A minority of referred patients had LD, while a third had CFS. LD is over-diagnosed by non-specialists, reflecting the complexities of clinical and/or laboratory diagnosis. Patients with CFS were susceptible to misdiagnosis in non-NHS settings, reinforcing concerns about missed opportunities for appropriate treatment for this group and about the use of inappropriate diagnostic modalities and anti-microbials in non-NHS settings.

HBV vaccine has 95% efficacy in children to prevent HBV infection and related cancer. We conducted a prospective study in HIV-1 infected children receiving ART (n = 49) and controls (n = 63) to assess humoral and cellular responses to HBV vaccine provided with three doses under an accelerated schedule of 4 weeks apart. At 1 month post-vaccination all children, except 4 HIV-1 infected, displayed protective antibody (ab) titers to HBV vaccine; ab titers were lower in infected children (P < 0.0001). Ab titers decreased (P < 0.0001) in both HIV-1 infected and control children at 6 months. The frequency of circulating Tfh (cTFh) cells was 20.3% for controls and 20.8% for infected children prior to vaccination and remained comparable post-vaccination. Cytokine expression by cTfh cells upon activation with HBV antigen was comparable in the two groups at baseline and 1 month post-vaccination. Higher plasma levels (P < 0.0001) of CXCL13 were found in infected children which correlated with cTfh cell frequency at baseline. In conclusion, a lower ab response to HBV vaccine was measured in HIV-1 infected children. The frequency and activation profile of cTfh cells was comparable in infected children and controls suggesting that cells other than Tfh cells are responsible for impaired ab response to HBV vaccine.

Background:The growing burden of antibiotic resistance (AR) is a global public health problem. Despite the threats to global efforts to combat infectious diseases, data to guide its prevention and control in sub-Saharan Africa is limited. This study aimed to assess AR and antibiotic use among adult inpatients in an urban tertiary hospital in Sierra Leone.Methods and materials: Using a cross-sectional study design, data on antibiotic use was collected from consecutive adult inpatients (≥18 years) between October 2017 and February 2018 at Connaught Hospital in Freetown, Sierra Leone. Antibiotic resistance rates of bacterial isolates from urine and sputum of adult inpatients (≥ 18 years) were assessed from February through June 2018.Results: Of the 920 patients interviewed, 753 (81.8%) were prescribed an antibiotic. Before antibiotics use, 85.1% had no leucocytes count and none had a bacterial culture. Antibiotics commonly prescribed were cephalosporins (25.0%), penicillins (23.2%) and imidazoles (20.8%). Indications for prescribing were surgical prophylaxis (15.7%), pneumonia (15.1%), and trauma (5.8%).Of the 164 samples, 90.8% was urine. The common urinary isolates were Escherichia coli (29.2%), Klebsiella pneumoniae (19.0%), Enterococcus faecalis (13.1%) and Acinetobacter baumanii (9.4%), while that of sputum were K. pneumoniae (31.3%), E. coli (18.8%), S. aureus (12.5%) and P. aeruginosa (12.5%). Penicillin resistance rate for E. faecium and S. aureus was 100%. Gram negative resistance patterns were ampicillin (93% for both E. coli and A. baumanii and 90% K. pneumoniae), ampicillin-sulbactam (67% for both E. coli and K. pneumoniae), ciprofloxacin (82% K. pneumoniae, 70%E. coli, and 50% P. aeruginosa) and ceftriaxone (70%E. coli, 68%K. pneumoniae and 67% E. cloacae). The resistance rate to carbapenems for all Enterobacteriaceae was 13%, and 32% for all Gram-negative organisms. Conclusion:We found high rates of AR, and antibiotic use, most of which were not guided by laboratory evidence. Drivers of poor prescribing practices and AR are lack of microbiological support and oversight. These are common factors in many developing countries, which lack funds and serve a sicker population. Greater investments are needed to establish antimicrobial stewardship programs and provide clinicians with diagnostic support to enable improvements in patient outcomes and rational use of antibiotics.

Background Lymphoedema is a pathological process that results from damage, infection, blockage, or genetic defects in the lymphatic system. The main causes of lower limb lymphoedema in Ethiopia are lymphatic filariasis (LF) and podoconiosis. Many natural products are being used for management of wound and inflammatory conditions in Ethiopia. Few of these products have been systematically evaluated using in vitro tests. Objective The objective of this study was to conduct in vitro cytotoxicity assays, anti-inflammatory, and wound healing activity tests on selected Ethiopian plant extracts. Methods The 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT) assay was used to evaluate cytotoxicity of the plant extracts. For the anti-inflammatory activity, cyclooxygenase enzymes 1 (COX-1), cyclooxygenase enzymes 2 (COX-2) and 15-lipoxygenase enzyme inhibitory assay was used. Antioxidant activities were conducted using DPPH assay. Quantification of cell multiplication based on the measurement of BrdU incorporation during deoxyribonucleic acid (DNA) synthesis, was used to measure deoxyribonucleic acid (DNA) /cell proliferation. Results Azadirachta indica A. Juss (82%) and Lawosinia inermis L (87.6%) showed significant inhibition against COX-1 at 25 mg/ml, while Achyranthus aspera L (91.7%) and A. indica (95%) were effective in inhibiting COX-2 at the same concentration. Similarly, L. inermis L inhibited 88.8% of COX-2 at the same concentration. L. inermis (74.8%) showed the highest inhibitory activity against 15-LOX, followed by A. asper (73.1%) and A. indica (66%) at 25mg/ml. All the tested extracts showed free radical scavenging activity at 10 mg/ml. A. indica and L. inerms have shown better stimulation of human epidermal keratinocytes, with optimal stimulation observed between 2.5 mg/ml and 5 mg/ml of the extracts. Conclusion Plant extracts or compounds that inhibited these enzymatic inflammatory activities may contain potential drivers or templates for the development of effective anti-inflammatory drugs. Antioxidants that maintain non-toxic ROS levels in wound tissue can improve the wound healing process.

Although, Coffee agroforestry have a considerable contribution in supporting biodiversity, yet their contribution are insufficiently documented. Thus, this study was aimed to assess the diversity tree species in small holder coffee farms in Bedeno district, East Hararghe Zone, Oromia Regional State, Ethiopia. Eleven kebeles were selected purposively and four of them were randomly selected from which 119 households were selected, whose coffee farms used for Tree inventories in this study. The study was carried out in between October 28, 2019 and April 15, 2020. Data was analyzed by Statistical Package for Social Sciences (SPSS) version 20 and Microsoft Office Excel 2010, using descriptive statistics such as means, percentages and frequency. A total of 53 tree species representing 28 families, constituting 69.8% indigenous and 30.2% exotic tree species were recorded in the current study coffee farms. The result of this study shows significant difference (p<0.05) between three wealth categories across four study kebeles and tree species diversity of coffee farms influenced by wealth status of the household. The rich class owned more diversified tree species. The highest and lowest mean value of richness (11.5, 3), Shannon index (2.3, 0.9) and abundance (22.8, 4.8) were recorded on the farm of rich and poor household respectively. There was no significant difference among the study kebeles and the position of kebeles was not influenced tree species diversity in this specific study. Therefore, traditional shade based coffee production system should be encouraged for tree species diversity conservation in smallholder coffee farms.