WHO Protocol Research Articles

Study of phytochemical content, antioxidant and larvicidal property of different solvent extracts of Clerodendrum infortunatum and Citrus grandis

The present study was carried out to investigate the phytochemical, antioxidant and larvicidal property of different solvent extracts of leaves of Clerodendrum infortunatum and fruit peel of Citrus grandis. The antioxidant property was studied by ferric reducing antioxidant power (FRAP), total antioxidant capacity (TAC), 1,1‑diphenyl‑2‑picrylhydrazyl (DPPH), 2,2’-azinobis-(3-ethylbenzothiazoline-6-sulfonate) (ABTS) and thiobarbituric acid reactive species (TBARS) assays. The total phenolic and flavonoid contents of the extracts were estimated following standard protocols. Larvicidal activity of the plant extracts were evaluated following standard WHO protocol. In a series of test doses (100 to 2000 μg/mL), 20 numbers of Aedes aegypti larvae were exposed and the mortality was recorded after 24 h and LC50 were calculated. The study showed that the C. grandis extracts have better phytochemical, antioxidant and larvicidal activity compared to C. infortunatum. Among the four solvent fractions, diethyl ether extract showed higher activity in both the plants. The present study thus showed potential larvicidal property of the plants against A. aegypti. However, further characterization and identification of active compound (s) need to be carried out to study the exact mode of action.

Establishment of a novel triage system for SARS-CoV-2 among trauma victims in trauma centers with limited facilities

ObjectivesThe triage of trauma patients with potential COVID-19 remains a major challenge given that a significant number of patients may be asymptomatic or pre-symptomatic. This study aimed to compare the...

Implementation of a standardised and quality-assured enhanced gonococcal antimicrobial surveillance programme in accordance with WHO protocols in Kampala, Uganda

ObjectivesThe emergence of multidrug-resistant Neisseria gonorrhoeae (NG) is a major global health threat necessitating response and control measures. NG antimicrobial resistance (AMR) surveillance data from sub-Saharan countries is exceedingly limited....

Insecticide resistance status and mechanisms in Aedes aegypti populations from Senegal.

Aedes aegypti is the main epidemic vector of arboviruses in Africa. In Senegal, control activities are mainly limited to mitigation of epidemics, with limited information available for Ae. aegypti populations. A better understanding of the current Ae. aegypti susceptibility status to various insecticides and relevant resistance mechanisms involved is needed for the implementation of effective vector control strategies. The present study focuses on the detection of insecticide resistance and reveals the related mechanisms in Ae. aegypti populations from Senegal.Bioassays were performed on Ae. aegypti adults from nine Senegalese localities (Matam, Louga, Barkedji, Ziguinchor, Mbour, Fatick, Dakar, Kédougou and Touba). Mosquitoes were exposed to four classes of insecticides using the standard WHO protocols. Resistance mechanisms were investigated by genotyping for pyrethroid target site resistance mutations (V1016G, V1016I, F1534C and S989P) and measuring gene expression levels of key detoxification genes (CYP6BB2, CYP9J26, CYP9J28, CYP9J32, CYP9M6, CCEae3a and GSTD4).All collected populations were resistant to DDT and carbamates except for the ones in Matam (Northern region). Resistance to permethrin was uniformly detected in mosquitoes from all areas. Except for Barkédji and Touba, all populations were characterized by a susceptibility to 0.75% Permethrin. Susceptibility to type II pyrethroids was detected only in the Southern regions (Kédougou and Ziguinchor). All mosquito populations were susceptible to 5% Malathion, but only Kédougou and Matam mosquitoes were susceptible to 0.8% Malathion. All populations were resistant to 0.05% Pirimiphos-methyl, whereas those from Louga, Mbour and Barkédji, also exhibited resistance to 1% Fenitrothion. None of the known target site pyrethroid resistance mutations was present in the mosquito samples included in the genotyping analysis (performed in > 1500 samples). In contrast, a remarkably high (20-70-fold) overexpression of major detoxification genes was observed, suggesting that insecticide resistance is mostly mediated through metabolic mechanisms. These data provide important evidence to support dengue vector control in Senegal.

Detection of genomic mutations in katG and rpoB genes among multidrug-resistant Mycobacterium tuberculosis isolates from Tehran, Iran

Multidrug-resistant (MDR) Mycobacterium tuberculosis strains, defined as resistant to at least isoniazid and rifampin, have emerged as a major worldwide health threat. Spontaneous point mutations in various genes of M. tuberculosis cause resistance to isoniazid, with the most frequent gene target being katG; and resistance to rifampin is usually due to mutation in the rpoB gene. The current study was aimed to detect the point mutations in the katG and rpoB regions related to isoniazid and rifampin resistance. A total of 203 respiratory specimens were collected from patients suspected of having tuberculosis respiratory infections referred to hospitals of Tehran, Iran, during 2018–2019. The isolation and identification of M. tuberculosis isolates were performed according to the WHO protocol. Drug susceptibility testing was carried out by proportional method. PCR analysis and sequencing were used to detect mutations in the selected katG and rpoB regions. Forty-four M. tuberculosis strains were isolated, of which 12 (27.3%) and 10 (22.7%) were resistant to isoniazid and rifampin, respectively. Ten isolates were resistant to both isoniazid and rifampin and were considered as MDR isolates. Of the ten MDR isolates, six (60%) carried mutations in both rpoB and katG. The most common mutations among isoniazid- and rifampin-resistant isolates were in codon 315 of the katG gene (70%) and codon 441 of the rpoB gene (50%), respectively. The results of this study indicated that MDR-TB continues to be a serious public health problem in Iran.

Association of Plasmodium falciparum kelch13 R561H genotypes with delayed parasite clearance in Rwanda: an open-label, single-arm, multicentre, therapeutic efficacy study

Partial artemisinin resistance is suspected if delayed parasite clearance (ie, persistence of parasitaemia on day 3 after treatment initiation) is observed. Validated markers of artemisinin partial resistance in southeast Asia, Plasmodium falciparum kelch13 (Pfkelch13) R561H and P574L, have been reported in Rwanda but no association with parasite clearance has been observed. We aimed to establish the efficacy of artemether-lumefantrine and genetic characterisation of Pfkelch13 alleles and their association with treatment outcomes. This open-label, single-arm, multicentre, therapeutic efficacy study was done in 2018 in three Rwandan sites: Masaka, Rukara, and Bugarama. Children aged 6-59 months with P falciparum monoinfection and fever were eligible and treated with a 3-day course of artemether-lumefantrine. Treatment response was monitored for 28 days using weekly microscopy screenings of blood samples for P falciparum. Mutations in Pfkelch13 and P falciparum multidrug resistance-1 (Pfmdr1) genes were characterised in parasites collected from enrolled participants. Analysis of flanking microsatellites surrounding Pfkelch13 was done to define the origins of the R561H mutations. The primary endpoint was PCR-corrected parasitological cure on day 28, as per WHO protocol. 228 participants were enrolled and 224 (98·2%) reached the study endpoint. PCR-corrected efficacies were 97·0% (95% CI 88-100) in Masaka, 93·8% (85-98) in Rukara, and 97·2% (91-100) in Bugarama. Pfkelch13 R561H mutations were present in 28 (13%) of 218 pre-treatment samples and P574L mutations were present in two (1%) pre-treatment samples. 217 (90%) of the 240 Pfmdr1 haplotypes observed in the pretreatment samples, had either the NFD (N86Y, Y184F, D1246Y) or NYD haplotype. Eight (16%) of 51 participants in Masaka and 12 (15%) of 82 participants in Rukara were microscopically positive 3 days after treatment initiation, which was associated with pre-treatment presence of Pfkelch13 R561H in Masaka (p=0·0005). Genetic analysis of Pfkelch13 R561H mutations suggest their common ancestry and local origin in Rwanda. We confirm evidence of emerging artemisinin partial resistance in Rwanda. Although artemether-lumefantrine remains efficacious, vigilance for decreasing efficacy, further characterisation of artemisinin partial resistance, and evaluation of additional antimalarials in Rwanda should be considered. The US President's Malaria Initiative. For the French translation of the abstract see Supplementary Materials section.

World Health Organization Policy Facing the Spread of COVID-19 in Indonesia

Introduction to the Problem : This article discusses WHO policy set out in WHO protocol with 4 scenarios to be recommended to countries , namely countries without a case, countries with 1 or more cases, countries with cluster cases, and cluster with greater local transmission. In this case, Indonesia has a policy which is formed based on the WHO advice. Purpose/Objective of the Study : To find out whether the policies implemented to manage COVID-19 spread in Indonesia have similarities with the protocol of the WHO. Design/Methodology/Approach: Data were collected from primary and secondary data sources in the form of literature legal research and statute approach. Findings: The results showed that the recommended protocols adopted by the Indonesian government are mostly focused on ending the spread, rather than preventing the COVID-19 outbreak from entering a territtory. As a result, there had been some considerations regarding to the implementation of WHO protocols, especially when closing an area or restricting national access. However, WHO policy is not an obligation to be implemented by a country because the most crucial thing is that anticipating the spread, breaking the spread chain and finding a cure from this health condition for patients. Paper Type : Research Article

Secondary diseases of the thoracic organs in HIV-­infected patients of phthysiopulmonological profile: 5­-year observation (according to a highly specialized hospital)

Objective – to establish the spectrum of secondary pathology of the thoracic organs in HIV-infected patients of phthisiopulmonary profile with inpatient treatment in the last 5 years, taking into account the appointment of antiretroviral therapy (ART) and the level of CD4+ T-lymphocytes in peripheral blood.
 Materials and methods. A cohort retrospective study was carried out. The group included 434 indivi-duals who were hospitalized in the clinic of the SI «National Institute of Phthisiology and Pulmonology named after F.G. Yanovsky NAMN of Ukraine» in the period 2015—2019, with a confirmed diagnosis of HIV infection. Anamnestic, and clinical and laboratory data of patients were obtained from paper out patient and inpatient case histories, the electronic database of the Institute EMCIMED.Results and discussion. The data on the number of cases and the time of ART administration, the established CD4+ cell level, and final diagnoses of secondary diseases of various thoracic organs in hospitalized patients with HIV were analyzed and compared. On the whole, an unsatisfactory situation with the appointment of ART was established in accordance with the latest WHO and Ukrainian protocols on the medical management of people living with HIV. Surgical mini-invasive therapeutic and diagnostic manipulations and surgical interventions were performed in 183 (42.2 %) patients. Low levels of CD4 cells were determined in all patients, regardless of the type of established secondary disease. In 53.2 % of cases with various types of tuberculous lesions (lungs, pleura, peripheral lymph nodes) and when TB is combined with other secondary diseases, the level of CD4 T-lymphocytes was less than 200 cells/µL. In the spectrum of secondary diseases, TB of one or more organs of the thorax predominated, 75.8 % of cases. Among other secondary diseases, Pneumocystis pneumonia and lymphadenitis took the second and third places in the frequency of detection.
 Conclusions. In the structure of secondary diseases of thoracic organs among hospitalized patients with HIV infection in the last five years, as before, tuberculosis is in the lead. Among all patients with HIV and secondary diseases of the thorax organs, regardless of the type of diseases, cases with an average CD4-lymphocyte level less than 400 cells/µL prevailed.Only 53.0 % of patients received ART, and more than a third of them were prescribed ART during hospitalization at the Institute’s clinic. In another third of cases, specific therapy was not prescribed at all.

Study of the Relationship between Vitamin D Level and the Increase in the Severity of Covid-19 Infection in Kirkuk City

The study aimed to find the relation between Covid-19 infection and reduction in vitamin-D levels andwith development of severe infection The study was conducted in Kirkuk city during July 2020, included120 COVID-19 patients who diagnosed by collecting of naso/oropharyngeal swabs and the virus RNAwas qualitatively detected by real-Time PCR in Public Health Laboratory according manufactureinstruction and WHO protocol. The study also included 30 healthy persons as control group. The studyincluded the collection of blood samples for determination of vitamin-D level (I-chroma, Korea) by directimmunofluorescence technique and according to manufacture instruction. The study also included collectionof associated information like age, sex, residence, BMI and by contacting with all patients daily until the10th day of infection to know their status after treatment. The study showed that, majority of patients wereaged from 22 to 41 years of old (P. value <0.001). The study showed that 62.5% of COVID-19 patientswere males compared with 37.5% females (P<0.05). The study showed that were asymptomatic, 44.17% ofcases of COVID-19 patients were with mild infection and 10% were with severe infection (P<0.001). Thestudy showed a significant relation between Covid-19 infection status with age as the highest mean of ageof Covid-19 infected patients was recorded in those who with severe infection. The study showed that thelowest mean of serum Vitamin was found in COVID-19 patients comparing with healthy control (12.8±3.6v.s. 29.3±3.1 ng/ml) (P: <0.001). The study also demonstrated that the level of vit. D was significantlyreduced in severe infected COVID-19 patients followed by patients with moderate infection and the highestmean was in patients with asymptomatic infection (P<0.001).

Larvicidal Efficacy and GC-MS Analysis of Hyptis suaveolens Leaf Extracts against Anopheles Species

Mosquitoes are the most important group of insects in terms of public health importance, which transmit serious human diseases. The continuous application of synthetic insecticides to control these mosquitoes causes development of resistance in vector species, and an adverse effect on environmental quality and non-target organisms including human health. Therefore, the use of active toxic agents from plant extracts as alternative mosquito control strategy cannot be over emphasized, as these are non-toxic, easily available at affordable prices, biodegradable and show target - specific activities against different species of vector mosquitoes. The aim of the present study was to evaluate the larvicidal efficacy of the aqueous and methanol leaf extracts of H. suaveolens against the fourth instars larvae of Anopheles species. Standard WHO protocols was adopted for the larvicidal bioassay. Larvicidal activity was evaluated at concentrations of 200, 400, 600, 800 and 1000 mg/L. The larval mortality was observed after 24 and 48hours bioassay. The results are mean of three replicates and the mortalities recorded were subjected to chi-square test and probit analysis to determine median lethal concentrations (LC50). TheGC-MS analysis ofthe methanolic leaf extract of the plantrevealed the presence of twelve compounds on the chromatogram. Among the major compounds areOleic Acid (33.33%), Octadecanoic acid (13.52%), 1,3-Cyclohexadiene-1-methanol,alpha.,2,6,6-(10.42%), 1,3-Cyclopentanediol, trans (9.60%), n-Hexadecanoic acid (9.01%) and 4-Hepten-3-one, 4-methyl (7.0%).The phytochemical screening of the aqueous and methanol leaf extracts of the plant revealed the presence of Tannins, Terpenoids, Flavonoids, Steroids, Carbohydrates, Cardiac glycoside and resins. The LC50 values estimated were 316.22mg/Lfor methanol extract and 323.59 mg/L for aqueous extract. The differences between the two extracts were however not significantly different at P>0.05. The findings also revealed that mortality was concentration dependent and both extracts showed promising larvicidal activity against Anopheles species larvae. Therefore, the crude leaf extract of the plant is recommended to be used as alternative to synthetic larvicides and further research is needed to test the activity of the plant on non-target organisms.

Ecologically sustainable mosquito repellence using live Artemisia annua Linnaeus plants in boarding schools of MWEA rice irrigation scheme, Kenya

Mosquitoes continue to transmit malaria despite the use of several methods of control such as treated bed nets, aerosols and repellent creams. Mosquito biting cause stress and medical problems to school going children. An experimental ecological study was undertaken to evaluate the effectiveness of two months old potted Artemisia annua plants for mosquito repellence in boarding schools’ dormitories of Mwea Rice Irrigation Scheme, Kenya. Two months old potted live A.annua plants were hung next to doors and windows of dormitories and mosquito collection for four months as per WHO protocol was done. The study found significant differences in the mean mosquito catches in treatment dormitories in both girls and boys boarding schools p-values of 0.005, 0.001, 0.001, and 0.001 for the 2nd, 3rd, 4th and 5th months respectively. The study concluded that live A.annua reduced mosquito density in dormitories of boarding schools. Further there was reduction of mosquito density in neighbouring dormitories, as far as 50metres where A. annua was not introduced. The study recommends that A.annua would be very important for implementing vector control strategies to prevent man-vector contact for the prevention of vector borne diseases.The study recommends use of A.annua as vector control strategy to prevent man-vector contact for the prevention of vector borne diseases.

AFTER THE DELUGE: AN ACTION NOTEBOOK FOR A RESPONSIBLE SOCIOLINGUIST

In this paper, we begin with inevitability and cyclicity of pandemic during the last two centuries. The problems seem to be coming back to us again and again through Small-pox, Tuberculosis, Plague, Influenza, HIV/AIDS, Ebola, and now COVID-19. The 2003 Severe Acute Respiratory Syndrome (SARS) pandemic and the Avian Influenza resulted in establishment of WHO protocols and awareness. However, as we consider the people at the Bottom of the Pyramid in developing and poor countries, the problem of survival of ethnic groups and their languages appear to be more acute. We know that 96% of India’s mother-tongues are spoken by only 4% of the population. But as India houses 3592 numerically weak mother tongues (spoken by 705 tribes or ethnic groups and 1284 castes scattered all over our rural landscape), with high degree of poverty combined with social hierarchies based on caste, religion and ethnicity, the shape of our population pyramid is relatively flat and bulging at the bottom making the problem of the survival of mother-tongues and learning in other-tongues complex. Our problem is that these ethnic groups and speakers of indigenous languages are fast losing their grip over their respective mother-tongues as they have to survive in an urban cauldron. It is this group that faced/faces the COVID-19 crisis more than anyone else, and it is this group that was seen walking back from urban centres to their villages. But those who stayed back in villages are also vulnerable to the pandemic. The effect of COVID-19 on our indigenous groups could be dangerous. After defining and describing ‘Danger’, we argue that the creativity of these indigenous language speakers is facing a grave threat. This is not only a matter of survival or production, but also an issue of printing, publishing, being read, translated, and sold. After discussing a few theoretical positions, from Ethnologue to Fishman and others, a list of tasks of Responsible Sociolinguistics is enlisted here. Then a detailed comparison is held between Biological and Linguistic Endangerment. What lessons could be learned by sociolinguists and language planners is discussed. The kind of tensions existing as real threat to survival are discussed in terms of systems theory and power-conflict theory. We argue that Linguistics should be used for healing of the wounds and injured pride of the smaller speech groups.

Resistance to temephos in Anopheles stephensi larvae is associated with increased cytochrome P450 and α-esterase genes overexpression

The widespread use of synthetic insecticides has resulted in the development of insecticide resistance among disease mosquito vector. Resistance development involves several genes, including CYP450 and esterase family genes. In the current study, expression profiles of seven CYP450 genes namely, CYP9M10, CYP9J40, CYP6AA7, CYP9J34, CYTP450 B9, CYP6M2, CYP6Z2 and three esterase genes namely, esterase β1, alpha esterase, KM234962 were investigated in temephos resistant and susceptible in larvae. The third instar larvae of An. stephensi were subjected to insecticide selection with temephos (Tem Res) following the WHO protocol. Our results show CYP6M2,CYP6Z2 and alpha esterase genes are prominent in temephos resistant in larvae. We suggest that P450 genes and esterase genes, α-esterase and esterase β1 are mostly involved in temephos resistance in larval stage. These results suggest that metabolic resistance may be more prevalent in larval mosquito and play an important role in temephos resistance.

The implementation of policies and the impact of handling Covid-19 originating from the World Health Organization's Point of View

The purpose of this article is to describe the capacity and role of WHO in dealing with the spread of COVID-19 and to discuss in-depth articles at the stages of policy implementation that specifically discuss the WHO protocol that is applied in dealing with the spread of Covid-19. The implementation of the policy to handle the spread of COVID-19 considers various aspects not only health but also the economic and social impacts resulting from government decision making. In addition, response measures are implemented through the Acceleration of COVID-19 Handling task which is part of the formation of structures, structure is one of the aspects that are considered in Edward III's implementation theory besides communication, resources and disposition because the presence of a structure helps implement policies has a significant effect. on policy implementation. The support of all elements of the government, the private sector in compliance with government and WHO instructions, especially regarding social distancing and physical distancing, will have a big impact in preventing the spread of COVID-19.

Be quick or be dead: high temperatures reduce Aedes aegypti (Diptera: Culicidae) larval development time and pyriproxyfen larvicide efficiency in laboratory conditions

Several studies have assessed the efficiency of insect growth regulators to control Aedes aegypti under laboratory conditions. However, empirical evidence evaluating how insect growth regulators respond to different temperatures is scarce. In this paper, we evaluate whether temperature may influence the efficiency of pyriproxyfen. To do so, we analyzed the effect of three temperatures (20, 25 and 30 °C) combined with five pyriproxyfen concentrations (0.0001, 0.001, 0.01, 0.1 and 1 mg L−1) on Ae. aegypti larval control. Each experiment had five replicates containing 250 mL of the test solution and 20 larvae according to WHO protocol. Tests were conducted until all mosquitoes had either fully emerged from the control beakers or died. The outcomes showed that, as we increased the temperature, not only did the larval developmental time decrease (from 23.5 to 10.7 days) but also the concentration of larvicide required for 50% (EC50 of 0.0002 and 0.0050 mg L−1 for 20 and 30 °C, respectively) and 95% efficiency increased (EC50 of 0.009 and 0.013 mg L−1 for 20 and 30 °C, respectively). We highlight how temperature changes produce different results from larvicide applications (p < 0.05) and provide data that allow scientists and the government to evaluate field populations’ responses and integrate the use of larvicides more appropriately. We suggest that the effects of environmental factors on larvicide applications should be tested for field mosquito populations so that different temperature conditions can be integrated with the surveillance programs of Aedes aegypti.

Anopheles gambiae larvicidal and adulticidal potential of Phyllanthus amarus (Schumach and Thonn, 1827) obtained from different localities of Nigeria

Objective: To screen phytochemicals in ethanolic leaf extracts of Phyllanthus amarus collected from three different geographical zones in Nigeria and evaluate their effects on larva and adult of Anopheles gambiae. Methods: The sample extracts of Phyllanthus amarus prepared with ethanol solvent were tested against Anopheles gambiae at two important developmental stages of its life cycle using slightly modified WHO protocols. Results: Alkaloids, saponins, tannins, flavonoids, glycosides, phenols, and terpenes were detected in each extract. Among these samples, the extract from northwest exhibited the highest larvicidal activity (LC50=263.02 ppm), followed by southeast and southwest extracts (LC50=288.40 and 295.12 ppm, respectively after 48 h), while the extract from southwest exhibited the highest adulticidal activity (LC50=275.42 ppm), followed by northwest and southeast extract (LC50=301.99 and 316.22 ppm, respectively after 24 h). A 50% larva mortality was almost attained at 600 ppm after 48 h duration of exposure to the northwest extract. Conclusions: The tested samples possess strong larvicidal and adulticidal property against Anopheles gambiae which depends on their chemical composition and localities of collection. Further studies are needed to explore the insecticidal activity against a wider range of mosquito species, and to identify active ingredient(s) of the extract responsible for such activity.

Larvicidal effects of methanol, acetone and hexane dried leaves extracts of Azadirachta indica against Anopheles gambiae sensu stricto (Diptera: Anophelinae) Giles, 1902

Insecticidal effects of methanol, acetone and hexane extracts from dried leaves of Azadirachta indica have been assessed on stage 4 larvae of Anopheles gambiae s.s Giles, 1902 at the laboratory of Zoology of the University of Ngaoundere. Biological tests carried out according to the WHO protocol revealed that the extracts obtained from the various organic solvents have larvicidal activities. The acetone extract was the most effective. The LC50 values were 51.34 ppm, 56.54 ppm and 65.37 ppm for acetone, methanol and hexane extract respectively. The LH50 values were 4 h 06 min 36 sec, 3h 34 min 59 sec and 4 h 29 min 34 sec respectively for the three extracts. Phytochemical screening revealed the presence of terpenoids, sterols, saponins, flavonoids, and tannins; secondary metabolites responsible for the insecticidal activity. Each of these extracts showed low toxicity compared to Temephos (positive control) at the WHO Recommended concentration of 0,012 mg/L.

Lower mortality rate in health workers and their families infected with COVID-19 associated pneumonia in Quetta, Baluchistan.

Objectives:A bunch of pneumonia cases in Wuhan, China, was caused by a novel beta-corona virus, (COVID-19) in December 2019 from where it spread rapidly across the globe. The aim of the study was to find out relevant reasons and offered suggestions to reduce the risk of infection and check clinical outcomes of the infected healthcare workers.Methods:This study was conducted in COVID-19 Real Time Polymerase Chain Reaction (RT-PCR) laboratory, Bolan Medical Complex Hospital Quetta, Baluchistan from May to June 2020. Eight hundred (n=800) health workers and their families were included in this study. Data were obtained with standardized data collection forms shared by the WHO. Nasopharyngeal samples were collected following the WHO protocols. RNA was extracted and amplified using real time reverse transcriptase polymerase chain reaction (RT-PCR). Serum ferritin level, C-reactive protein, D-dimer and radiological results of the RT-PCR confirmed individuals were also recorded and analyzed.Results:Among (n=800) health workers and their families 457 (57.1%) were COVID-19 PCR negative, 332 (41.5%) positive and 11 (1.4%) individuals were PCR positive but asymptomatic carriers, 234 (29.5%) were male and 103 (12.9%) were female. Mortality rate in our study was very low, only three patients (0.87%) died of this COVID-19 pneumonia.Conclusion:Our results showed increased rate of positive cases with fortunately lower mortality rate, although this novel pneumonia was associated with acute respiratory distress syndrome ARDS and intensive care unit (ICU) admission. Timely decisions, risk awareness knowledge and supply of necessary equipments are inevitable for the control of such epidemics.

Feasibility and Role of Right Ventricular Stress Echocardiography in Adult Patients.

Background:The great technological advancements in the field of echocardiography have led to applications of stress echocardiography (SE) in almost all diagnostic fields of cardiology, from ischemic heart disease to valvular heart disease and diastolic function. However, the assessment of the right ventricle (RV) in general, and in particular in regard to the contractile reserve of the RV, is an area that has not been previously explored. We, therefore, propose a study to investigate the potential use of SE for the assessment of RV function in adult patients.Aims and objectives:The primary aim is to evaluate the feasibility of right ventricular SE. The secondary aim is to assess right ventricular contractile reserve.Matherials and Methods:Eighty-one patients undergoing a physical or dobutamine stress echocardiogram for cardiovascular risk stratification or chest pain were the subject of the study. An exercise leg cycle using a standard WHO protocol was used to simultaneously assess the right and left ventricular global and regional function as well as acquiring Doppler data. Whereas the patient had limitations in mobility, a dobutamine SE was be performed. We evaluated the average values of tricuspid annular plane systolic excursion (TAPSE), fractional area change (FAC), S-wave, systolic pulmonary artery pressure (sPAP), and right ventricle global longitudinal (free wall) strain (RVGLS) during baseline and at the peak of the effort. RV contractile reserve was defined as the change in RVGLS from rest to peak exercise. We also assessed the reproducibility of these measurements between two different expert operators (blind analysis).Results:At least 3 over 5 RV function parameters were measurable both during baseline and at the peak of the effort in 95% of patients, while all 5 parameters in 65% of our population, demonstrating an excellent feasibility. All RV-studied variables showed a statistically significant increase (P < 0.001) at peak compared to the baseline. The average percentage increases at peak were 31.1% for TAPSE, 24.8% for FAC, 50.6% for S-wave, 55.2% for PAPS, and 39.8% for RV strain. The reproducibility between operators at baseline and peak was excellent. Our study demonstrates that TAPSE, FAC, and S-wave are highly feasible at rest and at peak, while TAPSE, S-wave, and sPAP are the most reliable measurements during RV stress echo.Conclusion:RVGLS is useful in the assessment of RV contractile reserve in patients with good acoustic window. Further studies are needed to evaluate the impact of contrast echocardiography in improving RV contractile reserve assessment during SE.

Health Professionals’ Hand Hygiene Best Practice on Infection and Resistance Reduction at District Health Facilities, Cameroon

Hospital-based hand hygiene measures and best practice have been empirically proven to prevent cross-transmission of infection and resistance spreading. Little is documented on hand hygiene best practices in reducing pathogenic micro-organisms transmission dynamic, infection and resistance spread at district/community health facilities and hospitals in Cameroon. Our study thus, aimed at evaluating health workers hand hygiene measures compliance and best practices against pathogenic infections over a period of seven months at Nylon Health District, Douala, Cameroon. A cross-sectional study using an observation grid analysis based on WHO protocol was used to collect samples from 155 consented health workers from eight Nylon health facilities. A univariate logistic regression was performed to define the compliance rates and assessment of indicators at 95% confidence interval (CI). An overall hand hygiene compliance rate of 7.74% (12/155) was observed. Public and private health facilities had similar hand hygiene compliance rates of 7.69% and 7.84% respectively. Doctors had the most nails within 0.5 cm/ and the nails of the midwives were the most varnished and/or artificial nails. Professional qualifications (state certified nurse/midwives (OR=10.74; 95% CI OR [1.22; 94.43]; p-value=0.03) and doctors (OR=8.38; CI 95% OR [1.67; 41.95]; p-value=0.01)) and the wearing of jewellery and/or artificial nails or varnish, and/or nails of size>5 mm during treatment (OR=0.16; 95% CI OR [0.03; 0.97]; p-value=0.04) were the factors significantly influencing the compliance of hand washing. This study shows that hand hygiene measures best practice amongst health staff at district health facilities was low which calls for urgent awareness and health education to reinforce the hospital’s infection prevention and control standards training activities so as to improve quality care delivery and reduce antimicrobial resistance spread in Cameroon.