We present a case of Nannizziopsis spp infection in an immunocompromised patient, describe clinical findings, investigation results and treatment. This rare fungal infection is reported in reptiles and humans, but not other mammals. There are only twenty case reports in medical literature to date, most in immunocompromised patients.

A 64-year-old kidney transplant recipient from urban Nigeria presented with a verrucous plaque on his dorsal left hand which has grown rapidly over the two months. He was concerned that it might represent cancer. On further examination he also had a subcutaneous fluctuant masses on his left flank and left upper arm, a fleshy mucosal plaque and a large tender fluctuant swelling over his right tibia. He was clinically well, but in the preceding months he reported haemoptysis and 7 kilograms weight loss.

Skin biopsies from multiple sites showed identical features: suppurative granulomatous inflammation and elongated elements consistent with fungal hyphae. Grocott special staining showed scattered fungal hyphae. Beta-D-glucan was raised at 441.4 pg/mL [3-6 pg/mL]. Subsequent molecular identification confirmed Nanniziopsis spp, likely to be N. guarroi. He was treated with intravenous amphotericin-B for 7 weeks and was then switched to oral posaconazole for one month with complete resolution.

Nannizziopsis is an emerging human pathogenic fungus that predominantly causes disease in immunocompromised individuals. This case highlights the importance of suspecting atypical fungal infection in immunocompromised individuals presenting with polymorphic skin lesions and the critical diagnostic role of skin biopsy and culture.

PURPOSE: Overcrowding in emergency department (ED) is a concerning global problem and has been identified as a national crisis in some countries. Several emergency sorting systems designed successfully in the world. Launched in 2004, a group of branches in South African triage scale (SATS) developed. The effectiveness of the case sorting system of SATS was evaluated to reduce the patient's length of stay (LOS) and mortality rate within the ED at Suez Canal University Hospital. METHODS: The study was designed as an intervention study that included a systematic random sample of patients who presented to the ED in Suez Canal University Hospital. This study was implemented in three phases: pre-intervention phase, 115 patients were assessed by the traditional protocols; intervention phase, a structured training program was provided to the ED staff, including a workshop and lectures; and post-intervention phase, 230 patients were assessed by SATS. All the patients were retriaged 2 h later, calculating the LOS per patient and the mortality. Data was collected and entered using Microsoft Excel software. Collected data from the triage sheet were analyzed using the SPSS software program version 22.0. RESULTS: The LOS in the ED was about 183.78 min before the intervention; while after the training program and the application of SATS, it was reduced to 51.39 min. About 15.7% of the patients died before the intervention; however, after the intervention the ratio decreased to 10.7% deaths. CONCLUSION SATS is better at assessing patients without missing important data. Additionally, it resulted in a decrease in the LOS and reduction in the mortality rate compared to the traditional protocol.
Egypt ; Emergency Service, Hospital ; Humans ; Length of Stay ; South Africa ; Triage/methods*

This article introduces the present development status, medical insurance charges, publicity and influence, legislation and practice of acupuncture-moxibustion in Namibia, and proposes some countermeasures for the current problems in the development of acupuncture-moxibustion in Namibia. Namibia has passed legislation of acupuncture-moxibustion and incorporated acupuncture-moxibustion into the medical insurance system in March 2020. The acupuncture-moxibustion will enter the fast track of development, but the acupuncture-moxibustion education, training and cooperation, talent cultivation mode, reimbursement scope of medical insurance, and standardization construction still need to be steadily improved and strengthened.
Acupuncture ; Acupuncture Therapy ; Moxibustion ; Namibia ; Reference Standards

Pulmonary paragonimiasis and tuberculosis are endemic in Asia, South America, and Africa. However, differential diagnosis among the diseases is difficult because they present with similar clinical symptoms and diagnostic features. Here, we report a case of pulmonary paragonimiasis that was identified using Ziehl-Neelsen stain after initially being assessed for pulmonary tuberculosis. Following anti-Paragonimus chemotherapy, the patient's symptoms, laboratory test results, and lung lesions improved. Thus, the identification of Paragonimus westermani using Ziehl-Neelsen stain can be considered in the diagnosis.
Africa ; Asia ; Diagnosis ; Diagnosis, Differential ; Drug Therapy ; Lung ; Paragonimiasis ; Paragonimus westermani ; South America ; Tuberculosis ; Tuberculosis, Pulmonary

BACKGROUND: Globally, over four million deaths are attributed to exposure to household air pollution (HAP) annually. Evidence of the association between exposure to HAP and under-five mortality in sub-Saharan Africa (SSA) is insufficient. We assessed the association between exposure to HAP and under-five mortality risk in 14 SSA countries. METHODS: We pooled Demographic and Health Survey (DHS) data from 14 SSA countries (N = 164376) collected between 2015 and 2018. We defined exposure to HAP as the use of biomass fuel for cooking in the household. Under-five mortality was defined as deaths before age five. Data were analyzed using mixed effects logistic regression models. RESULTS: Of the study population, 73% were exposed to HAP and under-five mortality was observed in 5%. HAP exposure was associated with under-five mortality, adjusted odds ratio (OR) 1.33 (95% confidence interval (CI) [1.03-1.71]). Children from households who cooked inside the home had higher risk of under-five mortality compared to households that cooked in separate buildings [0.85 (0.73-0.98)] or outside [0.75 (0.64-0.87)]. Lower risk of under-five mortality was also observed in breastfed children [0.09 (0.05-0.18)] compared to non-breastfed children. CONCLUSIONS HAP exposure may be associated with an increased risk of under-five mortality in sub-Saharan Africa. More carefully designed longitudinal studies are required to contribute to these findings. In addition, awareness campaigns on the effects of HAP exposure and interventions to reduce the use of biomass fuels are required in SSA.
Africa South of the Sahara ; Air Pollution, Indoor/adverse effects* ; Biomass ; Cooking ; Female ; Health Surveys ; Housing ; Humans ; Infant ; Infant Mortality ; Infant, Newborn ; Male ; Mortality

Most of lichens are formed by Ascomycota, less than 1% are lichenized Basidiomycota. The flora investigation of lichenized Ascomycota of South Korea has been well studied in the past three decades; however, prior to this study, none of basidiolichens was discovered. During the recent excursion, an unexpected clavarioid basidiolichen, Sulzbacheromyces sinensis was collected. Morphology and ecology has been recorded in detail. DNA was extracted, and ITS, 18S, 28S nuclear rDNA were generated. In order to further confirm the systematic position of the Korean specimens, maximum likelihood and Bayesian inference analysis including all the species of the order Lepidostromatales were conducted based on the ITS. As a result, the phylogenetic tree of the order Lepidostromatales was reconstructed, which differed from the previous studies. The inferred phylogenetic tree showed that species of Sulzbacheromyces in three different continents (Asia, South Africa and South America) were separated into three clades with support. In this study, the species worldwide distribution map of Lepidostromatales was illustrated, and S. sinensis had a widest distribution range (paleotropical extend to the Sino-Japanese) than other species (paleotropical or neotropical). Prior to this study, the range of distribution, southernmost and northernmost points and the fruiting time of S. sinensis were recorded, and the genus Sulzbacheromyces was firstly reported from Korean peninsula and Philippines.
Ascomycota ; Asia ; Basidiomycota ; DNA ; DNA, Ribosomal ; Ecology ; Fruit ; Geography ; Korea ; Lichens ; Philippines ; Phylogeny ; South Africa ; Trees

Adolescent ; Adult ; Child ; Decision Trees ; Female ; HIV Infections ; economics ; transmission ; Humans ; Infectious Disease Transmission, Vertical ; economics ; prevention & control ; Kenya ; Middle Aged ; Mothers ; South Africa ; Vietnam ; Young Adult

The aim of the study was to determine the feasibility of the Vitellaria paradoxa nutshell as a new medicinal resource for treating diabetes. A total of forty-one compounds were identified by HPLC-DAD-Q-TOF-MS and phytochemical methods in V. paradoxa nutshell methanol extract. Based on HPLC fingerprints, four characteristic constituents were quantified and the origin of twenty-eight V. paradoxa nutshells from seven sub-Saharan countries was compared, which were classified into three groups with chemometric method. Twenty-eight samples contained high total phenolic content, and exhibited moderate-higher antioxidant activity and strong α-glucosidase inhibitory activity. Furthermore, all fractions and isolated compounds were evaluated for their antioxidant and α-glucosidase inhibitory activities, and α-glucosidase inhibitory action mechanism of four characteristic constituents including protocatechuic acid, 3, 5, 7-trihydroxycoumarin, (2R, 3R)-(+)-taxifolin and quercetin was investigated via molecular docking method, which were all stabilized by hydrogen bonds with α-glucosidase. The study provided an effective approach to waste utilization of V. paradoxa nutshell, which would help to resolve waste environmental pollution and provide a basis for developing potential herbal resource for treating diabetes.
Africa South of the Sahara ; Chromatography, High Pressure Liquid ; Diabetes Mellitus ; drug therapy ; enzymology ; Glycoside Hydrolase Inhibitors ; chemistry ; pharmacology ; Humans ; Hypoglycemic Agents ; chemistry ; pharmacology ; Molecular Docking Simulation ; Plant Extracts ; chemistry ; pharmacology ; Plants, Medicinal ; chemistry ; Sapotaceae ; chemistry ; alpha-Glucosidases ; metabolism

BACKGROUND: Bacterial contamination of drinking water is a major public health problem in rural areas of sub-Saharan Africa. Unimproved water sources are a major reservoir of Escherichia coli (E. coli) causing severe diarrhoea in humans. This study assessed E. coli counts in drinking water from different sources and their relationship with water source protection status and neighbourhood sanitation and hygiene practices in rural villages of Mohale Basin in Lesotho. METHODS: Thirty drinking water sources were purposively sampled and their water analysed for E. coli counts. The types of water sources, their protection status and neighbourhood sanitation and hygiene practices in their proximity were also assessed. E. coli counts in water samples were compared to water source protection status, neighbourhood sanitation, hygiene practices, livestock faeces and latrine proximity to water sources. RESULTS: E. coli counts were found in all water samples and ranged from less than 30 colony-forming units (cfu)/100 ml to 4800 cfu/100 ml in protected sources to 43,500,000 cfu/100 ml in unprotected sources. A significant association between E. coli counts in drinking water samples and lack of water source protection, high prevalence of open defecation (59%, n = 100), unhygienic practices, livestock faeces and latrine detections in proximity to water sources was found in the study (P < 0.05). CONCLUSION Water sources in studied villages were contaminated with faeces and posed a health risk to consumers of that water. Community-led sanitation and hygiene education and better water source protection are urgently needed.
Drinking Water ; microbiology ; Escherichia coli ; isolation & purification ; Feces ; microbiology ; Health Behavior ; Humans ; Hygiene ; Lesotho ; Rural Health ; Sanitation ; methods ; statistics & numerical data ; Water Microbiology ; Water Quality ; Water Supply ; statistics & numerical data

BACKGROUND: Mine workers in South Africa face challenges relating to poor health and safety, including fatigue risks, and poor socioeconomic and living conditions. Fatigue results in impaired mental and physical performance. The aim of this study was to assess contributors to fatigue of mine workers in South Africa. METHODS: Data collection took place at four gold mines and one platinum mine in South Africa. A total of 21 focus groups were held with individuals in management, union representatives, and mine workers, and 564 questionnaires were completed by mine workers to gather information about fatigue and potential contributors to fatigue at these mines. RESULTS: Qualitatively (through focus groups), fatigue was attributed to extended working hours, harsh working conditions, high workloads, production pressure, and resource constraints, along with aspects relating to demographic and socioeconomic factors, living conditions, lifestyle, health, and wellness. Greater fatigue was significantly associated with younger age, indebtedness, a lack of exercise, poor nutrition, less sleep, increased alcohol use, poor self-reported health, more sick leave, higher stress, and lower job satisfaction. CONCLUSION: The aim of the study was achieved; numerous work-, sociodemographic-, lifestyle-, and wellness-related factors were linked to fatigue in the participating mine workers. Contributors to fatigue should be addressed to improve health, safety, and sustainability in the industry.
Data Collection ; Environment and Public Health ; Fatigue ; Focus Groups ; Job Satisfaction ; Life Style ; Miners ; Mining ; Platinum ; Sick Leave ; Social Conditions ; Socioeconomic Factors ; South Africa