Northern Division Research Articles

Genetic heterogeneity in the Salmonella Typhi Vi capsule locus: a population genomic study from Fiji.

Typhoid fever is endemic in many parts of the world and remains a major public health concern in tropical and sub-tropical developing nations, including Fiji. To address high rates of typhoid fever, the Northern Division of Fiji implemented a mass vaccination with typhoid conjugate vaccine (Vi-polysaccharide conjugated to tetanus toxoid) as a public health control measure in 2023. In this study we define the genomic epidemiology of Salmonella Typhi in the Northern Division prior to island-wide vaccination, sequencing 85% (n=419) of the total cases from the Northern and Central Divisions of Fiji that occurred in the period 2017-2019. We found elevated rates of nucleotide polymorphisms in the tviD and tviE genes (responsible for Vi-polysaccharide synthesis) relative to core genome levels within the Fiji endemic S. Typhi genotype 4.2. Expansion of these findings within a globally representative database of 12 382 S. Typhi (86 genotyphi clusters) showed evidence of convergent evolution of the same tviE mutations across the S. Typhi population, indicating that tvi selection has occurred both independently and globally. The functional impact of tvi mutations on the Vi-capsular structure and other phenotypic characteristics are not fully elucidated, yet commonly occurring tviE polymorphisms localize adjacent to predicted active site residues when overlayed against the predicted TviE protein structure. Given the central role of the Vi-polysaccharide in S. Typhi biology and vaccination, further integrated epidemiological, genomic and phenotypic surveillance is required to determine the spread and functional implications of these mutations.

Two Peaks of Seasonal Influenza Epidemics - China, 2023.

Influenza is a communicable respiratory disease that causes annual epidemics and occasional unpredictable pandemics. This study examines the occurrence of two unexpected influenza peaks within the year 2023. Influenza-like illness (ILI) data were reported, and specimens of ILI were collected by designated surveillance hospitals. Positive cases were confirmed using real-time reverse transcription polymerase chain reaction (rRT-PCR) testing conducted at national surveillance network laboratories. The data were then submitted to the Chinese Influenza Surveillance Information System. From December 2022 to January 2023, influenza activity was minimal until a spring epidemic began in February, peaking in late March. The outbreak spread from the north to the south, with A(H1N1)pdm09 being the predominant strain and A(H3N2) also circulating concurrently. The positivity rate in northern and southern provincial-level administrative divisions (PLADs) reached 60.0% (week 10) and 60.2% (week 13), respectively, before dropping to below 5% from May to August. Subsequently, rates surged starting in week 41 in the south and week 44 in the north, peaking at 54.4% (week 50) and 44.0% (week 49), respectively, and remained high until the end of 2023. A(H3N2) became the prevailing strain, with a notable increase in B/Victoria lineage viruses from December, resulting in two peaks during the 2023 influenza season. The pattern of the influenza epidemic shifted due to the coronavirus disease 2019 (COVID-19) outbreak and is gradually returning to its usual seasonal and intensity patterns. It is, therefore, crucial to continuously strengthen influenza surveillance, enhance the influenza surveillance network, and lay the groundwork for advancing integrated surveillance of multiple pathogens in China.

Costs of primary healthcare presentations and hospital admissions for scabies and related skin infections in Fiji, 2018-2019.

Scabies and related bacterial skin and soft tissue infections (SSTIs) are highly prevalent in many tropical, low- and middle-income settings. These skin conditions contribute to higher healthcare costs and burdens on healthcare systems. The Big Skin Health Intervention Fiji Trial ("Big SHIFT") carried out surveillance for scabies and SSTIs from July 2018 to June 2019 in the Northern Division of Fiji, an area with high prevalence of scabies, prior to a division-wide ivermectin-based mass drug administration (MDA) campaign. Using data from Big SHIFT, we sought to estimate the annual direct healthcare costs of scabies and related SSTIs for the Northern Division and extrapolate these costs to the national level. We categorized SSTIs as being potentially scabies-related or unlikely scabies-related, based on a previous study. The analysis used a health system perspective, with the main resource use categories of outpatient visits, bed days during admissions, medicines, and diagnostic tests. We extrapolated the total annual number of cases and direct healthcare costs for all divisions in Fiji based upon previous scabies and impetigo prevalence data across all divisions. The average cost per PHC presentation for scabies was US$17.7, and for potentially scabies-related SSTI was $18.3. The average cost per hospital admission for a potentially scabies-related SSTI case was $439. The estimated annual healthcare costs of scabies and related SSTIs in Fiji was US$3.0 million, with cost per capita of $3.3. Scabies and related SSTIs lead to a heavy economic burden in Fiji and prevention would reduce these healthcare costs.

Emergency Nurses Knowledge, Attitude and Practices Regarding Disaster Preparedness and Management in Emergency Departments in the Northern Division, The Republic of Fiji

Abstract Introduction Since the adoption of the Hyogo Framework, much work has been done to mitigate the effects of disasters as adequate preparation will enable Registered emergency nurses (ENs) to mitigate the negative consequences of disasters. Objective To assess the knowledge, attitude, and practices of ENs in the northern division of Fiji (ND) toward disaster preparedness and management. Method A quantitative, cross-sectional study design using a self-administered questionnaire queried 61 ENs working in Emergency Departments (ED) in divisional, sub-divisional hospitals and health centers in the ND. Results A low proportion (23%) of these ENs have attended disaster preparedness training from the time they started working with the employer demonstrating they are not prepared to mitigate the effects of disaster on the affected population in the ND. Though they have adequate knowledge and a positive attitude in engaging themselves towards disaster management, only 43% of these ENs were knowledgeable about appropriate policies and procedures. This study found that 72.1% have never read or seen their health disaster management policy. Conclusion Given the number of disasters experienced in Fiji every year, there is an urgent need for a comprehensive disaster management policy and training for ENs across the ND.

Quantifying the relationship between climatic indicators and leptospirosis incidence in Fiji: A modelling study.

Leptospirosis, a global zoonotic disease, is prevalent in tropical and subtropical regions, including Fiji where it's endemic with year-round cases and sporadic outbreaks coinciding with heavy rainfall. However, the relationship between climate and leptospirosis has not yet been well characterised in the South Pacific. In this study, we quantify the effects of different climatic indicators on leptospirosis incidence in Fiji, using a time series of weekly case data between 2006 and 2017. We used a Bayesian hierarchical mixed-model framework to explore the impact of different precipitation, temperature, and El Niño Southern Oscillation (ENSO) indicators on leptospirosis cases over a 12-year period. We found that total precipitation from the previous six weeks (lagged by one week) was the best precipitation indicator, with increased total precipitation leading to increased leptospirosis incidence (0.24 [95% CrI 0.15-0.33]). Negative values of the Niño 3.4 index (indicative of La Niña conditions) lagged by four weeks were associated with increased leptospirosis risk (-0.2 [95% CrI -0.29 --0.11]). Finally, minimum temperature (lagged by one week) when included with the other variables was positively associated with leptospirosis risk (0.15 [95% CrI 0.01-0.30]). We found that the final model was better able to capture the outbreak peaks compared with the baseline model (which included seasonal and inter-annual random effects), particularly in the Western and Northern division, with climate indicators improving predictions 58.1% of the time. This study identified key climatic factors influencing leptospirosis risk in Fiji. Combining these results with demographic and spatial factors can support a precision public health framework allowing for more effective public health preparedness and response which targets interventions to the right population, place, and time. This study further highlights the need for enhanced surveillance data and is a necessary first step towards the development of a climate-based early warning system.

OLD AGE LIAISON MENTAL HEALTH SERVICEIN QATAR INTERVENTIONS AND OUTCOMES

Background: There is wide variation in the degree of provision of liaison mental health services across many countries (3) Qatar is no exception, in a general hospital in southern part of Qatar, Liaison Old Age Mental health is provided by Adult Psychiatrists with a phone advise from an Old Age Psychiatrist when requested. A general Hospital in the Northern division of the country is provided by Adult Psychiatrists with one day input from an old age Psychiatrist. Older adults Patients with mental health problems using acute and general hospital inpatient services should have access to a liaison service that specializes in the diagnosis and management of older peoples mental health (5) The research represents a newold age liaison psychiatry service intervention and outcomes in the state of Qatar. Methods: We audited the number referrals to Old Age Mental Health Liaison one year before a new service intervention in a central General hospital and one year after the service intervention. All referrals are received by the Liaison coordination office in the General hospital and data was collected electronically from the office to ensure accuracy. We also audited the educational interventions done for both staff and patients/Families.Our study included all the number of referrals for patients aged 65 plus and under 65 with Dementia to ensure the maximum statistical power possible for the service intervention. Results: The total number of referrals for patients aged 65 and above or below 65 with Dementia from June 2021 to May 2022 were 125 (n=125). The total number of Old Age Liaison Similar referrals after the service intervention from June 2022 to May 2023 were 95 referrals (n=95, p 0.01, 24% reduction in referrals rates)The Chi squared test was used to calculate the p value. Expected average of referrals to a general hospital was estimated from several inner cities general hospitals (8,21) Conclusion: The authors believe that is the first service to focus on Old Age Mental Health Liaison in the state Qatar. The study was statistically significant and qualitatively included educational outcomes provided for both staff and Patients/families. In addition, it showed an overall reduction in the number of referrals following our intervention. We believe that our outcomes are evidence based and although our outcomes are limited, they are specific, measurable, attainable, and time linked.

Subsurface Structural Image of Galabat Field, North East of Iraq Using 2D Seismic Data

This research had been achieved to identify the image of the subsurface structure representing the Tertiary period in the Galabat Field northeast of Iraq using 2D seismic survey measurements. Synthetic seismograms of the Galabat-3 well were generated in order to identify and pick the reflectors in seismic sections. Structural Images were drawn in the time domain and then converted to the depth domain by using average velocities. Structurally, seismic sections illustrate these reflectors are affected by two reverse faults affected on the Jeribe Formation and the layers below with the increase in the density of the reverse faults in the northern division. The structural maps show Galabat field, which consists of longitudinal Asymmetrical narrow anticline of Fatha and Jeribe formations, where the Southeastern limb is steeper than the Northeastern limb. The seismic interpretation shows that Galabat Field has a positive inverted structure, it is an anticline at the level of the Tertiary Period. The direction of the anticline axis and the major reverses faults are Northwest -Southeast. It is concluded from the study that reverse faults originated due to Zagros tectonism which is widespread in the area are a major conduit that channeled petroleum flow from source to Miocene traps. In addition, these faults were caused by the presence of salt accumulation within the Fatha Formation and led to high variation in the thickness in the crest and limbs of the Galabat structure.

Seroprevalence of human brucellosis among the tribal and non-tribal population residing in an eastern state of India: Findings from the state-wide serosurvey.

Brucellosis is a neglected zoonotic disease found predominantly in lower- and middle-income countries (LMICs), causing significant public health concern in India. The objective of this study was to assess the prevalence of human brucellosis in Odisha, India among community members involved in animal husbandry as a common practice. This cross-sectional study included 817 adult participants from 11 districts in Odisha. Four districts from the Northern division, four districts from the Central division, and three districts from the Southern division were selected for the study. Blood samples were collected during a COVID-19 serosurvey in Odisha conducted from 1st to 17th September 2021. Immunoglobulin-G (IgG) antibodies were measured against Brucella using a commercial ELISA kit. Point estimates at 95% confidence intervals (CIs) and adjusted odds ratio were calculated. The overall prevalence of anti-Brucella IgG antibodies was calculated at 16.65% (95% CI: 14.19-19.42). The highest seropositivity was found in Sambalpur district (29.73%; 95% CI: 16.43-47.16) and the lowest was determined in Mayurbhanj district (4.44%; 95% CI: 0.99-15.60). Compared to males, females were more prone to contracting the disease (AOR: 1.13; 95% CI: 1.05-1.67). Participants from rural settings had higher prevalence of anti-Brucella IgG antibodies than urban dwellers (AOR: 4.53; 95% CI: 1.73-11.86). This study revealed that human brucellosis was associated with sociodemographic factors like gender, living settings, and household numbers. To prevent brucellosis, screening should be initiated, infected humans should be treated early, and the public should be educated about risk factors and preventive measures.

Fiji Emergency Medical Assistance Team’s (FEMAT) Response to Tropical Cyclone Yasa, Fiji

Background/Introduction:Tropical Cyclone Yasa made landfall on Fiji’s main islands as a Category 5 cyclone on December 17, 2020 causing an immense impact on the health system with damages to health infrastructure amounting to 1.2 million USD.1 FEMAT was activated to assess and assist with disaster response in the greatly impacted Northern and Eastern Divisions of Fiji.Objectives:To describe FEMAT’s response to Tropical Cyclone Yasa.Method/Description:FEMAT’s response to TC Yasa included community assessments, provision of medical supplies and temporary tents for health facilities, and coordinating the distribution of WASH kits. FEMAT’s Health Emergency Response Team (HERT) was mobilized and provided surveillance support and medical care in Evacuation Centers (EC) treating the injured and sick. Health inspectors were deployed with FEMAT to provide food safety surveillance and management of dead animals near and in water sources.Results/Outcomes:Four mobile FEMAT teams were deployed during the TC Yasa response for 17 days over the Christmas and New Year holidays. Teams were composed of physicians, nurses, and health inspectors, and were provided with vehicles stocked with medications, medical supplies, food, and tents. 354 different communities were visited by FEMAT HERT teams, including five islands, 170 villages, 167 settlements, four estates, and eight evacuation centers. 1,172 out-patient medical encounters were recorded. Over 110 sites were treated for potential vectors by spraying and disinfection.Conclusion:FEMAT operationalized a small, mobile medical teams approach to respond to Category 5 tropical cyclone that impacted Fiji in December of 2020.

Assessing Female Suicide From a Health Equity Viewpoint, U.S. 2004–2018

Geographic and urbanization differences in female suicide trends across the U.S. necessitates suicide prevention efforts on the basis of geographic variations. The purpose of this study was to assess female suicide rates by mechanism within Census divisions and by urbanicity to help inform geographically tailored approaches for suicide prevention strategies. Data from 2004 to 2018 were obtained from the National Vital Statistics System (analyzed in 2021). Annual counts of female suicides were tabulated for firearm, suffocation, and drug poisoning and stratified by the U.S. Census division and urbanicity. Age-adjusted rates were calculated to describe female suicide incidence by geographic areas and urbanicity. Data were analyzed annually and by 5-year timeframes. Trends in annual female suicide rates by mechanism for 3 urbanization levels were identified using Joinpoint Regression. Annual percent change estimates were calculated for age-adjusted female suicide rates between 2004 and 2018. Female suicide rates by mechanism were not homogeneous within Census divisions or by urbanization levels. Suicide rates by mechanism across Census divisions within the same urbanization level varied (range=3.38-11.15 [per 100,000 person per year]). From 2014 to 2018 in large metropolitan areas in the northern divisions, rates for suffocation were higher than for firearms and drug poisoning. During the same period, in all urbanization levels in southern divisions, rates for firearms were higher than for suffocation and drug poisoning. Female suicide mechanisms vary by urbanization level, and this variation differs by region. These results could inform female suicide prevention strategies on the basis of mechanism, urbanization, and geographic region.

Impact of diabetic retinopathy awareness training on community health workers' knowledge and referral practices in Fiji: a qualitative study.

Community health workers (CHWs) are effective in raising awareness about diabetes mellitus and diabetic retinopathy (DR). In Fiji, CHWs were trained in a 1-day diabetic retinopathy (DR) awareness to provide communities with adequate basic knowledge about diabetes and DR to improve awareness and enhance referrals for DR screening and treatment. This study aimed to explore the impact of this training on CHWs' knowledge of DR and their referral practices related to DR screening in Fiji 2 years post-training. This qualitative study was conducted in 2021 across three out of the four administrative divisions of Fiji, namely the Western, Northern and Central divisions. A total of 14 CHWs from the three divisions of Fiji participated in this study. All participants had attended a 1-day DR awareness training 2 years before this study. Participants were chosen purposively and were invited to participate in focus group discussion (FGD). The FGDs were audio-recorded and transcribed verbatim, and thematic analysis was conducted to identify and classify recurrent themes. CHWs indicated that their knowledge about both diabetes and DR improved significantly after the training. This boosted their confidence in talking about these issues and providing clarity regarding referrals for DR screening in their respective communities. Consequently, they have referred a significantly higher number of people for screening both in outreach and to health facilities. Challenges in referral included poverty, high transportation cost and social support needs, which hindered screening. Further, although CHWs felt some degree of integration within the health system, they thought more was needed. Investing in scalable models such as training CHWs is an important first step in tackling diabetes and DR in communities, particularly at the grassroots level in low-resource settings by increasing the community's knowledge of DR and improving access to screening, diagnosis and treatment.

Using Satellite-Based Data to Facilitate Consistent Monitoring of the Marine Environment around Ireland

As an island nation, Ireland needs to ensure effective management measures to protect marine ecosystems and their services, such as the provision of fishery resources. The characterization of marine waters using satellite data can contribute to a better understanding of variations in the upper ocean and, consequently, the effect of their changes on species populations. In this study, nineteen years (1998–2016) of monthly data of essential climate variables (ECVs), chlorophyll (Chl-a), and the diffuse attenuation coefficient (K490) were used, together with previous analyses of sea surface temperature (SST), to investigate the temporal and spatial variability of surface waters around Ireland. The study area was restricted to specific geographically delineated divisions, as defined by the International Council of the Exploration of the Seas (ICES). The results showed that SST and Chl-a were positively and significantly correlated in ICES divisions corresponding to oceanic waters, while in coastal divisions, SST and Chl-a showed a significant negative correlation. Chl-a and K490 were positively correlated in all cases, suggesting an important role of phytoplankton in light attenuation. Chl-a and K490 had significant trends in most of the divisions, reaching maximum values of 1.45% and 0.08% per year, respectively. The strongest seasonal Chl-a trends were observed in divisions VIId and VIIe (the English Channel), primarily in the summer months, followed by northern divisions VIa (west of Scotland) and VIb (Rockall) in the winter months.

Prevention of bacterial complications of scabies using mass drug administration: A population-based, before-after trial in Fiji, 2018–2020

SummaryBackgroundScabies is an important predisposing factor of impetigo which can lead to serious bacterial complications. Ivermectin-based mass drug administration can substantially reduce scabies and impetigo prevalence in endemic settings, but the impact on serious bacterial complications is not known.MethodsWe conducted a before-after trial in the Northern Division of Fiji (population: 131,914) of mass drug administration for scabies control. Prospective surveillance was conducted from 2018 to 2020. Mass drug administration took place in 2019, involving two doses of oral ivermectin or topical permethrin, delivered alongside diethylcarbamazine and albendazole for lymphatic filariasis. The primary outcomes were incidence of hospitalisations with skin and soft tissue infections, and childhood invasive infections and post-streptococcal sequelae. Secondary outcomes included presentations to primary healthcare with skin infections and community prevalence of scabies and impetigo.FindingsThe incidence of hospitalisations with skin and soft tissue infections was 17% lower after the intervention compared to baseline (388 vs 467 per 100,000 person-years; incidence rate ratio 0.83, 95% CI, 0.74 to 0.94; P = 0.002). There was no difference in incidence of childhood invasive infections and post-streptococcal sequelae. Incidence of primary healthcare presentations with scabies and skin infections was 21% lower (89.2 vs 108 per 1000 person-years, incidence rate ratio, IRR 0.79, 95% CI, 0.78 to 0.82). Crude community prevalence of scabies declined from 14.2% to 7.7% (cluster-adjusted prevalence 12.5% to 8.9%; prevalence ratio 0.71, 95% CI, 0.28 to 1.17). Cluster-adjusted prevalence of impetigo declined from 15.3% to 6.1% (prevalence ratio 0.4, 95% CI, 0.18 to 0.86).InterpretationMass drug administration for scabies control was associated with a substantial reduction in hospitalisations for skin and soft tissue infections.FundingNational Health and Medical Research Council of Australia and Scobie and Claire Mackinnon Trust.

Costs of mass drug administration for scabies in Fiji.

In 2019, the Murdoch Children’s Research Institute in partnership with the Fiji Ministry of Health and Medical Services carried out an integrated mass drug administration (MDA) for the treatment of scabies and lymphatic filariasis in the Northern Division of Fiji (population estimate 131,914). We conducted a retrospective micro-costing exercise focused on the cost of scabies control in order to inform budgeting and policy decision making in an endemic setting. We collected detailed information on financial and economic costs incurred by both parties during the course of the MDA campaign (April 2018 to July 2019). We also conducted interviews with personnel involved in the financial administration of the MDA campaign. The economic cost of delivering two doses of ivermectin was US$4.88 per person. The cost of donated drugs accounted for 36.3% of total MDA costs. In this first large-scale MDA for the public health control of scabies, the estimated cost of delivering MDA per person for scabies was considerably more expensive than the costs reported for other neglected tropical diseases. The important cost drivers included the remuneration of health care workers who were extensively involved in the campaign, coverage of hard-to-reach, mainly rural populations and the two-dose regimen of ivermectin. These results highlight the importance of these cost determinants and can be used to plan current and future MDA programs.

Procedural Success and Immediate Results of Percuteneous Trans Mitral Commissurotomy: An Experience from a Tertiary Care Hospital in Northern Division of Bangladesh

Background: One of the ultimate grave consequences of rheumatic heart disease is mitral stenosis. Percutaneous trans-mitral commissurotomy (PTMC) has been practiced with good results in the world since Inoue introduced it in 1982. But in Bangladesh we have very few research-oriented data regarding the effectiveness and patient compliance of this procedure. Aim of the study: The aim of this study was to audit the procedural success, in-hospital outcome in patients undergoing percutaneous trans-mitral commissurotomy (PTMC). Methods: This observational cross-sectional study was conducted in northern division of Bangladesh with the collaboration of the Department of Cardiology, Rangpur Medical College Hospital, Rangpur & Zia Heart Foundation, Dinajpur during the period from February 2018 to November 2019. In total 45 patients who fulfill the inclusion and exclusion criteria for PTMC was enrolled in this study as the study people. Among them the procedural success & immediate results were assessed. Proper written consents were taken from all the participants before starting data collection. A pre-designed questionnaire was used in patent data collection. All data were processed, analyzed and disseminated by MS Office and SPSS version as per need. Result: In our study in analyzing the comparative Echo Doppler data of pre & post PTMC among the participants in both mean (±SD) MVA (cm2) and mean (±SD) MVPG (mmHg) we found extremely statistically significant correlation between pre and post PTMC stages where the P values were less than 0.0001. Besides these, in analyzing the pre & post PTMC hemodynamic and procedural data of participants we observed, against LA Pressure (mmHg) (Mean ± SD), RV Pressure (mmHg) (Mean ± SD), LVEDP (mmHg) (Mean ± SD) and Transmitral PG (mmHg) (Mean ± SD) there were extremely significant correlation between pre and post PTMC stages. In all the parameters the p values were less than 0.0001. Conclusion: We conclude that, percutaneous trans-mitral commissurotomy (PTMC) is a safe procedure in experienced hand with good success rate and optimal results even in patients with special problems like pregnancy, previous CVA and redo cases.

Prospective Surveillance of Primary Healthcare Presentations for Scabies and Bacterial Skin Infections in Fiji, 2018-2019.

Scabies, impetigo, and other skin and soft tissue infections (SSTIs) are highly prevalent in many tropical, low-middle income settings, but information regarding their burden of disease is scarce. We conducted surveillance of presentations of scabies and SSTIs, including impetigo, abscesses, cellulitis, and severe SSTI, to primary health facilities in Fiji. We established a monthly reporting system over the course of 50 weeks (July 2018-June 2019) for scabies and SSTIs at all 42 public primary health facilities in the Northern Division of Fiji (population, ≈131,914). For each case, information was collected regarding demographics, diagnosis, and treatment. There were 13,736 individual primary healthcare presentations with scabies, SSTI, or both (108.3 presentations per 1000 person-years; 95% confidence interval [CI], 106.6-110 presentations). The incidence was higher for males than for females (incidence rate ratio [IRR], 1.15; 95% CI, 1.11-1.19). Children younger than 5 years had the highest incidence among all age groups (339.1 per 1000 person-years). The incidence was higher among the iTaukei (indigenous) population (159.9 per 1000 person-years) compared with Fijians of Indian descent (30.1 per 1000 person-years; IRR, 5.32; 95% CI, 5.03-5.61). Abscess was the condition with the highest incidence (63.5 per 1,000 person-years), followed by scabies (28.7 per 1,000 person-years) and impetigo (21.6 per 1,000 person-years). Scabies and SSTIs impose a substantial burden in Fiji and represent a high incidence of primary health presentations in this population. The incidence in low-middle income settings is up to 10-times higher than that in high-income settings. New public health strategies and further research are needed to address these conditions.

Prospective surveillance for invasive Staphylococcus aureus and group A Streptococcus infections in a setting with high community burden of scabies and impetigo

BackgroundInvasive Staphylococcus aureus (iSA) and group A Streptococcus (iGAS) impose significant health burdens globally. Both bacteria commonly cause skin and soft tissue infections (SSTIs), which can result in invasive disease. Understanding of the incidence of iSA and iGAS remains limited in settings with a high SSTI burden. MethodsProspective surveillance for admissions with iSA or iGAS was conducted at the referral hospital in Fiji’s Northern Division over 48 weeks between July 2018 and June 2019. ResultsThere were 55 admissions for iSA and 15 admissions for iGAS (incidence 45.2 and 12.3 per 100,000 person-years, respectively). The highest incidence was found in patients aged ≥65 years (59.6 per 100,000 person-years for iSA and iGAS). The incidence of iSA was higher in indigenous Fijians (iTaukei) (71.1 per 100,000 person-years) compared with other ethnicities (incidence rate ratio 9.7, 95% confidence interval 3.5–36.9). SSTIs were found in the majority of cases of iSA (75%) and iGAS (53.3%). Thirteen of the 14 iGAS strains isolated belonged to emm cluster D (n = 5) or E (n = 8). The case fatality rate was high for both iSA (10.9%) and iGAS (33.3%). ConclusionsThe incidence of iSA and iGAS in Fiji is very high. SSTIs are common clinical foci for both iSA and iGAS. Both iSA and iGAS carry a substantial risk of death. Improved control strategies are needed to reduce the burden of iSA and iGAS in Fiji.

Percuteneous Trans-Mitral Commissurotomy (PTMC); Procedural Success and Immediate Results, an Experience from Tertiary Care Hospital in Northern Division of Bangladesh

Background: One of the ultimate grave consequences of rheumatic heart disease is mitral stenosis. Percutaneous trans-mitral commissurotomy (PTMC) has been practiced with good results in the world since Inoue introduced it in 1982.
 Objective: The aim of this study was to audit the procedural success, in- hospital outcome in patients undergoing PTMC in our set up. Study Design: Observational cross sectional study. Place and Duration: The study was conducted in northern division of Bangladesh with the collaboration of department of cardiology, Rangpur Medical College Hospital, Rangpur & Zia Heart Foundation, Dinazpur from February 2018 to November 2019.
 Materials and Methods: Total Thirty patients who fulfill the inclusion and exclusion criteria for PTMC was enrolled in this study. Among them the procedural success & immediate results were assessed.
 Results: Among 30 patients , 22(73.33%) were female and 8(26.66%) were male showing a female predominance. The mean age was 28.28±8.4.The procedure was successful in 29(96.66%) patients. In 1(3.3%) patient, we failed due to inability to puncture the septum for unfavourable anatomy. There was no mortality related to the procedure, no systemic embolization but one patient (3.33%) had significant MR(G II ). Pre PTMC mean MVA (cm2) was 0.801± 0.1325 and post PTMC it was 1.545± 0.292 cm2. Mean MVPG pre PTMC was 27.108±5.94 mmHg and post PTMC , 6.61±5.008 mmHg with significant p value 0.0001. Mean LA pressure before procedure was 28.65±8.456 mmHg and post PTMC, 11.27±6.34 and p value was 0.0001. Most of the patients 25(83.3%) before PTMC were in severe pulmonary hypertension and after PTMC most of the patients 21(70%) were in mild pulmonary hypertension.We successfully done 7 special cases like pregnancy, re do cases, H/O CVD etc.
 Conclusions: We conclude that PTMC is a safe procedure in experienced hand with good success rate and optimal results even in patients with special problems like pregnancy, previous CVA and redo cases.
 University Heart Journal Vol. 17, No. 1, Jan 2021; 47-54

Hospital admissions for skin and soft tissue infections in a population with endemic scabies: A prospective study in Fiji, 2018-2019.

Scabies is an important predisposing factor for impetigo but its role in more serious skin and soft tissue infections (SSTIs) is not well understood. Information is limited on incidence of SSTIs in the presence of endemic scabies. We conducted a prospective study of hospital admissions for SSTIs in the Northern Division of Fiji (population: 131,914). Prospective surveillance for admissions with impetigo, abscess, cellulitis, wound infection, pyomyositis, necrotizing fasciitis, infected scabies, and crusted scabies was conducted at the Division’s referral hospital between 2018 to 2019. Information was collected on demographic characteristics, clinical features, microbiology, treatment and outcomes. Over the study period, 788 SSTI admissions were recorded corresponding to a population incidence 647 per 100,000 person-years (95%CI 571–660). Incidence was highest at the extremes of age with peak incidence in children aged <5 years (908 per 100,000) and those aged ≥65 years (1127 per 100,000). Incidence was 1.7 times higher among the Indigenous Fijian population (753 per 100,000) compared to other ethnicities (442 per 100,000). Overall case fatality rate was 3.3%, and 10.8% for those aged ≥65 years. Scabies was diagnosed concurrently in 7.6% of all patients and in 24.6% of admitted children <5 years. There is a very high burden of hospital admissions for SSTIs in Fiji compared to high-income settings especially among the youngest, oldest and indigenous population which is concordant with scabies and impetigo distribution in this population. Our findings highlight the need for strategies to reduce the burden of SSTIs in Fiji and similar settings.

Community perspectives on scabies, impetigo and mass drug administration in Fiji: A qualitative study.

Scabies is endemic in Fiji and is a significant cause of morbidity. Little is known about the sociocultural beliefs and practices that affect the occurrence of scabies and impetigo, or community attitudes towards the strategy of mass drug administration that is emerging as a public health option for scabies and impetigo control in Fiji and other countries. Data were collected during semi-structured interviews with 33 community members in four locations in Fiji’s Northern Division. Thematic analysis examined participants’ lived experiences of scabies and impetigo; community knowledge and perceptions about scabies and impetigo aetiology and transmission; community-based treatment and prevention measures; and attitudes towards mass drug administration. Many indigenous Fijian (iTaukei) participants noted extensive and ongoing experience of scabies and impetigo among children in their families and communities, but only one participant of Indian descent (Indo-Fijian) identified personal childhood experience of scabies. Scabies and impetigo were perceived as diseases affecting children, impacting on school attendance and families’ quality of sleep. Awareness of scabies and impetigo was considerable, but there were major misconceptions around disease causation and transmission. Traditional remedies were preferred for scabies treatment, followed by biomedicines provided by local health centres and hospitals. Treatment of close household contacts was not prioritised. Attitudes towards mass drug administration to control scabies were mostly positive, although some concerns were noted about adverse effects and hesitation to participate in the planned scabies elimination programme. Findings from this first study to document perspectives and experiences related to scabies and impetigo and their management in the Asia Pacific region illustrate that a community-centred approach to scabies and impetigo is needed for the success of control efforts in Fiji, and most likely in other affected countries. This includes community-based health promotion messaging on the social dynamics of scabies transmission, and a campaign of education and community engagement prior to mass drug administration.