the mainstay for both communicable and non-communicable diseases. The findings underscore the need for improvement of critical care resources across South Africa.

Determinants of the Limpopo Province of South Africa's Response to COVID-19: A Mixed Methods Protocol to Analyze and Share Lessons Learned.

COVID-19 is a priority health research agenda item in South Africa. The World Health Organization declared the COVID-19 outbreak as a Public Health Emergency of International Concern, which requires all countries to respond and share data with others. Responses included the implementation of measures to reduce the spread of COVID-19 and protect health systems from being overwhelmed by seriously ill patients. Each country was mandated to assess its own risk and rapidly implement the necessary measures to reduce COVID-19 transmission and minimize its impact. Countries were further encouraged to share their experiences of responding to the COVID-19 pandemic. Media reports in South Africa suggest that the Limpopo Department of Health implemented a successful COVID-19 response. This study aims to analyze, document and publish those successes to make them accessible to other researchers and public health practitioners. The study will also allow for the participation of public health students to meet the requirements of their postgraduate degrees. This convergent parallel mixed method study will collect secondary data of responses to COVID-19 by the Limpopo Department of Health from the records the department keeps. Quantitative and qualitative data detailing activities and statistics describing facilitators and barriers to implementation of COVID-19 response from March 2020 will be extracted from records.

Health System- and Patient-Related Factors Associated with COVID-19 Mortality among Hospitalized Patients in Limpopo Province of South Africa's Public Hospitals.

South Africa has recorded the highest COVID-19 morbidity and mortality compared to other African regions. Several authors have linked the least amount of death in African countries with under-reporting due to poor health systems and patients' health-seeking behaviors, making the use of clinical audits more relevant for establishing the root causes of health problems, and improving quality patient care outcomes. Clinical audits, such as mortality audits, have a significant role in improving quality health care services, but very little is documented about the outcomes of the audits. Therefore, the study sought to determine the health care system and patient-related factors associated with COVID-19 mortality by reviewing the COVID-19 inpatient mortality audit narration reports. This was a retrospective qualitative research approach of all hospitalized COVID-19 patients, resulting in death between the first and second COVID-19 pandemic waves. Thematic analysis employed inductive coding to identify themes from mortality audits from all 41 public hospitals in Limpopo Province, South Africa. Four themes with seventeen sub-themes emerged: sub-standard emergency medical care provided, referral system inefficiencies contributed to delays in access to health care services, the advanced age of patients with known and unknown comorbidities, and poor management of medical supplies and equipment, as a health system and patient-related factors that contributed to the high mortality of COVID-19 patients. There is a need to routinely conduct clinical audits to identify clinical challenges and make recommendations for health promotion, risk communication, and community engagement. We recommend reviewing and expanding the scope of practice for health-care providers during epidemics and pandemics that include aspects such as task-shifting.

Computational Screening of Potential Inhibitors of Desulfobacter postgatei for Pyrite Scale Prevention in Oil and Gas Wells.

Sulfate-reducing bacteria (SRB), such as Desulfobacter postgatei are found in oil wells. However, they lead to the release of hydrogen sulfide. This in turn leads to the iron sulfide scale formation (pyrite). ATP sulfurylase is an enzyme present in SRB, which catalyzes the formation of adenylyl sulfate (APS) and inorganic pyrophosphatase (PPi) from ATP and sulfate. This reaction is the first among many in hydrogen sulfide production by D. postgatei . Consensus scoring using molecular docking and machine learning was used to identify three potential inhibitors of ATP sulfurylase from a database of about 40 million compounds. These selected hits ((S,E)-1-(4-methoxyphenyl)-3-(9-((m-tolylimino)methyl)-9,10-dihydroanthracen-9-yl)pyrrolidine-2,5-dione; methyl 2-[[(1S)-5-cyano-2-imino-1-(4-phenylthiazol-2-yl)-3-azaspiro[5.5]undec-4-en-4-yl]sulfanyl]acetate; and (4S)-4-(3-chloro-4-hydroxy-phenyl)-1-(6-hydroxypyridazin-3-yl)-3-methyl-4,5-dihydropyrazolo[3,4-b]pyridin-6-ol), known as A, B, and C, respectively) all had good binding affinities with ATP sulfurylase and were further analyzed for their toxicological properties. Compound A had the highest docking score. However, based on the physicochemical and toxicological properties, only compound C was predicted to be both safe and effective as a potential inhibitor of ATP sulfurylase, hence the preferred choice. The molecular interactions of compound C revealed favorable interactions with the following residues: LEU213, ASP308, ARG307, TRP347, LEU224, GLN212, MET211, and HIS309.

Tetra-kis-µ-l-alanine-κO:O'-bis-[tetra-aqua-terbium(III)] hexa-perchlorate.

The asymmetric unit of the title compound, [Tb(2)(C(3)H(7)NO(2))(4)(H(2)O)(8)](ClO(4))(6), contains a dinuclear cation and six perchlorate anions, one of which is disordered. In the cation, the four l-alanine mol-ecules are present in their zwitterionic form and bridge two Tb(3+) ions through their carboxyl-ate O atoms. Each Tb atom is also coordinated by four water mol-ecules in a square-anti-prismatic geometry. In the crystal structure, the cations and anions are held together via inter-molecular O-H⋯O and N-H⋯O hydrogen bonds.

Erratum: Tetra-kis-µ-l-alanine-κO:O'-bis-[tetra-aqua-terbium(III)] hexa-perchlorate. Corrigendum.

The surname of one of the authors and the affiliation of that author in the paper by Mohamed et al. [Acta Cryst. (2009), E66, m193-m194] are corrected.[This corrects the article DOI: 10.1107/S1600536809028955.].

The challenges of detecting and responding to a Lassa fever outbreak in an Ebola-affected setting.

OBJECTIVES: Lassa fever (LF), a priority emerging pathogen likely to cause major epidemics, is endemic in much of West Africa and is difficult to distinguish from other viral hemorrhagic fevers, including Ebola virus disease (EVD). Definitive diagnosis requires laboratory confirmation, which is not widely available in affected settings. The public health action to contain a LF outbreak and the challenges encountered in an EVD-affected setting are reported herein. METHODS: In February 2016, a rapid response team was deployed in Liberia in response to a cluster of LF cases. Active case finding, case investigation, contact tracing, laboratory testing, environmental investigation, risk communication, and community awareness raising were undertaken. RESULTS: From January to June 2016, 53 suspected LF cases were reported through the Integrated Disease Surveillance and Response system (IDSR). Fourteen cases (26%) were confirmed for LF, 14 (26%) did not have a sample tested, and 25 (47%) were classified as not a case following laboratory analysis. The case fatality rate in the confirmed cases was 29%. One case of international exportation was reported from Sweden. Difficulties were identified in timely specimen collection, packaging, and transportation (in confirmed cases, the time from sample collection to sample result ranged from 2 to 64 days) and a lack of response interventions for early cases. CONCLUSIONS: The delay in response to this outbreak could have been related to a number of challenges in this EVD-affected setting: a need to strengthen the IDSR system, develop preparedness plans, train rapid response teams, and build laboratory capacity. Prioritizing these actions will aid in the timely response to future outbreaks.

Infection prevention and control in health facilities in post-Ebola Liberia: don't forget the private sector!

Setting: Recognising the importance of infection prevention and control (IPC), a minimum standards tool (MST) was developed in Liberia to guide the safe (re-) opening and provision of care in health facilities. Objectives: To analyse the implementation of specific IPC measures after the 2014 Ebola virus outbreak between June 2015 and May 2016, and to compare the relative improvements in IPC between the public and private sectors. Design: A retrospective comparative cohort study. Results: We evaluated 723 (94%) of the 769 health facilities in Liberia. Of these, 437 (60%) were public and 286 (40%) were private. There was an overall improvement in the MST scores from a median of 13 to 14 out of a maximum possible score of 16. While improvements were observed in all aspects of IPC in both public and private health facilities, IPC implementation was systematically higher in public facilities. Conclusions: We demonstrate the feasibility of monitoring IPC implementation using the MST checklist in post-Ebola Liberia. Our study shows that improvements were made in key aspects of IPC after 1 year of evaluations and tailored recommendations. We also highlight the need to increase the focus on the private sector to achieve further improvements in IPC.

Contexte : En reconnaissance de l'importance de la prévention et contrôle de l'infection (PCI), le Liberia a élaboré le « minimum standards tool ¼ (MST) afin de guider en toute sécurité l'ouverture/réouverture des structures de santé et la prestation de soins.Objectifs : Analyser la mise en œuvre des mesures spécifiques de PCI après la flambée épidémique d'Ebola en 2014, entre juin 2015 et mai 2016, et comparer les améliorations relatives de la PCI entre le secteur public et privé.Schéma : Une étude rétrospective comparative de cohorte.Résultats : Nous avons évalué 723 (94%) des 769 structures de santé au Liberia. Parmi elles, 437 (60%) étaient publiques et 286 (40%), privées. Il y a eu une amélioration générale des scores MST depuis une médiane de 13 à 14, avec un score maximal de 16. Des améliorations ont été observées dans tous les aspects de la PCI à la fois dans les structures de santé publiques et privées, mais la mise en œuvre de la PCI a été systematiquement plus élevée dans les structures publiques.Conclusions: Nous avons démontré la faisabilité du suivi de la mise en œuvre de la PCI grâce à la check-list de la MST dans le Liberia d'après Ebola. Nous avons montré des améliorations dans des aspects clés de la PCI après une année d'évaluation et adapté les recommandations de la PCI. Nous mettons également en lumière le besoin d'accorder davantage d'attention au secteur privé, de manière à faire davantage de progrès dans la PCI.

Marco de referencia: Al reconocer la importancia de las medidas de prevención y control de las infecciones (PCI), se elaboró en Liberia un instrumento de normas mínimas encaminado a orientar la apertura o reapertura y la prestación de servicios en los establecimientos de atención de salud de manera segura.Objetivos: Analizar la ejecución de medidas específicas de PCI después de la epidemia del Ébola del 2014, entre junio del 2015 y mayo del 2016, y comparar los progresos relativos en la materia entre el sector público y el sector privado.Método: Un estudio retrospectivo de cohortes comparativo.Resultados: Se evaluaron 723 de los 769 establecimientos de salud de Liberia (94%). De estos, 437 pertenecían al sector público (60%) y 286 (40%) al sector privado. Se observó una mejoría global en las puntuaciones del instrumento de normas mínimas de una mediana de 13 a 14, sobre una puntuación máxima de 16. Hubo progresos en todos los aspectos de PCI en los establecimientos del sector público y privado, pero su aplicación fue sistemáticamente más alta en los centros del sector público.Conclusiones: El presente estudio puso en evidencia la factibilidad de vigilar la ejecución de las medidas de PCI utilizando la lista de verificación del instrumento de normas mínimas, después de la epidemia del Ébola en Liberia. Los resultados revelaron progresos en aspectos primordiales, después de un año de evaluaciones y recomendaciones adaptadas en materia de PCI. Se destacó además la necesidad de aumentar la atención prestada al sector privado, con el fin de promover mayores progresos en este campo.

Refinement of the subunit interaction network within the nucleosome remodelling and deacetylase (NuRD) complex.

The nucleosome remodelling and deacetylase (NuRD) complex is essential for the development of complex animals. NuRD has roles in regulating gene expression and repairing damaged DNA. The complex comprises at least six proteins with two or more paralogues of each protein routinely identified when the complex is purified from cell extracts. To understand the structure and function of NuRD, a map of direct subunit interactions is needed. Dozens of published studies have attempted to define direct inter-subunit connectivities. We propose that conclusions reported in many such studies are in fact ambiguous for one of several reasons. First, the expression of many NuRD subunits in bacteria is unlikely to lead to folded, active protein. Second, interaction studies carried out in cells that contain endogenous NuRD complex can lead to false positives through bridging of target proteins by endogenous components. Combining existing information on NuRD structure with a protocol designed to minimize false positives, we report a conservative and robust interaction map for the NuRD complex. We also suggest a 3D model of the complex that brings together the existing data on the complex. The issues and strategies discussed herein are also applicable to the analysis of a wide range of multi-subunit complexes. ENZYMES: Micrococcal nuclease (MNase), EC 3.1.31.1; histone deacetylase (HDAC), EC 3.5.1.98.

Ebola virus disease outbreak in Nigeria: Transmission dynamics and rapid control.

International air travel has already spread Ebola virus disease (EVD) to major cities as part of the unprecedented epidemic that started in Guinea in December 2013. An infected airline passenger arrived in Nigeria on July 20, 2014 and caused an outbreak in Lagos and then Port Harcourt. After a total of 20 reported cases, including 8 deaths, Nigeria was declared EVD free on October 20, 2014. We quantified the impact of early control measures in preventing further spread of EVD in Nigeria and calculated the risk that a single undetected case will cause a new outbreak. We fitted an EVD transmission model to data from the outbreak in Nigeria and estimated the reproduction number of the index case at 9.0 (95% confidence interval [CI]: 5.2-15.6). We also found that the net reproduction number fell below unity 15 days (95% CI: 11-21 days) after the arrival of the index case. Hence, our study illustrates the time window for successful containment of EVD outbreaks caused by infected air travelers.

The survival of Acinetobacter calcoaceticus inoculated on fingertips and on formica.

When inoculated on the fingers of three volunteers, strains of Acinetobacter calcoaceticus var. anitratus survived better than strains of var. lwoffii; 60 min after an inoculum of 10(4) cfu/finger, washings yielded between 2.6 x 10(1) (for a sporadic strain of var. lwoffii) and 7.2 x 10(2) cfu/finger (for an epidemic strain of var. anitratus). All five test strains survived better on formica than on skin, and from an inoculum of 10(4) cfu, between 6.4 x 10(2) and 2.2 x 10(3) cfu/finger were recoverable 60 min later. After inoculation of formica sheets, both strains of var. lwoffii could still be recovered in low numbers 24 h later, and two of the three strains of var. anitratus 60 h later. These findings suggest the presence of hitherto unrecognized antibacterial activity of skin against Acinetobacter calcoaceticus and suggest that outbreaks may be sustained by hand transmission. The ability of these organisms to survive desiccation on formica supports the proposal that transmission by air, dust or fomites may hitherto have been underestimated for this species.

Assessment of gamma dose rate over a suspected uranium mineralisation area of Jebel Mun, Western Sudan.

This study was conducted at the request of authorities in western Darfour State, to address the public concern about the levels of radioactivity in the area of Jebel Mun situated at Sudan-Chad international boundaries. It has been identified as a high background radiation area through aerial geological surveys conducted in late 1970s. The ambient gamma dose in the area was measured with the aid of a hand-held dose rate meter (Mini-Rad, Series 1000) and the surface rock samples were collected and analysed for their radioactivity content using a high-resolution gamma spectrometry equipped with HPGe with relative efficiency of 18%. The activity concentrations of 238U, 232Th and 40K were found to range from 39-253 Bq.kg(-1), 41-527 Bq.kg(-1) and 77-3027 Bq.kg(-1), respectively. From the values of the standard deviation it was concluded that the activity concentration of the considered primordial radionuclides was highly scattered (localised) which in turn indicates non-uniformity in the geological features and/or formations. 238U activity concentration corresponds to equivalent mass concentration of 7.77+/-6.12 ppm (3.19-20.73 ppm), which is of no economic importance. Samples are enriched in thorium relative to uranium as reflected by the Th:U mass ratio which ranges from 3 to 17. The absorbed dose rate in air as estimated from the measured activity concentrations of the primordial radionuclides using the DRCFs (dose rate conversion factors) falls within the range of 70-522 nGy.h(-1) with an average of 221+/-130 nGy.h(-1). It corresponds to an annual effective dose equivalent averaged of 0.27 mSv. The regression analysis has shown that the correlation between calculated and the measured ambient dose rate is marginally significant (r2 = 0.59). The 232Th series is the major producer of the surface radioactivity followed by 40K as they contribute 48% and 32% of the total absorbed dose, respectively.

Epistaxis in Kaduna, Nigeria: a review of 101 cases.

BACKGROUND: Epistaxis is defined as a hemorrhage from the nostril, nasal cavity, or nasopharynx. Sufferers and clinicians may develop significant anxiety despite the fact that majority of patients are treated successfully by the first attending physician. OBJECTIVE: To review aetiology and management outcomes of epistaxis in a resource constrained setting. METHODOLOGY: A retrospective review of 101 patients seen with epistaxis at the National Ear Care Centre, Kaduna over 7 years (January 2002- December 2008). RESULTS: The age of patients ranged between 2 and 75 years. The incidence of epistaxis of 0.5% was recorded out of total patient visit and slight male preponderance with a male:female ratio of 1.4:1. Dry-hot and cold harmattan weather had the highest prevalence. Trauma and infections were the main aetiological factors identified but over 40% of cases are idiopathic in origin. About 25% presented with active bleeding and 11% required admission. All were managed conservatively. Less than 2% received blood transfusion. CONCLUSION: Epistaxis is a common emergency that requires prompt intervention to reduce further morbidity and prevent mortality. Non operative intervention was a satisfactory approach in this study.