Laboratory-based Cross-sectional Study Research Articles

Heavy Metal Contamination in Green Leafy Vegetables Irrigated with Wastewater Collected from Harar Town Vegetable Farm, Ethiopia

Food safety issues are of growing concern to consumers globally because of the risks associated with consumption of foods contaminated with heavy metals. In Harar town, Kebele 05 vegetable farm is known to produce vegetables irrigated with wastewater. To what extent these vegetables are contaminated with heavy metals was not known. Thus, a laboratory based cross sectional study was conducted from October 2016 to January 2017 to assess the extent of heavy metal contamination of vegetables. Accordingly, a total of 72 samples from four leafy vegetables namely lettuce (Lactuca sativa), spinach (Spinacea oleracea), kale (Brassica carinata)) and cabbage (Brassica oleracea) were determined. Lead (Pb), Cadmium (Cd), and Chromium (Cr) concentration was determined using atomic absorption spectrophotometry. In all the vegetables, the mean concentrations of Pb, Cd and Cr were 0.17, 0.62 and 1.78 mg/kg, respectively in all vegetables. Cd was found in level more than the maximum limit recommended by FAO/WHO but the level of lead was within the normal range for all vegetables. Chromium was found also within the normal range in all vegetables except in lettuce. The findings of this study have important information on the implications of public health by sequestration of heavy metals to these leafy vegetables then to among vegetable consumers of Harar town and the surroundings. Thus, it is recommended that the concerned public health authorities need to create awareness in the community and discouraging the use of untreated wastewater for cultivating vegetables. Keywords: Contamination, Heavy metal, Vegetables, Wastewater DOI: 10.7176/FSQM/94-03 Publication date: February 29 th 2020

Automated versus manual method for reticulocyte count: A comparative study in rural central India

BACKGROUND: Reticulocytes are immature red blood cells that contain remnants of ribonucleic acid. Various reticulocyte parameters can help in the proper diagnosis of different anemias. It can be measured by manual as well as by automated method.OBJECTIVE: The aim is to compare between the manual and automated methods of reticulocyte count (RC) in anemia.MATERIALS AND METHODS: It was a laboratory-based cross-sectional study in which the comparison of RC by manual and automated method along with various reticulocyte parameters was done in 300 patients with anemia and 300 control samples matched for age and sex.RESULTS: The study cases included 146 females and 154 males. No statistically significant difference was found between the automated and manual count among the male (P = 0.77) as well as female patients (P = 0.61). No statistically significant difference was found in mean RC among the infants (P = 0.71), children (P = 0.59), and adults (P = 0.66) between automated and manual count. The difference between mean manual and automated RC was statistically significant only in the case of males in the macrocytic anemia group (P = 0.092). Among reticulocyte indices, mean immature reticulocyte fraction (IRF), mean reticulocyte volume (MRV), and reticulocyte hemoglobin cellular content (RHCC) was found to be statistically significant among all types of anemia (P = 0.001, 00001 and 0.0001 respectively) while it was insignificant in case of mean corrected RC (P = 0.89). A significant positive correlation was found between manual and automated RC method by using Pearson's correlation coefficient (r = 0.985, P = 0.0001).CONCLUSION: There was no significant difference between the automated and manual methods for reticulocyte counting. However, the manual method may be preferred as it is cost-effective; yet, it is laborious, time-consuming, need efficient technique, not suitable for heavily loaded laboratories and may be suitable for under-resourced laboratories. However, the automated method is preferred as it is fast, highly precise, and it is mandatory for certain diseases where reticulocyte parameters are required as a statistically significant difference was found among the different parameters such as IRF, MRV, and RHCC.

Prevalence and Antibiograms of Uropathogens from the Suspected Cases of Urinary Tract Infections in Bharatpur Hospital, Nepal

Background: This study was conducted to determine the prevalence and antibiotic susceptibility pattern of the uropathogens among the patients attending Bharatpur Hospital. Methods: A laboratory-based cross-sectional study was carried out among the patients attending Bharatpur Hospital from December 2017 to February 2018. Aseptically collected clean catch mid-stream urine samples from 200 clinically suspected patients were cultured and processed for the identification of the uropathogens in the laboratory using standard microbiological procedures. Antibiotic susceptibility test was performed for all the isolates against commonly used antibiotics using the Kirby-Bauer disc diffusion method according to Clinical and Laboratory Standards Institute guidelines 2017. Results: Out of 200 samples collected, 59(29.5%) of the samples showed the presence of pathogens causing urinary tract infection (UTI). Among them, 43(72.9%) were Gram-negative and 16(27.1%) were Gram-positive bacteria. UTI was found to be the most prevalent in females compared to the males and in the age group of 21-30 years. E. coli (72.0%) and Staphylococcus epidermidis (50.0%) were the most predominant Gram-negative and Gram-positive isolates respectively. The isolates were resistant to cefpodoxime (54.2%) and least resistant to gentamicin (10.2%). Twenty (33.9%) isolates were found to be multi-drug resistant (MDR). Conclusions: Higher frequency of antibiotic resistance among UTI patients alerts for continuous surveillance to assure effective control of this infection. Awareness of good hygienic practice especially in females and prudent use of antibiotics in case of infection can be sug-gested.
 Keywords: antibiotic susceptibility test; E. coli; MDR; urine.

Inapparent dengue virus infection among students in Mandalay, Myanmar.

A school- and laboratory-based cross-sectional descriptive study was conducted to find out the burden of inapparent dengue virus (DENV) infection in Mandalay where DENV is endemic and there is circulation of all four DENV serotypes. A total of 420 students who had no history of fever and visited the hospital within 6months were recruited from three monastic schools. Serum samples were collected and the DENV genome was checked by conventional one-step RT-PCR and anti-DENV IgM and IgG antibodies were determined. Inapparent dengue (DEN) infection is defined as individuals who were either RT-PCR-positive or anti-DENV IgM-positive with no clinical manifestations or mild symptoms, and which are not linked to a visit to a healthcare provider. Among 420 students, 38 students (9.0%, 95% CI, 6.4 to 12.2) were confirmed as recent inapparent DEN infection. The DENV serotype-1 was detected in six students. Thirty-one out of 38 (81.6%) laboratory-confirmed inapparent DEN-infected students had primary infections and seven (18.4%) had secondary infections. This study explored the prevalence of inapparent DEN infection rate in urban monastic schools in Mandalay and showed that the rate of primary infection among inapparent DENV-infected children was high.

The emergence of non-albicans candidemia and evaluation of HiChrome Candida differential agar and VITEK2 YST\xae platform for differentiation of Candida bloodstream isolates in teaching hospital Kandy, Sri Lanka

BackgroundCandidemia is an emerging hospital-acquired bloodstream infection (BSI). It is common among severely ill and immunocompromised patients. Even following appropriate therapy in candidemia, recent studies reveal relative high mortality (40%). The global incidence of candidemia shows an incline. In Sri Lanka, candida speciation often difficult where basic facilities are less available. We have compared the risk factors, epidemiology, demography, and performance of HiChrome Candida differential agar (HiCA) characteristics with the VITEK2 YST platform for differentiation of Candida albicans (CA) and non-albicans candida (NAC) from blood culture isolate.MethodsThis is a laboratory-based cross-sectional study. Positive aerobic BACTEC blood cultures having yeast were identified using HiCA and VITEK2® platform. Epidemiology, risk factors, and clinical outcomes were compared between CA and NAC bloodstream isolates.ResultsOut of 120 positive yeast samples, VITEK2® has identified 110 (92%) as Candida sp. From that CA-34 (31%) and NAC-76 (69%) were isolated. Candidemia following NCA in neonates (p = 0.02), infants (p = 0.04) and adults (p = 0.02) in ICU and immunocompromised patients were significantly higher. Compared to CA, NAC bacteremia period prevalence (0.00041%) and incidence (0.23 per 100,000-person-years) was significantly high (p = 0.03). NAC 48 (63%) isolates were resistance to azoles. Exposure to antifungals (odds ratio (OR); p = 0.03), prolonged intensive care stay > 14 days (OR-3.3; p = 0.04), having a central venous line for > 8 days (OR-4.3; p = 0.03) and on immunosuppressive treatment (OR-2.4; p = 0.04) was significantly poses risk for NAC candidemia. Sen day mortality was significant among non-albicans cases (p = 0.03) while 30-day mortality was significant among albicans cases (p = 0.04). Compared to VITEK2®, the HiCA method was 93% sensitive and 93% specific in detecting CA.ConclusionCompared to CA, candidemia following NAC was high. NAC isolates were having a high percentage of fluconazole and voriconazole resistance. VITEK2 YST® platform provides antifungal susceptibility with minimal inhibitory concentration (MIC). Impact, this would highlight the use of rapid candida identification flat form with MIC to direct appropriate antifungals for candidemia. For that implementation of novel diagnostic facilities like the VITEK2 YST platform at a tertiary care facility is demanding.

Performance of Rapid Immunochromatographic Test on Malaria Infecton Among Expectant Women in Kericho County, Kenya

Background: Microscopy is the gold standard method currently acceptable in diagnosis of malaria in a clinical setting but is subject to diagnostic bias as it cannot detect malaria parasites as they are very low or absent in peripheral circulation. Rapid immunochromatographic test (ICT) can detect the parasite antigen in peripheraral circulation and thus may be a suitable complementary epidemiological tool for malaria diagnosis among the expectant women in low parasitaemia areas. However, the sensitivity and accuracy of rapid ICT in diagnosis of malaria in pregnancy has not been established. Methods: A laboratory based cross sectional study was used. Blood samples from 314 pregnant women attending the antenatal clinic were screened for malaria parasites using microscopy, rapid ICT and polymerase chain reaction (PCR). Results: Out of the 314 samples analyzed for malaria, 44 samples (14.0%) were positive for P. falciparum by microscopy while 62 (19.7%) were positive by rapid ICT. The sensitivity and specificity of rapid ICT was 84.4% and 96.8% respectively while that of microscopy was 68.8% and 100.0% respectively. There was a moderate level of agreement between results of rapid ICT and microscopy and high level of agreement when rapid ICT results were compared against microscopy and PCR results (κ = 0.517; p <0.001 and κ = 0.821; p <0.001) respectively. Conclusion:The findings of this study suggest the potential adoption of rapid ICT as a complementary epidemiology tool for malaria diagnosis among expectant women in areas of low parasitaemia and where microscopy is difficult to implement.

Walking cadence (steps/min) and intensity in 21\u201340\u2009year olds: CADENCE-adults

BackgroundPrevious studies have reported that walking cadence (steps/min) is associated with absolutely-defined intensity (metabolic equivalents; METs), such that cadence-based thresholds could serve as reasonable proxy values for ambulatory intensities.PurposeTo establish definitive heuristic (i.e., evidence-based, practical, rounded) thresholds linking cadence with absolutely-defined moderate (3 METs) and vigorous (6 METs) intensity.MethodsIn this laboratory-based cross-sectional study, 76 healthy adults (10 men and 10 women representing each 5-year age-group category between 21 and 40 years, BMI = 24.8 ± 3.4 kg/m2) performed a series of 5-min treadmill bouts separated by 2-min rests. Bouts began at 0.5 mph and increased in 0.5 mph increments until participants: 1) chose to run, 2) achieved 75% of their predicted maximum heart rate, or 3) reported a Borg rating of perceived exertion > 13. Cadence was hand-tallied, and intensity (METs) was measured using a portable indirect calorimeter. Optimal cadence thresholds for moderate and vigorous ambulatory intensities were identified using a segmented regression model with random coefficients, as well as Receiver Operating Characteristic (ROC) models. Positive predictive values (PPV) of candidate heuristic thresholds were assessed to determine final heuristic values.ResultsOptimal cadence thresholds for 3 METs and 6 METs were 102 and 129 steps/min, respectively, using the regression model, and 96 and 120 steps/min, respectively, using ROC models. Heuristic values were set at 100 steps/min (PPV of 91.4%), and 130 steps/min (PPV of 70.7%), respectively.ConclusionsCadence thresholds of 100 and 130 steps/min can serve as reasonable heuristic thresholds representative of absolutely-defined moderate and vigorous ambulatory intensity, respectively, in 21–40 year olds. These values represent useful proxy values for recommending and modulating the intensity of ambulatory behavior and/or as measurement thresholds for processing accelerometer data.Trial registrationClinicaltrials.gov (NCT02650258).

Effect of nutritional status of pregnant women on birth weight of newborns at Butajira Referral Hospital, Butajira, Ethiopia.

Back ground:Maternal nutritional status influences the developmental environment of the fetus which consequently affects the birth weight of the newborn. However, the association between maternal nutritional factors and birth weight is complex and is not well characterized in Ethiopia.Objective:To assess the effect of maternal anthropometry and biochemical profile on birth weight of babies at Butajira Referral Hospital, Butajira, Ethiopia.Methods and materials:Laboratory-based cross-sectional study was conducted among 337 pregnant women at the hospital. Socio-demographic and obstetric characteristics were collected using pre-tested questionnaires. Blood sample was collected from each pregnant women for determination of total serum protein, total serum cholesterol and hemoglobin level. However, maternal dietary habits were not assessed in this study.Results:A total of 337 pregnant women were involved in the study. The mean (standard deviation) birth weight of the newborns was 3.14 ± 0.46 kg. After adjusting for different maternal factors, parity (p = 0.013), hemoglobin level (p = 0.046), pre-pregnancy body mass index (p < 0.001) and weight gain during pregnancy (p < 0.001) were positively associated with birth weight of the newborns, while the associations with total protein (p = 0.822) and total cholesterol (p = 0.423) were not significant.Conclusion:This study has shown that nutritional status of pregnant women as indicated by maternal anthropometry and hemoglobin level was associated with birth weight of the baby. Therefore, nutritional status of the pregnant women should be improved to reduce the risk of low birth weight.

Bacterial and Parasitic Assessment from Fingernails in Debre Markos, Northwest Ethiopia.

Background Food handlers with untrimmed finger nails could contribute or serve as a vehicle for the transmission of food poisoning pathogens. Objectives This study was conducted to determine the prevalence of bacteria and intestinal parasites among food handlers and antibiotic susceptibility profile of the isolated bacteria in Debre Markos University, Ethiopia. Materials and Methods This laboratory-based cross-sectional study involved 220 food handlers working in food service establishments in Debre Markos University between 1st January 2015 to 31th June 2016. Subjects' finger nail specimens of both hands were examined microscopically for intestinal parasites. For bacterial isolation, samples were cultured and bacterial species were identified following standard laboratory procedures. Antimicrobial susceptibility test was performed for all bacterial isolates by using Kirby-Bauer disk diffusion method. Results Of the total 220 subjects examined, 29.5% showed positive culture for different bacterial species from their fingernail contents. Coagulase-negative Staphylococcus was the predominant bacteria species (12.3%) followed by Staphylococcus aureus (5%), E. coli (2.7%), Klebsiella species (2.7%), Enterococcus species (1.8%), Pseudomonas aeruginosa (1.8%), Proteus species (1.4%), Citrobacter species (1.4%), and Serratia species (0.9%). None of the food handlers showed positive culture for Shigella and salmonella and parasites in respect of their finger nail specimens. Isolation of bacteria in finger nail has significant association with finger nail status (P=0.044) and inverse relation with service years (P=0.048). All Staphylococcus aureus and coagulase-negative Staphylococcus species isolates were uniformly susceptible to vancomycin. Only one (9.1%) of Staphylococcus aureus isolates was resistant for methicillin. Conclusion To prevent the food poisoning pathogens, implementation and adherence to infection are the key practices, specially food handlers with long finger nail harbor food debris, microbial contaminations, and allergens.

Prevalence and antimicrobial susceptibility pattern of Salmonella and Shigella among food handlers in catering establishments at Debre Markos University, Northwest Ethiopia

BackgroundFood-borne diseases are a major health problem in developing countries including Ethiopia. This study determined the prevalence and antibiotic susceptibility patterns of Shigella and Salmonella among food handlers working in student and staff food service establishments at Debre Markos University. MethodsA laboratory-based cross-sectional study was conducted among 220 food handlers from January 2015 to June 2016. Stool and fingernail samples from the subjects were cultured on bacteriological culture medium, and Shigella and Salmonella were isolated and identified following standard procedures. Antimicrobial susceptibility testing was performed for all isolates using the Kirby–Bauer disk diffusion method. ResultsThe overall prevalence of Shigella and Salmonella in this study was 5.9%, with 3.6% of stool specimens testing positive for Salmonella species and 2.3% testing positive for Shigella species. None of the food handlers had positive cultures for Shigella or Salmonella in respect of their fingernail specimens. The isolation of either Shigella or Salmonella had a significant inverse relationship with the number of service years (p=0.017). All isolates of Shigella and Salmonella were 100% susceptible to ciprofloxacin, norfloxacin, and gentamicin. However, all isolated pathogens were resistant to ampicillin (100%). ConclusionsThe findings of this study highlight the importance of food handlers in the transmission of pathogens to the customers (students and the general population). Screening of food handlers, training for food handling and hand hygiene practices, and regular monitoring of the food handling practices should be done in order to avoid diseases that can be acquired through improper food handling, like bacterial infections.

Evaluation of lipid profiles and hematological parameters in hypertensive patients: Laboratory-based cross-sectional study.

Introduction:Hypertension and dyslipidemia are the two coexisting and synergizing major risk factors for cardiovascular diseases. The cellular constituents of blood affect the volume and viscosity of blood, thus playing a key role in regulating blood pressure. Overweight and obesity are key determinants of adverse metabolic changes including an increase in blood pressure. The aim of this study was to evaluate lipid profiles and hematological parameters in hypertensive patients at Debre Markos Referral Hospital, Northwest Ethiopia.Methods:Laboratory-based cross-sectional study was conducted in 100 eligible hypertensive patients at the hospital. The required amount of blood was withdrawn from the patients by healthcare professionals for immediate automated laboratory analyses. Data were collected on socio-demographic factors, anthropometric measurements, blood pressure, lipid profiles, and hematological parameters.Result:The mean serum levels of triglyceride, total cholesterol, and low-density lipoprotein were significantly higher than their respective cut-off values in the hypertensive patients. Besides, 54%, 52%, 35%, and 11% of the hypertensive patients had abnormal low-density lipoprotein, total cholesterol, triglyceride, and high-density lipoprotein levels, respectively. Higher levels of low-density lipoprotein, hemoglobin, and red blood cell count were observed in the hypertensive patients whose blood pressure had been poorly controlled than the controlled ones (p < 0.05). Waist circumference had a significant positive association with the serum levels of total cholesterol and white blood cell count (p < 0.05).Conclusion:Hypertensive patients had a high prevalence of lipid profile abnormalities and poorly controlled blood pressure which synergize in accelerating other cardiovascular diseases. Some hematological parameters such as red blood cell count are also increased as do the severity of hypertension.

Evidence of non-influenza respiratory viruses among children under five years hospitalized with pneumonia, Greater Accra, 2013-2017

Introduction : acute respiratory illness contributes significantly to hospitalizations. It causes morbidity and mortality in younger children throughout the world, especially in developing countries. Pneumonia is a lower respiratory infection which causes inflammation of the lung parenchyma and leads to reduced oxygenation, shortness of breath and death. It is caused by a number of infectious agents which includes; viruses, bacteria and fungi. In 2015, pneumonia accounted for about 15% of deaths among children below five years, killing 920,136 children globally. Greater Accra records an estimated 16300 cases of pneumonia annually of which 40% are children under five years. Viral etiological agents responsible for pneumonia are not investigated, with treatment mostly focused on antibiotics. Against this introduction, this study sought to determine the contribution of non-influenza respiratory viruses (Respiratory syncytial virus, human para-influenza and adenovirus) in children under five years hospitalized with pneumonia in the Greater Accra region. Methods : a laboratory-based cross sectional study was conducted where nasopharyngeal (NP) and oropharyngeal (OP) specimen were obtained from children under five years hospitalized with pneumonia in two three health facilities. Specimen were tested via reverse transcription polymerase chain reaction (RT PCR). Data were entered into a Microsoft visual basic interface linked to SQL database. Analysis was performed using STATA v13 and data presented in proportions and charts. Results : a total of 238 nasopharyngeal and oropharyngeal swabs were obtained children under five years hospitalized with pneumonia from February 2013 through to April 2017. The mean age of the participants was 14 months (+/-13months), ranging from 2 to 58months, with 51.3% (122) males being the majority. A total of 60 (25.2%) tested positive for at least one of respiratory syncytial virus, adenovirus, human para-influenza virus 1 and 3. Relatively 39 (16.4%) were positive for RSV, 11 (4.6%) for adenovirus, 8 (3.4%) HPIV-3 and 5 (2.1%) HPIV-1. Conclusion : the study demonstrated the presence of non-influenza respiratory virus namely; RSV, HPIV-1, HPIV-3 and Adenoviruses among children under five years hospitalized with pneumonia in Greater Accra. Hence, non-investigation of these viruses before treatment with antibiotics could lead to a gap in proper patient management.

Detection of Carbapenem resistance among Escherichia coli and Klebsiella pneumoniae isolates in a tertiary care hospital in South India

Introduction: Carbapenems are a class of ?lactam antibiotics with a broad spectrum of activity and greatest potency against Gram positive and Gram negative bacteria and their use has markedly increased in the past few decades. The development of carbapenem resistance has now become a grave concern in the treatment of diseases.Materials and Methods: The study was a laboratory based cross sectional study done with the main aim to detect the presence of carbapenem resistance among E. coli and K. pneumoniae isolates. A total of 550 samples (pus, urine, sputum, etc) were subjected to culture. The antibiotic susceptibility for various antibiotics was studied by Kirby Bauers Disk Diffusion Test. Carbapenem resistance and Metallo-betalacatamase (MBL) production was detected using Modified Hodge Test and EDTA Disk Synergy Test respectively.Result: A total of 129 isolates (43%) were meropenem resistant out of which 42 isolates (14%) were MBL producing. Carbapenase production was noted in 42.1% of E.coliand45.8% of K. pneumoniae. Twelve percent of the E. coli and 20.8% of the K. pneumoniae were found to have prevalence of MBL producers respectively.Conclusion: High incidence of carbapenem resistance and MBL producers was noted in the isolates. Given the emerging pattern of resistance to these third line antimicrobials and limited new molecules it is imperative to frame a new antibiotic policy and its strict implementation.

Laboratory evaluation of an optimised internet-based speech-in-noise test for occupational high-frequency hearing loss screening: Occupational Earcheck

Objective: The “Occupational Earcheck” (OEC) is a Dutch online self-screening speech-in-noise test developed for the detection of occupational high-frequency hearing loss (HFHL). This study evaluates an optimised version of the test and determines the most appropriate masking noise. Design: The original OEC was improved by homogenisation of the speech material, and shortening the test. A laboratory-based cross-sectional study was performed in which the optimised OEC in five alternative masking noise conditions was evaluated. Study sample: The study was conducted on 18 normal-hearing (NH) adults, and 15 middle-aged listeners with HFHL. Results: The OEC in a low-pass (LP) filtered stationary background noise (test version LP 3: with a cut-off frequency of 1.6 kHz, and a noise floor of −12 dB) was the most accurate version tested. The test showed a reasonable sensitivity (93%), and specificity (94%) and test reliability (intra-class correlation coefficient: 0.84, mean within-subject standard deviation: 1.5 dB SNR, slope of psychometric function: 13.1%/dB SNR). Conclusions: The improved OEC, with homogenous word material in a LP filtered noise, appears to be suitable for the discrimination between younger NH listeners and older listeners with HFHL. The appropriateness of the OEC for screening purposes in an occupational setting will be studied further.

Preanalytical factors affecting medical laboratory operations: A look at laboratory request forms in a selected tertiary health-care facility in Ibadan

Aim: To document the frequencies of wrongly filled laboratory request forms with a view to improving process efficiency. Background: Available data have shown that 70% of laboratory errors are preanalytical. Most hospitals in developing countries do not have standardized laboratory request forms and often, laboratory users do not provide all the required information needed for smooth laboratory operations; however, the frequency of these issues are often not documented. This study was aimed to document the frequencies of wrongly filled laboratory request forms with a view to improving process efficiency. Materials and Methods: This was a laboratory-based cross-sectional study. A total of 5000 laboratory request forms, collected from five different laboratory units in the University College Hospital, Ibadan, Nigeria were retrospectively reviewed for the completeness of information supplied in the request forms after obtaining appropriate ethical approval. Descriptive statistics were used to analyze the data collected. Results: Findings showed that laboratory request forms across hospital laboratories were not standardized following international best practice. Required information needed for efficient laboratory operations were either incomplete or not provided in the request forms. Conclusion: The need to standardize all request forms using global recommended template with a view to supplying all the necessary information required for smooth laboratory operation and generation of credible data is highlighted in this study.

Incubation of Cue-Induced Craving in Adults Addicted to Cocaine Measured by Electroencephalography

ImportanceA common trigger for relapse in drug addiction is the experience of craving via exposure to cues previously associated with drug use. Preclinical studies have consistently demonstrated incubation of cue-induced drug-seeking during the initial phase of abstinence, followed by a decline over time. In humans, the incubation effect has been shown for alcohol, nicotine, and methamphetamine addictions, but not for heroin or cocaine addiction. Understanding the trajectory of cue-induced craving during abstinence in humans is of importance for addiction medicine.ObjectiveTo assess cue-induced craving for cocaine in humans using both subjective and objective indices of cue-elicited responses.Design, Setting, and ParticipantsSeventy-six individuals addicted to cocaine with varying durations of abstinence (ie, 2 days, 1 week, 1 month, 6 months, and 1 year) participated in this laboratory-based cross-sectional study from June 19, 2007, to November 26, 2012. The late positive potential component of electroencephalography, a recognized marker of incentive salience, was used to track motivated attention to drug cues across these self-selected groups. Participants also completed subjective ratings of craving for cocaine before presentation of a cue, and ratings of cocaine “liking” (hedonic feelings toward cocaine) and “wanting” (craving for cocaine) after presentation of cocaine-related pictures. Data analysis was conducted from June 5, 2015, to March 30, 2016.Main Outcomes and MeasuresThe late positive potential amplitudes and ratings of liking and wanting cocaine in response to cocaine-related pictures were quantified and compared across groups.ResultsAmong the 76 individuals addicted to cocaine, 19 (25%) were abstinent for 2 days, 20 (26%) were abstinent for 1 week, 15 (20%) were abstinent for 1 month, 12 (16%) were abstinent for 6 months, and 10 (13%) were abstinent for 1 year. In response to drug cues, the mean (SD) late positive potential amplitudes showed a parabolic trajectory that was higher at 1 (1.26 [1.36] µV) and 6 (1.17 [1.19] µV) months of abstinence and lower at 2 days (0.17 [1.09] µV), 1 week (0.36 [1.26] µV), and 1 year (–0.27 [1.74] µV) of abstinence (P = .02, partial η2 = 0.16). In contrast, the subjective assessment of baseline craving (mean [SD] rating: 2 days, 26.05 [9.85]; 1 week, 18.70 [11.01]; 1 month, 10.87 [10.70]; 6 months, 6.92 [8.47]; and 1 year, 3.00 [3.77]) and cue-induced liking (mean [SD] rating: 2 days, 3.06 [2.34]; 1 week, 2.33 [2.87]; 1 month, 1.15 [2.03]; 6 months, 1.00 [2.24]; and 1 year, 1.00 [1.26]) and wanting (mean [SD] rating: 2 days, 3.44 [2.62]; 1 week, 2.72 [2.87]; 1 month, 1.46 [2.33]; 6 months, 1.00 [2.16]; and 1 year, 1.00 [1.55]) of cocaine showed a linear decline from 2 days to 1 year of abstinence (P ≤ .001, partial η2 > 0.26).Conclusions and RelevanceThe late positive potential responses to drug cues, indicative of motivated attention, showed a trajectory similar to that reported in animal models. In contrast, we did not detect incubation of subjective cue-induced craving. Thus, the objective electroencephalographic measure may possibly be a better indicator of vulnerability to cue-induced relapse than subjective reports of craving, although this hypothesis must be empirically tested. These results suggest the importance of deploying intervention between 1 month and 6 months of abstinence, when addicted individuals may be most vulnerable to, and perhaps least cognizant of, risk of relapse.

Endemicity of Malaria parasites among Tuberculosis infected HIV patients attending Bombo-Military Hospital, Luwero district, Uganda

Background Malaria parasites, Tuberculosis, and HIV respectively are recognized public health global menace. The prevalence of Tuberculosis and HIV in Malaria endemic regions needs urgent attention to avert catastrophic health consequences. Objective: To evaluate the endemicity of Malaria among Tuberculosis infected HIV patients attending Bombo-Military Hospital. Materials And Methods This was a laboratory-based cross-sectional study in which 100 HIV patients were screened for malaria parasites and Mycobacterium tuberculosis and parasite density determined using standard Microbiological and parasitology methods. Data generated were tested for statistical significance. Results Out of 100 participants (18 females were civilians and 82 males were soldiers), 2.4% of males had malaria, 3.7%) had PTB, 1 (1.2%) had both malaria and PTB. Of the 18 females, only 1 (5.6%) had PTB. Malaria parasites and TB prevalence of 3.3% were among those aged 21-30 years. The highest 16.7% prevalence of PTB and malaria-PTB co-infections was among those aged 51-60 years. Malaria parasites prevalence among soldiers was 2.4%, and 1.2% had malaria and PTB while 3.7% had PTB alone. Participants’ demographic characteristics (p&lt;0.05; r=0.243) influenced malaria endemicity among Tuberculosis infected HIV patients studied. Conclusion Malaria parasites remained endemic even among Tuberculosis infected HIV patients studied Malaria disease surveillance, advocacy on innovative prevention and control strategies, an updated policy that will support effective intervention, are highly recommended.

Epidemiology of Carbapenem Resistance among Multi-drug Resistant Enterobacteriaceae in Uganda.

BackgroundMulti-drug resistant (MDR) Enterobacteriaceae are on the increase worldwide and their spread has become a global challenge. Escalating the challenge is the possibility that many of these are Carbapenemase-producing Enterobacteriaceae (CPE). This further complicates patient management. The magnitude of MDR-CPE in many developed settings has been reported, however, there is paucity of data from resource limited settings. We evaluated the epidemiology of MDR-CPE of clinical origin in South Western Uganda.MethodsFrom September 2013 to June 2014, all Enterobacteriaceae isolated from diverse specimens obtained from patients attending Mbarara Regional Referral Hospital, South-western Uganda, were screened for MDR in a laboratory-based cross sectional study. Isolates found to be MDR were screened for carbapenem susceptibility/resistance phenotypically by Kirby Bauer disc diffusion method following CLSI guidelines and genetically using the multiplex real-time Polymerase Chain Reaction (RT-PCR).ResultsOf the 658 strains isolated, 183 (27.8%) were MDR and 68 (37.15%) of those MDR exhibited at least one form of carbapenem resistance with 23 (12.57%) and 56 (30.60%) isolates expressing phenotypic and genetic resistance, respectively. Eleven MDR-CPE (6.01%) isolates exhibited both phenotypic and genotypic resistance to carbapenems. Only blaVIM and blaOXA-48 genes were detected among the genetically resistant isolates.ConclusionThe high prevalence of MDR-CPE calls for aggressive infection control and prevention strategies, including reinforcement of hand hygiene, using contact precautions and early detection of CPE through use of targeted surveillance and molecular techniques in resource limited settings.

Antimicrobial Drug Resistance and Disinfectants Susceptibility of Pseudomonas aeruginosa Isolates from Clinical and Environmental Samples in Jimma University Specialized Hospital, Southwest Ethiopia

P. aeruginosa is one of the most important pathogen that causes nosocomial infections often acquired from hospital environment and contaminated medical devices. The infections caused by this bacterium are particularly problematic because it is inherently resistant to several unrelated antimicrobial agents and antiseptics. Hence, the aim of this study was to determine drug resistance and disinfectants susceptibility of P. aeruginosa isolated from clinical samples and hospital environments. A laboratory based cross sectional study was conducted from May to September, 2012 on a total of 81 P. aeruginosa isolates. A standard bacteriological technique (conventional biochemical tests and pigment production) was used to identify the bacterium. Drug resistance and disinfectant susceptibility tests were determined by Kirby-Bauer disc-diffusion and through the classic method of successive dilutions respectively. In this study a total of 305 (160 clinical and 145 environmental) samples were investigated for P. aeruginosa and 81 isolates were obtained. This gives an overall P. aeruginosa isolation rate of 26.5% (81/305). About 47.5% of the clinical and 34.2% environmental isolates were detected from wounds and ward sinks respectively. Of these P. aeruginosa isolates, 95.1% were resistance to Trimethoprim-sulphametoxazole, 62% to Gentamicin, and 58% to Ceftriaxone. But, only 4.9% of isolates were resistance to Amikacin. Moreover, disinfectant susceptibility test revealed that hydrogen peroxide and sodium hypochlorite had a higher (92.6% & 91.4%) bactericidal activity compared to ethanol and savlon at the recommended user dilution. In general, our results indicated that P. aeruginosa was significantly resistance to commonly prescribed antimicrobial drugs, a situation that demands a more rational and appropriate use of antibiotics. Hydrogen peroxide and sodium hypochlorite were relatively more effective when used in recommended dilution. However, all tested disinfectants or antiseptics showed reduced bactericidal activities in higher dilutions. Therefore, strict adherence to the recommended dilution is important for better activity. The correct use of them also has to be considered appropriately as part of infection control practices.

Reproductive Tract Infections Among Women Attending a Gynecology Outpatient Department in Vientiane, Lao PDR

To clinically and microbiologically identify reproductive tract infections (RTI), including sexually transmitted infections (STI), and to monitor the antibiotic susceptibility of Neisseria gonorrhoeae among women attending a gynecology outpatient department in Vientiane, Laos. Clinical and laboratory-based cross-sectional study. Women aged 15 to 49 years underwent a pelvic examination, and specimens were taken for laboratory testing. Of 1125 study participants, 82% clinically presented with an RTI syndrome. However, only 64% had an etiologically diagnosed RTI, including 11% with an STI. Endogenous infections were most prevalent (candidiasis 40%; bacterial vaginosis 25%), followed by STI [Chlamydia trachomatis 4.1%; N. gonorrhoeae (NG) and Trichomonas vaginalis, both 3.7%]. The 41 NG isolates showed 20% resistance to ciprofloxacin, 98% to penicillin, and complete to tetracycline. High RTI/STI level combined with high NG resistance emphasizes that concurrent with syndromic case management, periodic evaluations of etiological diagnosis should be available to ensure adequacy of treatment algorithms and prescribed medications.