RESUMO

Introduction: Surgical campaigns for thyroid surgery in low-income environments are very efficient, but there is little literature reporting results. These campaigns are complex due to multiple particularities: highly evolved cases, the need for professionals to travel or an obvious socio-cultural barrier influence towards the surgical act. We describe a surgical campaign in Cameroon to treat patients with goiter and issue some medical and sociocultural recommendations in view of our experience for its implementation with guarantees. Material and methods: An experienced group carried out an 11-day campaign at the Saint Martin de Porres Dominican Hospital, Yaounde, Cameroon. Demographic data, TSH values, surgery and complications after a 12-month follow-up were analyzed. Results: Thirty-eight patients with goiter were selected for the campaign and 32 patients (mean age, 40-years-old; 30 females) were operated. Bilateral goiter, as assessed with echography, was diagnosed in 13 patients (41%). Ten patients (31%) had a WHO grade II goiter (visible with the neck in a normal position). The surgical procedures were 18 unilateral thyroidectomy with isthmectomie, 13 total thyroidectomy, and 1 totalizing thyroidectomy, due to previous unilateral thyroidectomy (cancer recurrence). A pathological study in 13 patients (40%, extra cost 60 €) showed benign multinodular goiter/thyroid nodule (12 patients) and an extensive papillary carcinoma (one patient). Six months postoperatively, 3 patients had a slight dysphonia and one patient had persistent hypocalcemia. Follow-up was completed in all patients, either face to face (75%, 24 patients) or by phone (25%, 8 patients who failed to have a TSH test because of its cost, 23 €). Conclusions: Surgical campaigns to treat thyroid pathology can be carried out with guarantees if a series of important steps are followed: active participation of the patient's environment, thyroid ultrasound by the surgical team to decide which technique, intense awareness about monitoring and hormone replacement therapy, and the participation of local personnel for long-term follow-up.

Assuntos

RESUMO

OBJECTIVES: The implementation of pediatric oncology advanced practice nurse (s) roles in low- and middle-income countries (LMICs) presents opportunities and challenges. The authors explore the implications of pediatric oncology advanced practice nursing roles in Pakistan, Cameroon, Turkey, and Mexico. Potential benefits and drawbacks of advanced practice nursing roles, impacts on nursing care, and strategies for advanced practice nursing role development in LMIC settings are considered. METHODS: Information from scholarly articles, policy documents, and four LMIC pediatric oncology nurse expert perspectives on existing and imagined advanced practice nursing roles in pediatric oncology in LMIC were synthesized. RESULTS: Current literature and policies point to efforts across LMICs to establish a wide variety of advanced nursing practices, not necessarily aligned with internationally accepted advanced practice nursing standards of practice or education. The LMIC nurses describe a wide range of national general nurse education and government advanced practice nurse recognition/licensing. Challenges to achieving or strengthening advanced practice nursing roles include, for example, healthcare professional resistance, government unwillingness to recognize/license advanced practice nurses, and lack of advanced practice nursing faculty. To promote a pediatric oncology advanced practice nursing role in LMICs requires navigating the national nursing scope of practice and nursing culture. CONCLUSION: The strategic introduction of pediatric oncology advanced practice nursing roles in LMICs has the potential to significantly enhance patient care by, for example, addressing healthcare workforce shortages and facilitating timely care delivery. However, challenges related to role complexity, resistance from traditional healthcare structures, and role overlap must be considered. Tailoring these roles to local contexts and fostering stakeholder collaboration are essential for successful implementation. IMPLICATIONS FOR NURSING PRACTICE: The adoption of advanced practice nursing roles can lead to improved quality of care for pediatric oncology patients and their families in LMICs, where cancer care is challenging. The positive impact of pediatric oncology advanced practice nurses on patient outcomes and healthcare delivery cannot be discounted but must align with local nursing and healthcare culture and expectations.

Assuntos

RESUMO

The widespread of chlorhexidine and antibiotics in the water bodies, which grew during the global COVID-19 pandemic, can increase the dispersion of antibiotic resistance. We assessed the occurrence of these pharmaceutical compounds as well as SARS-CoV-2 and analysed the bacterial community structure of hospital and urban wastewaters from Brazil, Cameroon, and Madagascar. Water and wastewater samples (n = 59) were collected between January-June 2022. Chlorhexidine, azithromycin, levofloxacin, ceftriaxone, gentamicin and meropenem were screened by Ultra-High-Performance Liquid Chromatography coupled with mass spectrometer. SARS-CoV-2 was detected based on the nucleocapsid gene (in Cameroon and Madagascar), and envelope and spike protein-encoding genes (in Brazil). The total community-DNA was extracted and used for bacterial community analysis based on the 16S rRNA gene. To unravel likely interaction between pharmaceutical compounds and/or SARS-CoV-2 with the water bacterial community, multivariate statistics were performed. Chlorhexidine was found in hospital wastewater effluent from Brazil with a maximum concentration value of 89.28 µg/L. Additionally, antibiotic residues such as azithromycin and levofloxacin were also present at concentrations between 0.32-7.37 µg/L and 0.11-118.91 µg/L, respectively. In Cameroon, azithromycin was the most found antibiotic present at concentrations from 1.14 to 1.21 µg/L. In Madagascar instead, ceftriaxone (0.68-11.53 µg/L) and levofloxacin (0.15-0.30 µg/L) were commonly found. The bacterial phyla statistically significant different (P < 0,05) among participating countries were Proteobacteria, Patescibacteria and Dependentiae which were mainly abundant in waters sampled in Africa and, other phyla such as Firmicutes, Campylobacterota and Fusobacteriota were more abundant in Brazil. The phylum Caldisericota was only found in raw hospital wastewater samples from Madagascar. The canonical correspondence analysis results suggest significant correlation of azithromycin, meropenem and levofloxacin with bacteria families such as Enterococcaceae, Flavobacteriaceae, Deinococcaceae, Thermacetogeniaceae and Desulfomonilaceae, Spirochaetaceae, Methanosaetaceae, Synergistaceae, respectively. Water samples were also positive for SARS-CoV-2 with the lowest number of hospitalized COVID-19 patients in Madagascar (n = 7) and Brazil (n = 30). Our work provides new data about the bacterial community profile and the presence of pharmaceutical compounds in the hospital effluents from Brazil, Cameroon, and Madagascar, whose limited information is available. These compounds can exacerbate the spreading of antibiotic resistance and therefore pose a risk to public health.

Assuntos

RESUMO

This study reports a challenging diagnosis of Plasmodium ovale malaria in a Colombian citizen returning from Cameroon. Initial microscopy screenings conducted at two private hospitals yielded conflicting results, with the first showing negative smears and the second diagnosing P. vivax. Subsequent microscopy examinations at two government laboratories identified P. ovale, although the routine species-specific PCR strategy was negative. PCR confirmation was finally obtained when P. ovale wallikeri primers were used. Although P. ovale is not frequently found in Colombia, there is a clear need to include both P. ovale curtisi and P. ovale wallikeri in the molecular diagnostic strategy. Such need stems primarily from their extended latency period, which affects travelers, the increasing number of African migrants, and the importance of accurately mapping the distribution of Plasmodium species in Colombia.

Assuntos

RESUMO

Starches from some legume grown in Cameroon were evaluated for their granule structure and size, turbidity, firmness and gel strength, thermal and freeze-thaw properties. Amylose contents were in the range of 26.21%-44.85%. Morphological analysis of the starch granules showed bimodal distribution, multiple sizes and shapes from small spherical to the bigger kidney shape. Significant differences were observed among starch in light transmittance, firmness and gel strength. The thermal parameters of starches were evaluated using differential scanning calorimeter and significant differences were observed. The peak gelatinisation temperature was positively correlated to starch granule size but the amylose content showed no evidence of their impact on legume starch properties studied. The data reported can be useful to facilitate the selection of variety of legume and conditions closer to the desired application.

Neste trabalho, amidos de algumas leguminosas cultivadas em Camarões foram avaliados quanto à estrutura e tamanho dos grânulos, turbidez, firmeza e resistência do gel, propriedades térmicas e de congelamento e descongelamento. Os conteúdos de amilose estavam na faixa de 26,21% a 44,85%. A análise morfológica dos grânulos de amido mostrou distribuição bimodal, múltiplos tamanhos e formas desde o pequeno esférico até o maior formato de rim. Diferenças significativas foram observadas entre os amidos na transmissão de luz, firmeza e força do gel. Os parâmetros térmicos dos amidos foram avaliados usando calorímetro diferencial de varredura e diferenças significativas foram examinadas. A temperatura de pico de gelatinização foi positivamente correlacionada com o tamanho do grânulo de amido, no entanto, o teor de amilose não mostrou evidência de impacto nas propriedades do amido de leguminosas estudadas. Os dados informados podem ser úteis para facilitar a seleção de variedades de leguminosas e condições mais próximas da aplicação desejada.

Assuntos

Assuntos

RESUMO

Starches from some legume grown in Cameroon were evaluated for their granule structure and size, turbidity, firmness and gel strength, thermal and freeze-thaw properties. Amylose contents were in the range of 26.21%-44.85%. Morphological analysis of the starch granules showed bimodal distribution, multiple sizes and shapes from small spherical to the bigger kidney shape. Significant differences were observed among starch in light transmittance, firmness and gel strength. The thermal parameters of starches were evaluated using differential scanning calorimeter and significant differences were observed. The peak gelatinisation temperature was positively correlated to starch granule size but the amylose content showed no evidence of their impact on legume starch properties studied. The data reported can be useful to facilitate the selection of variety of legume and conditions closer to the desired application.

Assuntos

RESUMO

AIMS: Elucidating the identity of an isolate of Aspergillus sp. obtained during searches for anti-coffee leaf rust (CLR) biocontrol agents, from healthy coffee berry samples, preliminarily verify whether it is an aflatoxin-producer, confirm its ability to grow as an endophyte in healthy coffee tissues and assess its biocontrol potential against CLR. METHODS AND RESULTS: One, among hundreds of fungal isolates fungus were obtained from healthy coffee tissues belonged to Aspergillus (isolate COAD 3307). A combination of morphology features and molecular analyses; including four regions-internal transcribed spacer, second-largest subunit of RNA polymerase (RPB2), ß-tubulin (BenA) and calmodulin (CAL)-identified COAD 3307 as Aspergillus flavus. Inoculations of healthy Coffea arabica with COAD 3307 confirmed its establishment as an endophyte in leaves, stems, and roots. Treatment of C. arabica plants by combinated applications of COAD 3307 on aerial parts and in the soil, significantly (P > .0001) reduced CLR severity as compared to controls. Thin-layer chromatography indicated that COAD 3307 is not an aflatoxin-producing isolate. In order to confirm this result, the extract was injected into high-performance liquid chromatography system equipped with a fluorescence detector, and no evidence of aflatoxin was found. CONCLUSIONS: COAD 3307 is an endophytic isolate of A. flavus-a species that has never been previously recorded as an endophyte of Coffea spp. It is a non-aflatoxin producing strain that has an anti-CLR effect and merits further evaluation as a biocontrol agent.

Assuntos

RESUMO

The use of herbal tea with Artemisia annua by travelers and traditional communities in Africa has increased in recent years as a supposed form of malaria prophylaxis, although its use is not recommended due to lack of efficacy. The risk of severe malaria complications that can lead to death is real regarding said behavior, and awareness needs to be raised. We report a case of severe Plasmodium falciparum malaria imported in the Amazon rainforest by a traveler returning from Cameroon who treated himself with Artemisia annua herbal tea.

Assuntos

RESUMO

Objective To describe the implementation of case-area targeted interventions to reduce cholera transmission using a rapid, localized response in Kribi district, Cameroon. Methods We used a cross-sectional design to study the implementation of case-area targeted interventions. We initiated interventions after rapid diagnostic test confirmation of a case of cholera. We targeted households within a 100­250 metre perimeter around the index case (spatial targeting). The interventions package included: health promotion, oral cholera vaccination, antibiotic chemoprophylaxis for nonimmunized direct contacts, point-of-use water treatment and active case-finding. Findings We implemented eight targeted intervention packages in four health areas of Kribi between 17 September 2020 and 16 October 2020. We visited 1533 households (range: 7­544 per case-area) hosting 5877 individuals (range: 7­1687 per case-area). The average time from detection of the index case to implementation of interventions was 3.4 days (range: 1­7). Oral cholera vaccination increased overall immunization coverage in Kribi from 49.2% (2771/5621 people) to 79.3% (4456/5621 people). Interventions also led to the detection and prompt management of eight suspected cases of cholera, five of whom had severe dehydration. Stool culture was positive for Vibrio cholerae O1 in four cases. The average time from onset of symptoms to admission of a person with cholera to a health facility was 1.2 days. Conclusion Despite challenges, we successfully implemented targeted interventions at the tail-end of a cholera epidemic, after which no further cases were reported in Kribi up until week 49 of 2021. The effectiveness of case-area targeted interventions in stopping or reducing cholera transmission needs further investigation

Assuntos