Incidence and risk factors for neonatal tetanus in admissions to Kilifi County Hospital, Kenya.

BACKGROUND: Neonatal Tetanus (NT) is a preventable cause of mortality and neurological sequelae that occurs at higher incidence in resource-poor countries, presumably because of low maternal immunisation rates and unhygienic cord care practices. We aimed to determine changes in the incidence of NT, characterize and investigate the associated risk factors and mortality in a prospective cohort study including all admissions over a 15-year period at a County hospital on the Kenyan coast, a region with relatively high historical NT rates within Kenya. METHODS: We assessed all neonatal admissions to Kilifi County Hospital in Kenya (1999-2013) and identified cases of NT (standard clinical case definition) admitted during this time. Poisson regression was used to examine change in incidence of NT using accurate denominator data from an area of active demographic surveillance. Logistic regression was used to investigate the risk factors for NT and factors associated with mortality in NT amongst neonatal admissions. A subset of sera from mothers (n = 61) and neonates (n = 47) were tested for anti-tetanus antibodies. RESULTS: There were 191 NT admissions, of whom 187 (98%) were home deliveries. Incidence of NT declined significantly (Incidence Rate Ratio: 0.85 (95% Confidence interval 0.81-0.89), P<0.001) but the case fatality (62%) did not change over the study period (P = 0.536). Younger infant age at admission (P = 0.001) was the only independent predictor of mortality. Compared to neonatal hospital admittee controls, the proportion of home births was higher among the cases. Sera tested for antitetanus antibodies showed most mothers (50/61, 82%) had undetectable levels of antitetanus antibodies, and most (8/9, 89%) mothers with detectable antibodies had a neonate without protective levels. CONCLUSIONS: Incidence of NT in Kilifi County has significantly reduced, with reductions following immunisation campaigns. Our results suggest immunisation efforts are effective if sustained and efforts should continue to expand coverage

Determination of Nutritional Value of Alfalfa Varieties and Lines by Using the In Vitro Method and Gas Production Technique

This study was organized to determine the nutritional value of different alfalfa varieties and lines selected within the scope of the Cukurova Region Alfalfa Breeding Project, conducted at the Eastern Mediterranean Agricultural Research Institute, by using the in vitro gas production technique. In the project, Nimet was certified as a new variety. The used alfalfa lines were YSH 26-12, YSH 23-9, YSH 21-1, YSH 27-9, YSH 37-12, YSH 35-11, YSH 28-6, YSH 16-11, YSH 14-3, and YSH 11-4. The certified Nimet variety was used as a control. Alfalfas have been harvested in April, at the beginning of blooming. Chemical composition, metabolic energy (ME), net energy lactation (NEL), and organic matter digestibility (OMD) of the certified Nimet variety with 10 different alfalfa lines used in the experiment were determined by Hohenheim in vitro gas production technique. The incubation times in the Hohenheim gas production technique are 3, 6, 9, 12, 24, 48, 72 and 96th hours. Crude protein (CP), crude cellulose (CC), NDF, and ADF contents of the alfalfa varieties and lines ranged between 19.06-22.40%, 24.90-33.30%, 33.16-45.73%, and 30.77-39.75%, respectively. After 96-hour incubation, the highest total gas production (GP) was found at the YSH 11-4 line (45.32 ml) (P < 0.05). While ME, OMD and NEL contents were found to be high at the YSH 11-4 line, ME and OMD values were statistically different from the YSH 28-6, YSH 16-11, YSH 14-3, and YSH 21-1 lines. On the other hand, NEL values were determined different from YSH 23-9, YSH 21-1, YSH 28-6, YSH 16-11, YSH 14-3 lines

Vibrational Raman and IR data on brown hair subjected to bleaching

Brown human hair was bleached three times (45 min × 3) and four times (45 min × 3 + 15 min) with commercial formulations containing persulfate salts and hydrogen peroxide. The hair samples were characterized by Raman and IR spectroscopy in the Attenuated Total Reflectance (ATR) mode to gain more insights into the possible secondary structure and Cα-Cβ-S-S-Cβ-Cα conformational changes induced by bleaching. The latter were evaluated through band-fitting procedures; the relative content of the disulfide bridges and oxidized sulfur species (cysteic acid, Bunte salt, cystine oxides) was assessed. The observed conformational changes could be significant in developing restoring agents to be used after hair decoloration. The use of two different spectroscopic techniques allowed to discriminate the information coming from the cortical region of hair (Raman) and the cuticle (ATR/IR). This article refers to “Structural investigation on damaged hair keratin treated with α,β-unsaturated Michael acceptors used as repairing agents” (Di Foggia et al., Int. J. Biol. Macromol. 167 (2021) 620–632 https://doi.org/10.1016/j.ijbiomac.2020.11.194)

Interactions between Damaged Hair Keratin and Juglone as a Possible Restoring Agent: A Vibrational and Scanning Electron Microscopy Study

Juglone, a quinonic compound present in walnut extracts, was proposed as a restoring agent for hair keratin treated with permanent or discoloration processes. The proposed mechanism of restoration by juglone involves the formation of a Michael adduct between the quinone and the thiol moieties of cysteine residues. To this purpose, the first part of the present paper involved the spectroscopic study of the product of the reaction between juglone and N-acetyl-L-cysteine as a model compound. IR spectroscopy and Scanning Electron Microscopy (SEM) monitored the chemical and morphological variations induced by applying juglone to hair keratin. In order to simulate the most common hair treatments (i.e., permanent and discoloration), juglone was applied to hair that had been previously treated with a reducing agent, i.e., methyl thioglycolate (MT) or with bleaching agents (based on hydrogen peroxide and persulfates) followed by sodium hydrogen sulfite. IR spectroscopy allowed us to monitor the formation of Michael adducts between juglone and cysteine residues: the Michael adducts' content was related to the cysteine content of the samples. In fact, MT and sodium hydrogen sulfite favored the reduction of the disulfide bonds and increased the content of free cysteine residues, which can react with juglone. SEM analyses confirmed the trend observed by IR spectroscopy since hair samples treated with juglone adopted a more regular hair surface and more imbricated scales, thus supporting the possible use of juglone as a restoring agent for damaged hair keratins

Susceptibility of Cryptococcus neoformans and Cryptococcus gattii from clinical and environment sources in Nairobi, Kenya

Objective: To determine anti-fungal susceptibility of Cryptococcus neoformans andCryptococcus gattii from environmental and clinical sources in Nairobi, Kenya.Design: Prospective study.Setting: Kenya Medical Research Institute, Mycology laboratory, Nairobi, Kenya.Subjects: A total of 123 isolates were tested for their susceptibility to fluconazole(FLC), amphotericin B(AMP) and fluorocytosine (5FC). Clinical isolates were 70(66Cryptococcus neoformans and 4 Cryptococcus gattii) while environmental isolates were53(41 C. neoformans and 12 C. gattii). The isolates were characterised using variousphenotypic tests including microscopic morphology, physiological and biochemicaltests (API 20 Caux), pigmentation on bird seed agar and reaction on canavanineglycine-bromthymolblue agar. European Committee on Anti-microbial SusceptibilityStandards (EUCAST) was used as the reference method for susceptibility testing.Results: Most C. neoformans isolates; clinical (61/66; 92.4%) and environmental (38/41;92.7%) were susceptible to FLC. The number of C. neoformans isolates inhibited atsusceptible dose dependent (SDD) range (16-32μg/ml) by FLC were clinical (4/66; 6.1%)and environmental (2/41; 4.9%). One C. neoformans isolate each; clinical (1/66; 1.5%)and environmental (1/41; 2.4%) was resistant to FLC. All C. gatti isolates from clinicaland environmental were fully susceptible to FLC. The percentage of C. neoformansisolates that were susceptible (S) (MIC ≤ 1.0 μg/ml) to AMP were; clinical(52/66; 90.2%)and environmental (37/41; 78.8%) while the rest were susceptible dose dependent(SDD) with MIC (2-8μg/ml). Reduced susceptibilities to 5FC was displayed in allclinical and environmental C. neoformans and C. gatii isolates; for instance resistanceto 5FC was reported in C. neoformans; clinical (8/66; 12.1%) and environmental (1/41;2.4 %). Among the C. gattii isolates there was also decreased susceptibility to 5FCwith Minimum Inhibition Concentration (MIC) range of between 0.5-32 μg/ml. Therewere no significant differences in susceptibility ranges among all the clinical andenvironmental isolates.Conclusion: This study demonstrated reduced susceptibilities among C. neoformansand C. gattii isolates to commonly used anti-fungal drugs

Unpredictable Dynamic Behaviour of Ruthenium Chelate Pyrrole Derivatives

Reaction of [Ru(H)2(CO)(PPh3)3] 1 with an equimolar amount of pyrrole-2-carboxylic acid (H2L1) leads to the homoleptic chelate derivative k2(O,O)-[RuH(CO)(HL1)(PPh3)2] 2. Prolonged acetonitrile refluxing promotes an unusual k2(O,O)- -&gt; k2(N,O)- dynamic chelate conversion, forming a neutral, stable, air- and moisture- insensitive, solvento-species k2(N,O)-[Ru(MeCN)(CO)(L1)(PPh3)2] 3. Analogously, reaction of 1 with the pyrrole-2-carboxyaldehyde (HL2) affords k2(N,O)-[RuH(CO)(HL2)(PPh3)2] 4, 5, as a couple of functional isomers. Optimized reaction conditions such as temperature and solvent polarity allow the isolation of dominant configurations. Structure 5 is a pyrrolide Ru-carbaldehyde, obtained from cyclization of the pendant CHO function, whereas species 4 can be viewed as an ethanoyl-conjugated Ru-pyrrole. Derivatives 3-5 were characterized by single crystal X-ray diffraction, ESI-Ms, IR, and NMR spectroscopy, indicating distinct features for the Ru-bonded pyrrolyl groups. DFT computational results, coplanarity, bond equalization, and electron delocalization along the fused five-membered rings support aromatic features. In accordance with the antisymbiotic trans-influence, both the isolated isomers 4 and 5 disclose CO ligands opposite to N- or O-anionic groups. The quantitative Mayer bond order evidences a stabilizing backbonding effect. Antibacterial and antifungal trials on Gram-positive (Staphylococcus aureus), Gram-negative (Escherichia coli), and Candida albicans were further carried out

Ruthenium-thymine acetate binding modes: Experimental and theoretical studies

Ruthenium complexes have proved to exhibit antineoplastic activity, related to the interaction of the metal ion with DNA. In this context, synthetic and theoretical studies on ruthenium binding modes of thymine acetate (THAc) have been focused to shed light on the structure-activity relationship. This report deals with the reaction between dihydride ruthenium mer-[Ru(H)2(CO)(PPh3)3], 1 and the thymine acetic acid (THAcOH) selected as model for nucleobase derivatives. The reaction in refluxing toluene between 1 and THAcOH excess, by H2 release affords the double coordinating species k1-(O)THAc-, k2-(O,O)THAc-[Ru(CO)(PPh3)2], 2. The X-ray crystal structure confirms a simultaneous monohapto, dihapto- THAc coordination in a reciprocal facial disposition. Stepwise additions of THAcOH allowed to intercept the monohapto mer-k1(O)THAc-Ru(CO)H(PPh3)3] 3 and dihapto trans(P,P)-k2(O,O)THAc-[Ru(CO)H(PPh3)2] 4 species. Nuclear magnetic resonance (NMR) studies, associated with DFT (Density Function Theory)-calculations energies and analogous reactions with acetic acid, supported the proposed reaction path. As evidenced by the crystal supramolecular hydrogen-binding packing and 1H NMR spectra, metal coordination seems to play a pivotal role in stabilizing the minor [(N=C(OH)] lactim tautomers, which may promote mismatching to DNA nucleobase pairs as a clue for its anticancer activity

Changing trends in incidence and aetiology of childhood acute non-traumatic coma over a period of changing malaria transmission in rural coastal Kenya: a retrospective analysis

OBJECTIVES: Recent changes in malaria transmission have likely altered the aetiology and outcome of childhood coma in sub-Saharan Africa. The authors conducted this study to examine change in incidence, aetiology, clinical presentation, mortality and risk factors for death in childhood non-traumatic coma over a 6-year period. DESIGN: Retrospective analysis of prospectively collected data. SETTING: Secondary level health facility: Kilifi, Coast, Kenya. PARTICIPANTS: Children aged 9 months to 13 years admitted with acute non-traumatic coma (Blantyre Coma Score =2) between January 2004 and December 2009 to Kilifi District Hospital, Kenya. EXCLUSION CRITERIA: delayed development, epilepsy and sickle cell disease. RESULTS: During the study period, 665 children (median age 32 (IQR 20-46) months; 46% were girls) were admitted in coma. The incidence of childhood coma declined from 93/100 000 children in 2004 to 44/100 000 children in 2009. There was a 64% overall drop in annual malaria-positive coma admissions and a 272% overall increase in annual admissions with encephalopathies of undetermined cause over the study period. There was no change in case death of coma. Vomiting, breathing difficulties, bradycardia, profound coma (Blantyre Coma Score=0), bacteraemia and clinical signs of meningitis were associated with increased risk of death. Seizures within 24 h prior to admission, and malaria parasitaemia, were independently associated with survival, unchanging during the study period. CONCLUSION: The decline in the incidence and number of admissions of childhood acute non-traumatic coma is due to decreased malaria transmission. The relative and absolute increase in admissions of encephalopathy of undetermined aetiology could represent aetiologies previously masked by malaria or new aetiologies

All-Arthroscopic Autologous Matrix-Induced Chondrogenesis for the Treatment of Osteochondral Lesions of the Talus

Several surgical techniques have been described for the treatment of talar chondral lesions. Among them, microfracture is well established. Autologous matrix-induced chondrogenesis (AMIC), using microfracture and biomaterials, has shown promising results for the treatment of knee osteochondral lesions and has been proposed for the ankle as an open technique. We describe an all-arthroscopic AMIC technique. The benefits of an all-arthroscopic procedure include smaller incisions with less soft-tissue dissection, better visualization of the joint, and a quicker recovery compared with open surgery. The use of matrix to support cartilage regeneration promotes good-quality cartilage tissue with satisfactory long-term outcomes. Our all-arthroscopic AMIC technique uses a type I-type III porcine collagen matrix (Chondro-Gide; Geistlich Pharma, Wolhusen, Switzerland) and is characterized by 2 different arthroscopic surgical phases. First, adequate exposure is achieved through use of a Hintermann spreader (Integra LifeSciences, Plainsboro, NJ) with sufficient joint distraction and wet lesion preparation. The second surgical step is performed dry, involving matrix placement and fixation. The all-arthroscopic AMIC technique for the treatment of osteochondral lesions of the talus allows a very precise reconstruction in the case of cartilage defects and avoids the need for a more invasive operation associated with higher morbidity and a longer surgical time

Impacto de diferentes niveles de nisina como agente bioconservador en la calidad química, sensorial y microbiológica de filetes de lubina (Dicentrarchus labrax) envasados al vacío y almacenados a 4 ± 2 °C.

Nisin is produced by Lactococcus lactis subsp. lactis and is also known as an antimicrobial agent especially effective against gram-positive bacteria. It has long been used as a preservative in foods and beverages and is generally regarded as safe (GRAS). In the present work, the effects of different concentrations of nisin (0.2, 0.4 and 0.8%) on the sensory, chemical and microbiological quality and shelf-life of vacuum-packed sea bass (Dicentrarchus labrax) fillets were investigated during chilled (4 ± 2 °C) storage. The sensory points for raw and cooked fillets increased with time during the storage period (p &lt; 0.05). The control group, with scores of 9.08, was rejected by panelists on day 12; whereas nisin-treated groups were rejected on day 14 with scores ranging from 9.00-9.17 score. As a result of chemical analyses, lower values (p &lt; 0.05) were obtained from the nisin groups with low oxidative rancidity. Moreover, nisin inhibited microbial growth, which shows antimicrobial activity. Consequently, it was concluded that the application of nisin (especially 0.8%) preserved the organoleptic quality and extended the shelf-life of sea bass fillets.La nisina es producida por Lactococcus lactis subsp. lactis y conocida como agente antimicrobiano, especialmente contra las bacterias grampositivas. Se ha utilizado como conservante en alimentos y bebidas durante mucho tiempo y generalmente se considera seguro (GRAS). En el presente trabajo, se investigaron los efectos de diferentes concentraciones de nisina (0,2, 0,4 y 0,8%) sobre la calidad sensorial, química y microbiológica y la vida útil de los filetes de lubina (Dicentrarchus labrax) envasados al vacío durante el enfriamiento y almacenamiento (4 ± 2 °C). La puntuación sensorial de los filetes crudos y cocidos aumentó con el tiempo durante el período de almacenamiento (p &lt;0,05). El grupo de control con puntuación de 9,08 fue rechazado por los panelistas el día 12, mientras que los grupos de tratamiento con nisina fueron rechazados el día 14 con un rango de puntuación de 9,00-9,17. Como resultado de los análisis químicos, se obtuvieron valores más bajos (p &lt; 0,05) de los grupos de nisina con baja rancidez oxidativa. Además, la nisina inhibió el crecimiento microbiano que muestra actividad antimicrobiana. En consecuencia, se evaluó que la aplicación de nisina (especialmente 0,8%) conservó la calidad organoléptica y prolongó la vida útil de la lubina