Ayukafangha Etando

Background/Objectives: Colistin has re-emerged as a critical last-resort antimicrobial for treating infections caused by multidrug-resistant Gram-negative bacteria. The discovery of plasmid-mediated mobile colistin resistance (mcr) genes in 2015 fundamentally changed the understanding of colistin resistance by demonstrating its capacity for horizontal transfer across bacterial species, hosts, and environments. Since then, increasing evidence has documented the widespread occurrence of mcr genes across Africa, threatening the long-term effectiveness of colistin. Earlier reviews have largely addressed single sectors or regions; here, we integrate all sectors, distinguish direct detection from inferred transmission, and propose prioritised actions. Methods: This narrative review synthesises current evidence on mobile colistin resistance in Africa through a One Health lens, integrating findings from human, animal, food, wildlife, and environmental sectors. Results: We provide a comprehensive overview of the molecular mechanisms, epidemiology, transmission pathways, and drivers of mcr dissemination across the continent. Available evidence indicates that mcr genes, particularly mcr-1, are distributed among clinical isolates, livestock, retail food products, wastewater, surface waters, agricultural soils, and wild birds, which is consistent with connected transmission across sectors. Key drivers include inappropriate antimicrobial use, livestock intensification, inadequate wastewater treatment, environmental contamination, climate change, and human and animal mobility. Conclusions: The frequent association of mcr genes with mobile genetic elements and other antimicrobial resistance determinants facilitates their persistence through horizontal gene transfer and co-selection. Despite increasing recognition of this threat, major gaps remain in surveillance, genomic characterisation, environmental monitoring, and understanding of transmission dynamics. Addressing these challenges will require stronger One Health surveillance, antimicrobial stewardship, genomic monitoring, improved environmental management, and coordinated policy interventions to mitigate the spread of mobile colistin resistance and preserve the clinical utility of colistin across Africa.

Wastewater antimicrobial resistance (AMR) surveillance is limited in many low- and middle-income countries where wastewater infrastructure is absent or inadequate. Surface water may provide an alternative for AMR surveillance in such settings. We investigated the resistome, virulome, and phylogenetic relationships of ESBL-producing Escherichia coli (ESBL-Ec) from surface water (SW), healthy residents (HR), and a clinical facility (CL) to determine whether SW isolates reflect human-associated AMR. During an eight-month longitudinal study in South Africa, 95 ESBL-Ec isolates (SW = 32, HR = 32, CL = 31) underwent whole-genome sequencing. Bioinformatics was used to characterise antimicrobial resistance genes (ARGs), virulence genes, sequence types (STs), phylogroups, and phylogenetic relationships. Seven phylogroups and 21 STs were identified. Phylogroups A, B1, and D and STs 10 and 38 occurred across all sources. Several clinically important lineages, including ST131, were shared between SW and HR isolates; no ST was unique to clinical isolates. Phylogenetic analysis revealed predominantly ST-driven clustering, with SW isolates showing greater similarity to HR isolates than to clinical isolates. Forty-five ARGs were detected, including 12 β-lactamase genes. blaCTX-M-15 was the dominant ESBL gene in all clinical isolates and in approximately half of SW and HR isolates. Resistance and virulence gene profiles were more frequently shared between SW and HR than between SW and CL isolates. Surface water did not fully reflect community and clinical ESBL-Ec populations but captured clinically relevant lineages and resistance determinants. These findings support SW monitoring as a complementary AMR surveillance approach in resource-limited settings lacking wastewater infrastructure.

Purpose ESBL- Klebsiella pneumoniae (ESBL-Kp) prevalence and resistance profiles were evaluated to determine if Surface water (SW) is an Alternative Antimicrobial-resistance Monitoring System (AlARMS) for nearby community (CM) and clinical (CS) settings. Method Over eight months, 462 (SW), 1,167 (CM), and 244 (CS) K. pneumoniae isolates were screened for ESBL production; antimicrobial susceptibility testing was conducted using VITEK 2. Results ESBL-Kp prevalence varied ( p < 0.05) among SW (14.9%), CM (6.8%), and CS (17.9%); multidrug resistance (MDR) was highest (94.6%) in CS and lowest in SW (25%). SW and CM isolates showed similar resistance ( p > 0.05) to amoxicillin-clavulanate, piperacillin-tazobactam, cephalosporins, carbapenems, amikacin, and tigecycline, but differed ( p < 0.001) for gentamicin, tobramycin, ciprofloxacin, and trimethoprim-sulphamethoxazole. SW and CS were similar ( p > 0.05) in resistance to cephalosporins, amikacin, gentamicin, and trimethoprim-sulphamethoxazole, but differed for amoxicillin-clavulanic acid, piperacillin-tazobactam, ciprofloxacin, and tigecycline. A non-MDR pattern was common to all sources, with more SW-CM (63.3%) than SW-CS (3.3%) overlap. MDR pattern overlapped was seen in SW-CM but not in SW-CS. Conclusion Surface water isolates did not fully mirror clinical or community phenotypes; nevertheless, shared clinically relevant patterns suggest transmission potential, necessitating refined molecular insights for AlARMS evaluation.

Background/Objectives: Although children’s playgrounds foster physical, cognitive and emotional health, sandpits can harbour antibiotic-resistant bacteria, representing a health concern for kids. Therefore, this point prevalence study investigated the presence and antimicrobial resistance of Escherichia coli in sandpits at four schools in Durban to ascertain the potential risk to schoolchildren and inform school authorities of the need to prevent such occurrences. Methods: Twenty samples were collected from schools on a single day. E. coli was isolated using colilert-18^® and confirmed using PCR. Antibiotic susceptibility testing was performed against 19 antibiotics using the disc diffusion method and Clinical and Laboratory Standards Institute (CLSI) guidelines. Results: E. coli was detected in 2/4 schools (50%), yielding 100 pure isolates. Of these, 71% (31 Site B and 40 Site C isolates) were resistant to at least one of the antibiotics tested, displaying 36 antibiograms. The highest resistance was to CFX (n = 40), and the lowest was to AMK and MEM (n = 1). All isolates were susceptible to CIP, CHL, GEN and TZP. At Site B, the highest resistance was against CFX (n = 16) and the lowest against AMK, CTX and NAL (n = 1). The highest resistance at Site C was against TET (n = 26), and the lowest against ATH and AUG (n = 1). Twenty isolates (20%) were multidrug-resistant, displaying resistance to at least one antibiotic from 3 classes. Conclusions: These results show that children with poor hygiene practices could get sick from playing in sandpits. Schools must change their sand regularly and ensure that sandpits are constantly exposed to the sun.

Bipolar affective disorder includes Bipolar Disease (BD) and Bipolar Spectrum Disorder (BSD). The prevalence of BSD, BD-I, BD-II, and subthreshold BD globally is estimated to be about 3.1%, 1.5%,0.03%, and 1.6%, respectively. BD is a multidimensional disease that exhibits a range of moods of mania, hypomania, and depression. The disease is chronic, complex, and fatal, with a high possibility of reappearance, infirmity, social incompetence, and felo-de-se. Managing emotional disruption, negative neuropsychology, physiology, and immunology is a challenge. This review focuses on therapeutic benefits, adverse drug reactions, and pharmacological intervention for BD and BSD, in particular lithium. Long-term management of BD with a single medication is ineffective and therefore, not recommended. It is advised to use multiple agents for treatment instead. Medications include mood stabilizers (lithium and anticonvulsants), atypical antipsychotics, and antidepressants. Along with medication provision, psychotherapy is of great significance for BD patients. The review was conducted on recent available scientific literature through the electronic database like Embase, ScienceDirect, Google Scholar, and PubMed using keywords like ‘Bipolar Disease,’ ‘Bipolar Disease Therapeutics,’ ‘Bipolar Disease and Psychotherapy’ to highlight the possible effective means of management of this disease of mood instability.

The introduction of effective vaccines in December 2020 marked a significant step forward in the global response to COVID-19. Given concerns with access, acceptability, and hesitancy across Africa, there is a need to describe the current status of vaccine uptake in the continent. An exploratory study was undertaken to investigate these aspects, current challenges, and lessons learnt across Africa to provide future direction. Senior personnel across 14 African countries completed a self-administered questionnaire, with a descriptive analysis of the data. Vaccine roll-out commenced in March 2021 in most countries. COVID-19 vaccination coverage varied from low in Cameroon and Tanzania and up to 39.85% full coverage in Botswana at the end of 2021; that is, all doses advocated by initial protocols versus the total population, with rates increasing to 58.4% in Botswana by the end of June 2022. The greatest increase in people being fully vaccinated was observed in Uganda (20.4% increase), Botswana (18.5% increase), and Zambia (17.9% increase). Most vaccines were obtained through WHO-COVAX agreements. Initially, vaccination was prioritised for healthcare workers (HCWs), the elderly, adults with co-morbidities, and other at-risk groups, with countries now commencing vaccination among children and administering booster doses. Challenges included irregular supply and considerable hesitancy arising from misinformation fuelled by social media activities. Overall, there was fair to reasonable access to vaccination across countries, enhanced by government initiatives. Vaccine hesitancy must be addressed with context-specific interventions, including proactive programmes among HCWs, medical journalists, and the public.

Objective: At the start of the Covid-19 pandemic, educational establishments, including universities, were closed. Educators in high-income countries quickly shifted all education online, building on available infrastructures and approaches. However, there were concerns in developing countries regarding the necessary skills among students and faculty as well as financial support for equipment and the internet. Consequently, a pilot was undertaken in Bangladesh to determine the impact of Covid-19 on the non-medical education system, building on similar research with healthcare professionals. Materials and Methods: A purposively designed questionnaire was disseminated among eight non-medical healthcare educators in private and public universities in Bangladesh. Results and Discussion: Private university educators reported their universities readily adopted e-learning systems and resumed classes more quickly than public universities. Both private and public university educators shared similar challenges, including a lack of training on e-learning initially, variable internet connections, affordability of internet bundles, concerns with available devices, as well as mental stress of faculty and students. Private universities reduced their tuition fees, extended submission deadlines, and shared class recordings to address challenges. Public universities arranged student loans, established Covid-19 testing centers, and the trained students in biosafety practices and molecular tests to volunteer in testing facilities. Conclusion: Lessons learned from the pandemic emphasize introducing hybrid education systems with full technological and financial support, alongside biosafety education in the curriculum. Bangladesh Journal of Medical Science Vol. 21 No. 04 October’22 Page : 731-743

The measures put in place to contain the rapid spread of COVID-19 infection, such as quarantine, self-isolation, and lockdown, were supportive but have significantly affected the mental wellbeing of individuals. The primary goal of this study was to review the impact of COVID-19 on mental health. An intensive literature search was conducted using PsycINFO, PsyciatryOnline, PubMed, and the China National Knowledge Infrastructure (CNKI) databases. Articles published between January 2020 and June 2022 were retrieved and appraised. Reviews and retrospective studies were excluded. One hundred and twenty-two (122) relevant articles that fulfilled the inclusion criteria were finally selected. A high prevalence of anxiety, depression, insomnia, and post-traumatic stress disorders was reported. Alcohol and substance abuse, domestic violence, stigmatization, and suicidal tendencies have all been identified as direct consequences of lockdown. The eminent risk factors for mental health disorders identified during COVID-19 include fear of infection, history of mental illness, poor financial status, female gender, and alcohol drinking. The protective factors for mental health include higher income levels, public awareness, psychological counseling, social and government support. Overall, the COVID-19 pandemic has caused a number of mental disorders in addition to economic hardship. This strongly suggests the need to monitor the long-term impact of the COVID-19 pandemic on mental health.