Severe bacterial neonatal infections in Madagascar,Senegal, and Cambodia: A multicentric community-based cohort study

BackgroundSevere bacterial infections (SBIs) are a leading cause of neonatal deaths in low- and middle-income countries (LMICs). However, most data came from hospitals, which do not include neonates who did not seek care or were treated outside the hospital. Studies from the community are scarce, and few among those available were conducted with high-quality microbiological techniques. The burden of SBI at the community level is therefore largely unknown. We aimed here to describe the incidence, etiology, risk factors, and antibiotic resistance profiles of community-acquired neonatal SBI in 3 LMICs.Methods and findingsThe BIRDY study is a prospective multicentric community-based mother and child cohort study and was conducted in both urban and rural areas in Madagascar (2012 to 2018), Cambodia (2014 to 2018), and Senegal (2014 to 2018). All pregnant women within a geographically defined population were identified and enrolled. Their neonates were actively followed from birth to 28 days to document all episodes of SBI. A total of 3,858 pregnant women (2,273 (58.9%) in Madagascar, 814 (21.1%) in Cambodia, and 771 (20.0%) in Senegal) were enrolled in the study, and, of these, 31.2% were primigravidae. Women enrolled in the urban sites represented 39.6% (900/2,273), 45.5% (370/814), and 61.9% (477/771), and those enrolled in the rural sites represented 60.4% (1,373/2,273), 54.5% (444/814), and 38.1% (294/771) of the total in Madagascar, Cambodia, and Senegal, respectively. Among the 3,688 recruited newborns, 49.6% were male and 8.7% were low birth weight (LBW). The incidence of possible severe bacterial infection (pSBI; clinical diagnosis based on WHO guidelines of the Integrated Management of Childhood Illness) was 196.3 [95% confidence interval (CI) 176.5 to 218.2], 110.1 [88.3 to 137.3], and 78.3 [59.5 to 103] per 1,000 live births in Madagascar, Cambodia, and Senegal, respectively. The incidence of pSBI differed between urban and rural sites in all study countries. In Madagascar, we estimated an incidence of 161.0 pSBI per 1,000 live births [133.5 to 194] in the urban site and 219.0 [192.6 to 249.1] pSBI per 1,000 live births in the rural site (p = 0.008). In Cambodia, estimated incidences were 141.1 [105.4 to 189.0] and 85.3 [61.0 to 119.4] pSBI per 1,000 live births in urban and rural sites, respectively (p = 0.025), while in Senegal, we estimated 103.6 [76.0 to 141.2] pSBI and 41.5 [23.0 to 75.0] pSBI per 1,000 live births in urban and rural sites, respectively (p = 0.006). The incidences of culture-confirmed SBI were 15.2 [10.6 to 21.8], 6.5 [2.7 to 15.6], and 10.2 [4.8 to 21.3] per 1,000 live births in Madagascar, Cambodia, and Senegal, respectively, with no difference between urban and rural sites in each country. The great majority of early-onset infections occurred during the first 3 days of life (72.7%). The 3 main pathogens isolated were Klebsiella spp. (11/45, 24.4%), Escherichia coli (10/45, 22.2%), and Staphylococcus spp. (11/45, 24.4%). Among the 13 gram-positive isolates, 5 were resistant to gentamicin, and, among the 29 gram-negative isolates, 13 were resistant to gentamicin, with only 1 E. coli out of 10 sensitive to ampicillin. Almost one-third of the isolates were resistant to both first-line drugs recommended for the management of neonatal sepsis (ampicillin and gentamicin). Overall, 38 deaths occurred among neonates with SBI (possible and culture-confirmed SBI together). LBW and foul-smelling amniotic fluid at delivery were common risk factors for early pSBI in all 3 countries. A main limitation of the study was the lack of samples from a significant proportion of infants with pBSI including 35 neonatal deaths. Without these samples, bacterial infection and resistance profiles could not be confirmed.ConclusionsIn this study, we observed a high incidence of neonatal SBI, particularly in the first 3 days of life, in the community of 3 LMICs. The current treatment for the management of neonatal infection is hindered by antimicrobial resistance. Our findings suggest that microbiological diagnosis of SBI remains a challenge in these settings and support more research on causes of neonatal death and the implementation of early interventions (e.g., follow-up of at-risk newborns during the first days of life) to decrease the burden of neonatal SBI and associated mortality and help achieve Sustainable Development Goal 3.

In a community-based, prospective cohort study, Bich-Tram Huynh and colleagues investigate the incidence and factors associated with several bacterial infections among neonates in rural and urban areas of three low-middle income countries.     

A putative Type IIS restriction endonuclease GeoICI from <Emphasis Type="BoldItalic">Geobacillus</Emphasis> sp. – A robust,thermostable alternative to mezophilic prototype BbvI

Screening of extreme environments in search for novel microorganisms may lead to the discovery of robust enzymes with either new substrate specificities or thermostable equivalents of those already found in mesophiles, better suited for biotechnology applications. Isolates from Iceland geysers’ biofilms, exposed to a broad range of temperatures, from ambient to close to water boiling point, were analysed for the presence of DNA-interacting proteins, including restriction endonucleases (REases). GeoICI, a member of atypical Type IIS REases, is the most thermostable isoschizomer of the prototype BbvI, recognizing/cleaving 5′-GCAGC(N_8/12)-3′ DNA sequences. As opposed to the unstable prototype, which cleaves DNA at 30°C, GeoICI is highly active at elevated temperatures, up to 73°C and over a very wide salt concentration range. Recognition/cleavage sites were determined by: (i) digestion of plasmid and bacteriophage lambda DNA (λ); (ii) cleavage of custom PCR substrates, (iii) run-off sequencing of GeoICI cleavage products and (iv) shotgun cloning and sequencing of λ DNA fragmented with GeoICI. Geobacillus sp. genomic DNA was PCR-screened for the presence of other specialized REases-methyltransferases (MTases) and as a result, another putative REase-MTase, GeoICII, related to the Thermus sp. family of bifunctional REases-MTases was detected.     

Physiological and Behavioral Responses of Horses to Wither Scratching and Patting the Neck When Under Saddle

Riding is considered to be an arousing activity for horses. It has been suggested that wither scratching may be a more useful tool for relaxation compared with the common practice of neck patting. In the current study, 18 horses were exposed to 3 treatments, including control or no interaction, neck patting, and wither scratching, for 1 min each following a short obstacle course. Heart rate, heart rate variability, and a variety of behaviors were measured in the horses. Wither scratching produced a significantly longer duration of relaxed-type behaviors. Wither scratching could be a useful tool to help a horse relax while under saddle. Additionally, the study identified 2 ear positions that may be useful for future research in horse behavior.     

Implied Spatial Meaning and Visuospatial Bias: Conceptual Processing Influences Processing of Visual Targets and Distractors

Concepts with implicit spatial meaning (e.g., "hat", "boots") can bias visual attention in space. This result is typically found in experiments with a single visual target per trial, which can appear at one of two locations (e.g., above vs. below). Furthermore, the interaction is typically found in the form of speeded responses to targets appearing at the compatible location (e.g., faster responses to a target above fixation, after reading "hat"). It has been argued that these concept-space interactions could also result from experimentally-induced associations between the binary set of locations and the conceptual categories with upward and downward meaning. Thus, rather than reflecting a conceptually driven spatial bias, the effect could reflect a benefit for compatible cue-target sequences that occurs only after target onset. We addressed these concerns by going beyond a binary set of locations and employing a search display consisting of four items (above, below, left, and right). Within each search trial, before performing a visual search task, participants performed a conceptual task involving concepts with implicit upward or downward meaning. The search display, in addition to including a target, could also include a salient distractor. Assuming a conceptually driven visual bias, we expected to observe, first, a benefit for target processing at the compatible location and, second, an increase in the cost of the salient distractor. The findings confirmed both predictions, suggesting that concepts do indeed generate a spatial bias. Finally, results from a control experiment, without the conceptual task, suggest the presence of an axis-specific effect, in addition to the location-specific effect, suggesting that concepts might cause both location-specific and axis-specific spatial bias. Taken together, our findings provide additional support for the involvement of spatial processing in conceptual understanding.     

Buried Alive: The Behavioural Response of the Mussels,Modiolus modiolus and Mytilus edulis to Sudden Burial by Sediment

Sedimentation in the sea occurs through natural processes, such as wave and tidal action, which can be exacerbated during storms and floods. Changes in terrestrial land use, marine aggregate extraction, dredging, drilling and mining are known to result in substantial sediment deposition. Research suggests that deposition will also occur due to the modern development of marine renewable energy. The response to individual burial under three depths of sediment, three sediment fractions and five burial durations was investigated in two mussel species, Modiolus modiolus and Mytilus edulis in specialist mesocosms. Both mussel species showed substantial mortality, which increased with duration of burial and burial by finer sediment fractions. M. modiolus was better able to survive short periods of burial than M. edulis, but at longer durations mortality was more pronounced. No mortality was observed in M. modiolus in burial durations of eight days or less but by 16 days of burial, over 50% cumulative mortality occurred. Under variable temperature regimes, M. edulis mortality increased from 20% at 8°C to over 60% at 14.5 and 20°C. Only M. edulis was able to emerge from burial, facilitated by increased byssus production, laid mostly on vertical surfaces but also on sediment particles. Emergence was higher from coarse sediment and shallow burials. Byssus production in M. edulis was not related to the condition index of the mussels. Results suggest that even marginal burial would result in mortality and be more pronounced in warm summer periods. Our results suggest that in the event of burial, adult M. modiolus would not be able to emerge from burial unless local hydrodynamics assist, whereas a small proportion of M. edulis may regain contact with the sediment water interface. The physiological stress resulting in mortality, contribution of local hydrodynamics to survival and other ecological pressures such as mussels existing in aggregations, are discussed.     

人β-基因3’旁侧的多态性BamHⅠ位点及其在β-地贫产前诊断中的意义

用印迹杂交技术和β-珠蛋白基因探针测定了中国人β-株蛋白基因3’旁侧BamHⅠ多态性位点。22kb带在β~A染色体上出现的频率为32％,但在β~T染色体上出现的频率为0。BamHⅠ多态性位点分布频率的这一特点在β-地贫产前诊断中具有重要意义。