Assessment of antimicrobial resistance laboratory-based surveillance capacity of hospitals in Zambia: findings and implications for system strengthening

BACKGROUND

A well-established antimicrobial resistance (AMR) laboratory-based surveillance (LBS) is of utmost importance in a country like Zambia which bears a significant proportion of the world's communicable disease burden. This study assessed the capacity of laboratories in selected hospitals to conduct AMR surveillance in Zambia.

METHODS

This cross-sectional exploratory study was conducted among eight purposively selected hospitals in Zambia between August 2023 and December 2023. Data were collected using the self-scoring Laboratory Assessment of Antibiotic Resistance Testing Capacity (LAARC) tool.

FINDINGS

Of the assessed facilities, none had full capacity to conduct AMR surveillance with varying capacities ranging from moderate (63% (5/8)) to low (38% (3/8)). Some of the barriers of AMR-LBS were the lack of an electronic laboratory information system (63% (5/8)) and the lack of locally generated antibiograms (75% (6/8)). Quality control for antimicrobial susceptibility testing (AST), pathogen identification and media preparation had the lowest overall score among all of the facilities with a score of 14%, 20% and 44%, respectively. The highest overall scores were in specimen processing (79%), data management (78%), specimen collection, transport and management (71%), and safety (70%). Most facilities had standard operating procedures in place but lacked specimen-specific standard operating procedures.

CONCLUSION

The absence of laboratories with full capacity to conduct AMR surveillance hinders efforts to combat AMR and further complicates the treatment outcomes of infectious diseases. Establishing and strengthening LBS systems are essential in quantifying the burden of AMR and supporting the development of local antibiograms and treatment guidelines.

Imaging Features of Craniofacial Giant Cell Granulomas: A Large Retrospective Analysis from a Tertiary Care Center

BACKGROUND AND PURPOSE

Craniofacial giant cell granulomas are rare lesions with varied appearances on imaging. We aimed to describe the imaging features of giant cell granulomas of the craniofacial bones.

MATERIALS AND METHODS

A retrospective analysis of the clinical features and imaging findings of 20 histopathology-proved cases of craniofacial giant cell granulomas, dating from 2006 to 2022, was performed.

RESULTS

Of the 20 cases, 10 each were seen in men and women. The epicenter of the lesions varied in location: in the maxilla in 8 patients, in the mandible in 5, in the temporal bone in 3, in the sphenoid/clivus in 3, and in the orbit in 1 patient. On the radiographs, the lesions appeared well-circumscribed, expansile, and lytic. On CT, the lesions were predominantly multiloculated, with thin septa, a soft-tissue component, and with expansion and remodeling of the underlying bone. On MR imaging, the solid component of the lesions was isointense on T1WI and hypointense on T2WI, with heterogeneous enhancement of the solid component and rim enhancement of the locules. Fluid-fluid levels were present in 3 patients.

CONCLUSIONS

Giant cell granulomas commonly present as locally aggressive, expansile, multiloculated lytic lesions, with solid as well as cystic areas. The solid component is typically hypointense on T2WI. Certain key imaging features of giant cell granulomas can aid the radiologist in narrowing the differential diagnosis.

MPDB 2.0: a large scale and integrated medicinal plant database of Bangladesh

Objective

MPDB 2.0 is built to be the continuation of MPDB 1.0, to serve as a more comprehensive data repertoire for Bangladeshi medicinal plants, and to provide a user-friendly interface for researchers, health practitioners, drug developers, and students who wish to study the various medicinal & nutritive plants scattered around Bangladesh and the underlying phytochemicals contributing to their efficacy in Bangladeshi folk medicine.

Results

MPDB 2.0 database (https://www.medicinalplantbd.com/) comprises a collection of more than five hundred Bangladeshi medicinal plants, alongside a record of their corresponding scientific, family, and local names together with their utilized parts, information regarding ailments, active compounds, and PubMed ID of related publications. While medicinal plants are not limited to the borders of any country, Bangladesh and its Southeast Asian neighbors do boast a huge collection of potent medicinal plants with considerable folk-medicinal history compared to most other countries in the world. Development of MPDB 2.0 has been highly focused upon human diseases, albeit many of the plants indexed here can serve in developing biofuel (e.g.: Jatropha curcas used in biofuel) or bioremediation technologies (e.g.: Amaranthus cruentus helps to reduce cadmium level in soil) or nutritive diets (Terminalia chebula can be used in nutritive diets) or cosmetics (Aloe vera used in cosmetics), etc.

Evaluation and selection of indicators for land degradation and desertification monitoring: types of degradation, causes, and implications for management

Indicator-based approaches are often used to monitor land degradation and desertification from the global to the very local scale. However, there is still little agreement on which indicators may best reflect both status and trends of these phenomena. In this study, various processes of land degradation and desertification have been analyzed in 17 study sites around the world using a wide set of biophysical and socioeconomic indicators. The database described earlier in this issue by Kosmas and others (Environ Manage, 2013) for defining desertification risk was further analyzed to define the most important indicators related to the following degradation processes: water erosion in various land uses, tillage erosion, soil salinization, water stress, forest fires, and overgrazing. A correlation analysis was applied to the selected indicators in order to identify the most important variables contributing to each land degradation process. The analysis indicates that the most important indicators are: (i) rain seasonality affecting water erosion, water stress, and forest fires, (ii) slope gradient affecting water erosion, tillage erosion and water stress, and (iii) water scarcity soil salinization, water stress, and forest fires. Implementation of existing regulations or policies concerned with resources development and environmental sustainability was identified as the most important indicator of land protection.

Evaluation and selection of indicators for land degradation and desertification monitoring: methodological approach

An approach to derive relationships for defining land degradation and desertification risk and developing appropriate tools for assessing the effectiveness of the various land management practices using indicators is presented in the present paper. In order to investigate which indicators are most effective in assessing the level of desertification risk, a total of 70 candidate indicators was selected providing information for the biophysical environment, socio-economic conditions, and land management characteristics. The indicators were defined in 1,672 field sites located in 17 study areas in the Mediterranean region, Eastern Europe, Latin America, Africa, and Asia. Based on an existing geo-referenced database, classes were designated for each indicator and a sensitivity score to desertification was assigned to each class based on existing research. The obtained data were analyzed for the various processes of land degradation at farm level. The derived methodology was assessed using independent indicators, such as the measured soil erosion rate, and the organic matter content of the soil. Based on regression analyses, the collected indicator set can be reduced to a number of effective indicators ranging from 8 to 17 in the various processes of land degradation. Among the most important indicators identified as affecting land degradation and desertification risk were rain seasonality, slope gradient, plant cover, rate of land abandonment, land-use intensity, and the level of policy implementation.

Quality of life among people with epilepsy: a cross-sectional study from rural southern India

BACKGROUND

Epilepsy can be associated with profound physical, social and psychological consequences and it has an impact on a person's quality of life. We assessed the quality of life and factors associated with a poor quality of life, among adults with epilepsy in a rural block of Tamil Nadu.

METHODS

We interviewed 91 epilepsy patients from 20 randomly selected villages using a structured questionnaire including World Health Organization Quality of Life BREF (WHOQOL-BREF), Patient Health Questionnaire 2 (PHQ-2) and Generalized Anxiety Disorder 7 (GAD-7) questionnaires.

RESULTS

The mean (SD) total score of the quality of life scale was 61.49 (12.56). Those who were single, separated or widowed (t statistic= -2.71, p<0.01), had not completed primary education (t statistic=-2.308, p<0.05), not currently going for work (t statistic=-2.748, p<0.01), had seizure in the past one year (t statistic=-4.068, p<0.01),had depressive symptoms (t statistic=-3.207, p<0.01),had higher anxiety scores (t statistic=-2.727, p<0.01), had low scores in the quality of life questionnaire. Multivariate analysis showed increasing age, education less than grade V, being unmarried, widowed or separated, lower per capita income, a high anxiety score and experiencing a seizure episode in the past one year to be significantly associated with a low score in the WHOQOL-BREF questionnaire (adjusted R²=0.378, SE 9.90).

CONCLUSION

The presence of anxiety, lack of primary education, being single, separated or widowed, increasing age, low per capita income and having a seizure episode in the past year are associated with lower quality of life among people with epilepsy.

Number, maturity and phagocytic activity of neutrophils in the three trimesters of pregnancy

Specific immunity decreases markedly in pregnancy. This study was designed to determine whether the non-specific immunity mediated by neutrophils plays any role in coping with this immunosuppressed condition. The number of leukocytes and neutrophils, especially the number of young band neutrophils, increased gradually with the advancement of pregnancy. The phagocytic activity of neutrophils increased in the 2nd and 3rd trimesters. Neutrophils may compensate in part for the weakened specific immunity of pregnant women.

Postage stamps as a health promotion tool in the Nepalese community

Over the last 15 years the government of Nepal has issued postage stamps as a way of raising awareness of health issues in the general population and especially in remote communities. The topics covered by 8 different stamps are good child health care practices, combating drug abuse, hazards of smoking, prevention of AIDS, prevention of blindness due to cataract, fighting cancer and rehabilitation of disabled people

Postage stamps as a health promotion tool in the Nepalese community

Over the last 15 years the government of Nepal has issued postage stamps as a way of raising awareness of health issues in the general population and especially in remote communities. The topics covered by 8 different stamps are good child health care practices, combating drug abuse, hazards of smoking, prevention of AIDS, prevention of blindness due to cataract, fighting cancer and rehabilitation of disabled people.

Climate- and human-induced woody vegetation changes in Botswana and their implications for human adaptation

For purposes of suggesting adaptive and policy options regarding the sustained use of forestry resources in Botswana, an analysis of the whole countrywide satellite data (showing the mean present distribution of vegetation in terms of species abundance and over all density) and the projection of vegetation cover changes using a simulation approach under different climatic scenarios were undertaken. The analysis revealed that changes in vegetation cover types due to human and natural causes have taken place since the first vegetation map was produced in 1971. In the southwest, the changes appear to be more towards an increasing prevalence of thorn trees; in the eastern part of the country where widespread bush encroachment is taking place, the higher population density suggests more human induced (agrarian-degradation) effects, while in the sparsely settled central Kalahari region, changes from tree savanna to shrubs may be indicative of the possible influence of climate with the associated effects of fires and local adaptations. Projection of future vegetation changes to about 2050 indicates degeneration of the major vegetation types due to the expected drying. Based on the projected changes in vegetation, current adaptive and policy arrangements are not adequate and as such a shift from the traditional adaptive approaches to community-based types is suggested. Defining forestry management units and adopting different management plans for the main vegetation stands that are found in Botswana are the major policy options.

Stylalgia: an Indian perspective

OBJECTIVE

The main objective was to study the stylalgia profile in Indians and the outcome of styloidectomy in such cases.

DESIGN

This prospective study was carried out by random selection of patients with stylalgia using periodic random numbers.

SETTING

This was a hospital-based study.

METHODS

Surgical excision of the symptomatic enlarged styloid process was performed by the transtonsillar route using a dilation and curettage (D and C) curette.

MAIN OUTCOME MEASURES

The patients were followed postoperatively for their pain relief.

RESULTS

Of 40 patients operated on, 31 (77.5%) became symptom free, 5 (12.5%) had considerable improvement in their symptoms, and 4 (10%) had no relief.

CONCLUSIONS

The incidence of an enlarged styloid process was found to be higher in an Indian rural population with female preponderance owing to their carrying of heavy weight on head. Styloidectomy was very rewarding. The D and C curette was found to be a very effective instrument for styloidectomy.

Effect of thymectomy on serum gonadotrophins and testosterone concentration

There is controversy about the relationship between thymic secretion and secretion of gonadotrophins and testosterone. One group of scientists reported that thymus is stimulatory to gonadotrophins and testosterone secretion, and according to other group thymic secretion is inhibitory to gonadotrophins and testosterone secretion. So we tried to observe what exactly happens to serum gonadotrophins and testosterone level following thymectomy. Thymectomy was performed in prepubertal animals and after 45 days of their operation serum gonadotrophins were measured by ELISA technique and serum testosterone was measured by RIA technique. The present study reveals a significant fall in serum FSH level along with significant rise in serum LH and testosterone level in male albino rats following thymectomy in comparison to that of sham thymectomized rats. It appears that thymus has an inhibitory influence on LH secreting gonadotrophs which has been withdrawn following thymectomy and as a result there occurs an increase in serum LH level. This LH stimulates interstitial cells of leydig and cause thereby an increase in serum testosterone level. The result also gives an indication that among the gonadotrophs in pituitary, one type is concerned with the secretion of LH while some gonadotrophs are concerned with secretion of FSH only; and the thymus possibly maintains the FSH secreting gonadotrophs intact at least till the age of puberty. Thymectomy may cause some disorganization of FSH secreting gonadotrophs which results in the fall in serum FSH level in thymectomized animals in comparison to that of sham thymectomized animal group.

Environmental Change in the Mid-Boteti Area of North-Central Botswana: Biophysical Processes.and Human Perceptions

Increased interest in environmental change issues has led researchers to consider more integrated approaches to change dynamics. This paper examines change in terms of land degradation in north-central Botswana from both biophysical and human perspectives. Although seasonal and periodic droughts were prevalent, analysis of rainfall data over the past 70 years revealed no downward trend. However, indicators of declining productivity such as soil erosion, loss of vegetation cover, and a declining groundwater table were amply evident. The GIS analysis of remotely sensed data has shown that complete vegetation recovery after drought is not taking place, particularly in the south-central part of the study area. These areas contained the highest human and livestock population densities. The local people acknowledged facing increasing resource depletion and indicated drought as the main cause. Pressures on available resources, particularly during drought periods, appeared to have impeded the regenerative capacity of the natural vegetation cover, thereby inducing land degradation. This situation may not easily be rectified because of widespread poverty and inappropriate local perceptions of the solutions. Both of these hinder the adoption of sustainable land management.

Diamine-oxidase activity and tissue di- and poly-amine contents of human ovarian, cervical and endometrial carcinoma

In view of the conflicting reports regarding the association of di- and poly-amines along with diamine oxidase (DAO) activity in human carcinomatous growths, the present study was undertaken to establish their interrelation and to justify whether analysis of di- and poly-amine contents along with DAO may have any diagnostic value in the assessment of the carcinomatous state. It was found that diamines like histamine, putrescine and cadaverine, and polyamines like spermine and spermidine, and also DAO, increased unequivocally in human ovarian, cervical and endometrial carcinoma in comparison with their adjoining normal tissues. A reasonable explanation has been put forward to support the observations made.

Polyamines in relation to human breast, rectal and squamous cell carcinoma

An intimate relation between polyamines and cellular growth is evident from the existing literature; but the role of polyamines in carcinomatous growth has not been established and it remains a controversy whether polyamine analysis can be of any use as a marker for carcinoma. In an attempt to find out the relation of polyamine to carcinomatous tissues, it has been found that putrescine, cadaverine, spermine and spermidine concentrations in breast, rectal and squamous cell carcinomatous tissues, analysed under the present experiment, increased unequivocally. The result has been discussed and a reasonable explanation has been given to support the finding.

Diamineoxidase activity and tissue histamine content of human skin, breast and rectal carcinoma

In view of the controversy that exists regarding the histamine content and diamine oxidase activity in relation to human carcinomatous growths, the present investigation was undertaken and carcinomatous tissues of skin, breast and rectum were analysed. The result of the experiment gives a clear evidence that both histamine concentration and diamine-oxidase activity increase significantly in all the three types of growth. The result has been discussed and a reasonable explanation has been offered for the observations made.

The sequence of 3'-termini of mRNAs from early region III of adenovirus 2

The cloned cDNA sequences corresponding to early region III transcripts (76.6-86.0 map units) of adenovirus 2 were analyzed with a view to determine the structure of their 3'-termini. The clones pE7, pE22 and pE34, which contain a part of or the entire coding sequence for the Mr 19000 glycoprotein, showed microheterogeneity with respect to the poly(A) addition site, with the polyadenylation occurring 17, 26, or 29 nucleotides downstream from the hexanucleotide, 5'-ATTAAA-3'. The clone pE17 which represents a copy of the mRNA ending at 86.0 map units showed the presence of the sequence 5'-AATAAA-3', 16 nucleotides before the poly(A) tail.

A histochemical study of leucine amino peptidase activity in the testes of immature and mature guinea-pigs

The distribution of the enzyme leucine amino peptidase (LAP) has been studied histochemically in immature and mature guinea-pig testes. Immature guinea-pig testis showed a very feeble LAP activity, while in mature ones strong LAP activity was noted. The present communication indicates a direct relationship between the activity of the enzyme LAP and sexual maturation.

DNA synthetic ability in cerebella from temperature and handling stressed neonatal rats

DNA synthetic ability of neonatal rat cerebellum was studied in two stressful conditions (cooling and excessive handling) which may be inadvertently imposed during the course of certain experiments. A rate study of the ability of animals handled excessively for 10 min to incorporate 14C-thymidine into the DNA tissue fraction (DNAF) from the acid soluble tissue fraction (ASF) of the cerebellum revealed a decreased DNA synthetic ability which lasted for 1 hr. Animals with very low core temperatures incorporated little 14C into the DNAF from the ASF 2 hr after an IP injection of 14C-thymidine. There was a proportional decrease in the ability to synthesize DNA as core temperature decreased.

Quantification of cell death in developing cerebellum by a 14C tracer method

To study the question of whether or not cell death contributes significantly to normal or stressed postnatal brain development in a way which is biochemically quantifiable, we carried out an experiment to assess the amount of cell death in developing cerebellum. By measuring the loss of DNA content and the loss of 14C from labelled thymidine previously incorporated into the DNA fraction (DNAF) in X-irradiated neonatal animals, shown by histological methods to have cell death to the degree of degranulating the external granular layer (EGL), we showed that when cells die both label and DNA content are greatly decreased in the cerebellum. Experiments on both normal and malnourished animals showed that cell death does not contribute significantly to cerebellar development in either malnutrition-stressed or normal animals. Here, we present a biochemical tool for assessing cell death and evidence that cell death does not contribute significantly to cerebellar development.

Purkinje cell dendritic alterations after transient developmental injury of theexternal granular layer

To examine the influence of granule cell axons on morphogenesis of their major synaptic target, the Purkinje cell dendrites, a transient injury of the external granular layer of developing rat cerebellum was induced by injecting 10 mg/kg methylazoxymethanol acetate on postnatal days 1, 2, 3 and 4. The antiproliferative action of the drug resulted in a diminution of the mitotic population which slowed the expansion of the internal granular and molecular layers. This was followed by a reconstitution of a thicker than normal external granular layer and a late phase of extensive growth. Perturbations of Purkinje cell dendritic morphology induced by this altered timing of granule cell accumulation were studied with Golgi-Cox impregnation techniques. Systematic observation were made of a number of defined abnormalities of Purkinje cells which included somas positioned below the normal monolayer; elongated dendrites; multiple somatic dendrites; S-shaped dendrites; dendrites disoriented away from the radial direction; and portions of dendrites below the soma of origin. The results indicated that most of these 'abnormalities' occur to a small extent in normal cerebellum but that these experimental conditions induced a bias in favor of their appearance. Some dendritic abnormalities, i.e., dendrites tilted out of the sagittal plane, dendrites directed toward the white matter, and apical dendrites growing vertically between cells of the external granular layer, were not noted in normal cerebellum and we attribute these particular changes to unique developmental possibilities occuring only after a more or less severe injury. This analysis of bias in dendritic morphology subsequent to subtle developmental injury provides informat on on processes of normal development and on the genesis of phylogenetic variants of Purkinje cell morphology.