HIV/AIDS has remained a challenge in Uganda among adolescent despite the ABC strategy used globally to prevent HIV infection. The study assessed the knowledge, attitudes and perceptions of secondary school teenagers towards HIV transmission and prevention in rural and urban schools of central Uganda. A cross sectional study using self-administered questionnaires and structured interviews was used to collect data from adolescents in secondary schools in Kampala and Buikwe districts. Eight schools were randomly selected with 4 schools in each district. A total of 245 students from schools were recruited in the study with 120 and 125 students from urban Kampala and rural Buikwe district schools respectively. Data were analyzed using SPSS version 11. The results were expressed as percentages in a 2 × 2 tables. The mean age of the participants was 15.9 ± 2.5 years. Results showed that 95.1% participants had knowledge on HIV/AIDS in both urban and rural schools and 27.4% knew all the modes of HIV transmission. About 83.7% knew the ABC strategy for HIV prevention and 37.6% would talk about HIV/AIDS mainly with friends. For HIV cure, 62.0% of study participants reported non-cure and 24.9% were not sure. The remaining 13.1% of the study participants in both urban and rural schools reported that HIV can be cured. And the modes of curing HIV that were mentioned by participants included spiritual healing, transmitting it to others through sexual intercourse and that antiretroviral (ARVs) drugs can cure it as well as that it can be cured abroad. About 65.7% of participants reported recognition of one with HIV/ AIDS and by having red lips, being sickly; weight loss, skin rash and being very rich were mentioned. About 39.2% of the study participants mentioned that they cannot get infected with HIV and can’t contract HIV at all and 18.4% believed that chances of getting HIV infection were high. On perception and attitude on condoms and their use, participants reported that it is a sign of mistrust, reduces sexual pleasures and they are embarrassing to buy. Majority of the participants in both urban and rural schools had some knowledge on HIV/AIDS and the ABC strategy for HIV prevention. However, there was a knowledge gap on the various modes of HIV transmission and prevention. There was misconception of the participants on HIV/AIDS cure, condom use and on the chances of contracting HIV. About the source of HIV/AIDS information, majority of the participants were getting information on HIV/AIDS from friends of which some information was misleading. This false information could be the reason for the increased HIV prevalence reported among the adolescents in the schools. Generally, participants had some knowledge on HIV/AIDS though they had knowledge gap on HIV transmission and prevention. Human immunodeficiency virus (HIV) and acquired immunodeficiency syndrome (HIV/AIDS) remain one of the most serious global challenges the world is facing today and most especially in the sub-Saharan African countries  2]. Glo. Glo2]. Globally, the most vulnerable group of individuals to HIV infection are reported to be the youth in the reproductive age group of 15 – 24 years with adolescents contributing to a large percentage  7]..7].In Uganda, the burden of HIV is continuing to be a national problem especially among the youth in adolescent age group that are both schooling and the non-schooling. The HIV prevalence in Ugandan general population following the two AIDS Indicator Surveys showed that it had increased from 6.4% in 2004/5 to 7.4% in 2012/ 2013  9]. How. How9]. The high HIV prevalence among the female adolescents has been attributed to the lack of power to negotiate with their male counterparts on the safe sexual matters especially if there is a cross-generation relationship –16]. Po. Po16]. Whereas, the ABC strategy , tremendously reduced the HIV prevalence from 30% in early 1990’s to nearly 6.4% by 2004/2005 , but in A cross-sectional study using self-administered questionnaire and structured interviews was carried out between October and November 2014, among secondary school adolescent students in both urban and rural schools of central Uganda. The essential features of the study included: 1) sampling of the secondary schools located in the district 2) Sampling of the adolescents that participated in the study 3) Data collection using a self-administered questionnaire and structured interview and 4) Conducting analysis of the collected data.Study was conducted in eight secondary schools in Kampala and Buikwe district in Uganda. An equal number of schools (4 schools in each) were randomly selected from Kampala city, the capital and largest city in Uganda that represented urban district and Buikwe district to represent rural areas. Kampala district was chosen purposively and for convenience while Buikwe district was chosen purposively and for logistical reasons. Buikwe district is located in central Uganda and is bordered by Kayunga District to the north, Jinja district to the east, Buvuma district to the southeast, the Republic of Tanzania to the south and Mukono district to the east. It was created by Act of Parliament and commenced operations on 1 July 2009.The target population was the adolescents, both male and female students in rural and urban areas of central Uganda. The accessible population was the sample size of students in the selected secondary schools. Sampling was done using multistage cluster sampling procedure. The schools were stratified in each selected district. A total of eight secondary schools were considered, with each selected district having 4 schools. A total of 245 participants were recruited into the study with 120 from urban schools of Kampala city and 125 participants from rural schools of Buikwe district. The sample size was adequate with an assumption of 80% power and an estimated error margin of 0.05. Using the Uganda Ministry of Education and Sports list of schools in Kampala and Buikwe district, the secondary schools were randomly selected. Four schools represented each district and of these, half were government sponsored and the rest were private schools. The sample size for each school was determined by proportionate sampling. In each school, a students’ list was obtained from which participants were randomly selected. The schools consisted of a total population of 4392 students with 2126 males and 2266 females. Within the selected schools, the participants in all classes aged between 10 to 19 years were recruited, consented/assented before the questionnaire with structured interviews were administered to them.The participants were both male and female students in the secondary schools within the age bracket of 10 – 19 years. Participants with the age group of 10 – 17 years had to give informed consent and assent and those between 18 – 19 years gave consent.Primary data were collected using a pre-tested self-administered questionnaire with structured interviews. The questionnaire was designed after considering recommendations from previous researchers on Theory of Planned Behaviour (TPB) and the ecological perspectives . The queKnowledge on HIV/AIDS was measured using the participants’ views on HIV/AIDS transmission and prevention. Correct responses to these questions were analyzed and an average percentage was computed. A percentage greater than 60% represented good knowledge about HIV/AIDS. Attitudes on HIV transmission, prevention and condom use were assessed. The background and demographic characteristics included age, residence and gender, which was a dichotomous measure such as female = 0 and male = 1. Dummy variables for religion were created based on the following categories; catholic, protestant, Pentecostal, Muslim and other religions. Also residence was a dichotomous measure .Before the study was conducted in the selected schools, questionnaires were pre-tested. Each participant responded to the questionnaire using a structured interview with the assistance of a research assistant. Adequate spacing was ensured to promote confidentiality. Questionnaires were screened, on each day for incomplete information and consistency. The principal investigator collected all the questionnaires, stored them under lock and key and personally supervised the entry of the data into a computer which was pass-worded. Data entry was done using Epi-data entry sheets created using logic checks. Double data entry was done using two separate data entrants. The two entry sheets were compared for consistency and analyzed using SPSS and any discrepancies was resolved by referring to source document.Each response to question in the questionnaire was coded and then entered into the epidata tool, version 3.1. The data was exported and analyzed using Statistical Package for Social Scientists (SPSS version 11). The frequencies and percentage response for each question was computed and the data was transformed into a 2 × 2 table.Ethical clearance and approval for study was obtained from the School of Medicine Research and Ethics Committee (SOMREC) at Makerere University College of Health Sciences and from the Uganda National Council of Science and Technology (UNCST). For participants in the age group 10 to 17 years, assent was sought from the parents/guardians and then consent was obtained from the student. For mature and emancipated minors, informed consent was independently sought from them. For the age group of 18 to 19 years, consent was sought from the students themselves. Confidentiality of information was ensured by the principal investigator during and after the study.The study assessed the knowledge, attitudes and perceptions of secondary school teenagers towards HIV transmission and prevention in rural and urban schools of central Uganda. A total of 245 secondary participants were recruited in the study with 120 and 125 participants from urban Kampala schools and rural Buikwe schools respectively. The ratio of males to females was 1:1.Demographic characteristics of the participants show that majority were in the age range of 15 – 18 years. The mean total age of the participants was 15.9 ± 2.5 years and for the rural and urban participants, it was 15.4 ± 2.1 years and 15.7 ± 1.8 years respectively. There was no gender difference in the place of residence whether urban or rural areas. Majority of the participants were Catholics, Anglicans and Muslims .On the knowledge about HIV/AIDS, 95.1%, (n = 233/245) of the study participants were knowledgeable and 4.9% (n = 12/245) were not. About 49.0% (n = 120/125) of the study participants in rural schools were knowledgeable about HIV/ AIDS as compared to the 46.1% (n = 113/120) study participants in urban schools .Knowledge about HIV transmission, about 27.4% (n = 67/245) of the total participants knew all the established modes of HIV transmission with 14.3% (n = 35/120) and 13.1% (n = 32/125) from urban and rural schools respectively. The sexual intercourse was the most mentioned mode HIV transmission  of the study participants with 18.0% (n = 44/120) and 14.3% (n = 35/125) from urban and rural schools respectively. Blood transfusion  with 2.5% (n = 120) and 3.7% (n = 9/125) from urban and rural schools respectively was mentioned. The sharing of sharp objects with an infected person  with 2.4% (n = 6/120) and 2.0% (n = 5/125) from urban and rural schools respectively was mentioned. The least mode of HIV transmission mentioned was oral sex or contact through wounds with an infected person  with 0.4% (n = 1/120) and 2.0% (n = 5/125) from urban and rural schools respectively .On the HIV prevention strategy, about 83.7% (n = 205/245) of the study participants were knowledgeable on the ABC HIV prevention strategy with rural schools more informed  as compared to 36.3% (n = 89/120) for urban schools. About 16.3% (n = 40/245) with 12.7% (n = 31/120) and 3.6% (n = 9/125) from urban and rural schools respectively were not knowledgeable about the ABC HIV prevention strategy .The age, at which the participants first heard about HIV/AIDS information, Responses on whether HIV/AIDS is curable, about 62.0% (n = 152/245) of the study participants with 30.2% (n = 74/120) and 31.8% (n = 78/125) in urban and rural areas respectively reported that there is no cure for HIV/AIDS. Whereas 13.1% (n = 32/245) reported that there is cure for the diseases and 24.9% (n = 61/245) reported not sure . And forOn whether, one can physically recognize if someone has HIV/AIDS. About 54.7% (n = 134/245) participants with 24.5% (n = 60/120) and 30.2% (n = 74/125) in urban and rural areas respectively mentioned “SOMETIMES YES”. And 34.3% (n = 84/245) with 19.2% (n = 47/120) and 15.1% (n = 37/125) in urban and rural areas respectively mentioned that it is impossible to physically recognize if someone has HIV/AIDS . About 1On the possibility of getting HIV infection, about 39.2% (n = 96/245) study participants with 20.4% (n = 50/120) and 18.8% (n = 46/125) in urban and rural areas respectively mentioned that it is impossible to get HIV infection. About 31.0% (n = 76/245) with 15.5% (n = 38/120) and 15.5% (n = 38/125) in urban and rural areas respectively mentioned that the chance of getting HIV infection is minimal. About 18.4% (n = 45/245) of the study participants with 8.6% (n = 21/120) and 9.8% (n = 24/125) in urban and rural areas respectively mentioned that the chance of getting HIV infection is high and 11.4% (n = 28/245) with 4.5% (n = 11/120) and 6.9% (n = 17/125) in urban and rural areas respectively mentioned that the chance of getting HIV infection is moderate .On the perception and attitude towards condoms and condom use, about 41.6% (n = 102/245) of the study participants with 20.4% (n = 50/120) and 21.2% (n = 52/125) in urban and rural areas respectively reported that condom use reduces sexual pleasure.About 34.3% (n = 84/245) of the study participants with 18.0% (n = 44/120) and 16.3% (n = 40/125) in urban and rural areas respectively mentioned that using the condoms is a sign of mistrust. About 18.8% (n = 46/245) participants with 9.8% (n = 24/120) and 9.0% (n = 22/125) in urban and rural areas respectively reported that condoms are embarrassing to buy. In rural schools only, participants mentioned that condom use reduces sexual pleasure and it is a sign of mistrust . And 0.8% (n = 2/245) of the participants mentioned that condom use, reduces sexual pleasure and are embarrassing to buy and 0.4% (n = 1/245) reported that condom use is a sign of mistrust and are embarrassing to buy .The study assessed the knowledge, attitudes and perceptions of secondary school teenagers towards HIV transmission and prevention in rural and urban areas of central Uganda. In this study, 51.0% n = 125/245) of the participants were from rural schools and of the total participants, 55.5% (n = 136/245) were females. There was no difference in the gender distribution of male and female participants in the study groups. Most of the participants were residing in rural areas (51.0%) in comparison to urban areas (49.0%). The results show that all religious affiliations were represented in the study groups, with majority being Anglicans (31.5%) followed by Catholics 28.6%) and then Muslims (21.3%). The age distribution of the participants varied from 12 years to above 18 years with the majority in the range of 16 years (17.5%) and ≥18 years (17.1%) . The mea.6% and t5/245 of abstinence, be faithful and condoms use (ABC strategy) message and the outcome of the study is comparable to previous studies elsewhere . Th. Thabstilsewhere , but by lsewhere . Variouslsewhere  31]  [34 [3432] , with 145 of the The study findings showed that, majority of the participants were knowledgeable on the ABC HIV prevention strategy  with rural schools more informed about the strategy  as compared to 36.3% (n = 89/120) for urban schools. The difference could have been due to the complexity of the socioeconomic groups in urban areas where the participant reside and the exposure of these participant to sexual activities at an early age, some of whom become rebellious to their parents and thus run away from their homes to go and live on streets where they encounter different individuals with various behaviors including engaging themselves in risky sexual acts. They are also not exposed to HIV prevention programmes as compared to the rural areas. However, there was a small group of participants  with 12.7% n = 31/120) and 3.6% (n = 9/125) from urban and rural schools respectively , who wer/120 and The study results show that the participants first got the information on HIV/AIDS as early as 4 – 8 years of age but most of them got the information about the same at the age range of 9 – 12 years  with 24.1% (n = 59/120) and 31.4% (n = 77/125) for urban and rural schools respectively . The finThe findings also indicate that most of the participants in both urban and rural schools got the information on HIV/AIDS and talk about it mainly from the friends  . HoweverYES, that HIV has cure, 50.0% (n = 16/32) in both urban and rural schools reported that antiretroviral (ARVs) drugs can cure it which is misleading. About 28.2% (n = 9/32) with 21.9% (n = 7/32) and 6.3% (n = 2/32) of the study participants in both urban and rural schools respectively reported that it can be cured abroad. The findings also show that 15.6% (n = 5/32) of the participants with 12.5% (n = 4/32) and 3.1% (n = 1/32) in both urban and rural schools respectively reported that it can be spiritually cured. The participants in urban schools also reported that it can be cured if transmitted to other people   with 30.2% (n = 74/120) and 31.8% (n = 78/125) in urban and rural areas respectively reported that there is no cure for HIV/AIDS whereas 13.1% (n = 32/245) reported that there is cure and 24.9% (n = 61/245) reported that they were not sure if it is cured. In both the urban and rural schools, there was no difference in the participants’ responses on whether HIV/AIDS can be cured or not or not sure . The fin = 2/32) . This mi = 2/32)  since mabeing rich” sometimes is a risk factor to HIV infection since such individuals usually have multiple sexual partners hence increasing the risk of getting infected and this is a myths as reported in previous study [The study findings show that 54.7% n = 134/245) of the study participants, with 24.5% (n = 60/120) and 30.2% (n = 74/125) in urban and rural schools respectively reported that sometimes it is possible physically to recognize if someone has HIV/AIDS. And 34.3% (n = 84/245) with 19.2% (n = 47/120) and 15.1% (n = 37/125) of the participants in urban and rural schools respectively reported that it’s impossible to physically recognize if someone has HIV/AIDS. About 11.0% (n = 27/245) with 5.3% (n = 13/120) and 5.7% (n = 14/125) in urban and rural schools respectively reported that it is always possible to physically recognize if someone has HIV/AIDS . And for/245 of tus study . And usuOn the chances of getting HIV infection, 39.2% n = 96/245) of the study participants with 20.4% (n = 50/120) and 18.8% n = 46/125) in urban and rural schools respectively reported that it is impossible to get HIV infection. About 31.0% (n = 76/245) with 15.5% (n = 38/120) and 15.5% (n = 38/125) in urban and rural schools respectively reported that the chance of getting HIV infection is minimal especially if precaution are taken in relation to sexual activities with individuals who may be infected with the HIV. About 18.4% (n = 45/245) of the study participants with 8.6% n = 21/120) and 9.8% (n = 24/125) in urban and rural schools respectively reported that the chance of getting HIV infection is high especially if someone engages themselves in a reckless life and having so many sexual partners. About 11.4% (n = 28/245) of the study participants with 4.5% (n = 11/120) and 6.9% n = 17/125) in urban and rural schools respectively reported that the chance of getting HIV infection is moderate especially if precautions are taken by the individuals . The fin of the s/120 and  in urban/125 in uOn the views of condom use, 41.6% n = 102/245) of the study participants with 20.4% (n = 50/120) and 21.2% n = 52/125) in urban and rural schools respectively reported that condom use reduces sexual pleasure. About 34.3% (n = 84/245) participants with 18.0% (n = 44/120) and 16.3% (n = 40/125) in urban and rural areas respectively reported that using the condoms is a sign of mistrust. About 18.8% (n = 46/245) participants with 9.8% (n = 24/120) and 9.0% n = 22/125) in urban and rural schools respectively reported that condoms are embarrassing to buy. And 2.9% (n = 7/245) participants with 0.8% (n = 2/120) and 2.1% (n = 5/125) in urban and rural schools respectively did not agree with all the above which their fellow participants had reported . However/125 in u in urban5 of the The major limitation of the study was that some participants’ responses were inaccurate in relation to the question asked. Also the study was conducted during school time when students are supposed to be in class and this somehow created some inconveniences among the school staff.The study findings showed that there was no gender difference among the secondary school participants in both urban and rural areas in Kampala and Buikwe districts respectively. Most of the participants were mainly Anglican, Catholics and Moslems and they had a mean age of 15.9 ± 2.5 years. Majority of the participants were aware of HIV/AIDS but there was knowledge gap on the modes of HIV transmission and prevention. The participants were aware of the ABC strategy for HIV prevention and most of the information on the HIV/AIDS was got from the friends. A sizeable number of the participants reported that HIV had no cure though some reported that it could be cured by spiritual healing or when transmitted to others and that it could be cured abroad. A number of participants reported that they could recognize one who had HIV/AIDS and they mentioned that being sickly, red lips, weight loss, skin rash and also “being very rich” were major signs. A proportion of the participants reported that they couldn’t contract HIV at all. Participants had negative attitude on condoms and condom use and they reported that condoms reduced sexual pleasures, that condom use was a sign of mistrust and that they were embarrassing to buy. This reduces the potential of participants to use condoms and hence ends up having risky sexual behaviors. Generally, participants had some knowledge on HIV/AIDS though they had knowledge gap on HIV transmission and prevention.


Background: Chronic lymphocytic leukemia (CLL) is one of the most prevalent adult leukemias. This malignancy is known by lymphocytosis for a duration of more than 3 months. In fact, it is a heterogeneous clinical disease with changeable progression. Chromosomal aberrations are significant parameters to predict result and survival rate and find treatment strategies for each patient. Cytogenetic methods are known as sensitive and relatively new procedures to detect abnormalities in genome.Materials and Methods: In order to identify CLL-related chromosomal abnormalities, 48 CLL patients included 38 Men and 10 Women with mean age of 58.25±36 were enrolled in this case series study.The survey was done at Cancer Molecular Pathology Research Center, Mashhad University of Medical Sciences. Interphase fluorescent in situ hybridization (I-FISH) was done on unstimulated peripheral blood or bone marrow samples, which were cultured in whole medium culture; it was used to detect chromosomal abnormalities such as 11q- , 13q14-, 17p- , 6q- and trisomy 12 in CLL patients.Results: Analysis demonstrated that 45.5% of CLL cases had chromosomal abnormalities; 13.63% haddel 17p, 40.90% had del 13q14 and 9.09% had del 11q. Statistical analysis of data revealed a significant relevancy between age variable and splenomegaly occurrence . The younger the patients were, the less the splenomegaly occurrence.Conclusion: Laboratory findings were correlated with clinical data.  Acquired chromosomal aberrations play a significant role in CLL pathogenesis. CLL is represented by a comparative stable genome in contrast with other malignancies or solid tumors5. Chronic lymphocytic leukemia (CLL), which includes more than 30% of adult leukemias, is one of the most prevalent adult leukemias in western world9 per liter) for a duration of more than 3 months6. Among all known clinical features; lymphadenopathy, organomegaly, fever and fatigue have been detected as the most prevalent symptoms in CLL4 though 25% of patients are asymptomatic6.This malignancy is recognized in patients  by lymphocytosis , ZAP-70, chromosomal aberrations and complex karyotype, are considered as prognostic markers 6,9. The most recurrent chromosomal abnormalities are partial loss of one chromosome, such as deletions on 6q, 11q, 17p and 13q, gains of whole chromosome such as trisomy 1218. One particular study mentioned that specific cytogenetic abnormalities like 11q or 17p deletions are presented with poor clinical outcome, moreover, mutations in certain genes such as TP53 are responsible for poor prognosis. New studies which use next generation sequencing (NGS) technique have identified new gene aberrations such as NOTCH1 and SF3B1 mutations like BIRC3 disruptions that may lead to some clinical heterogeneities5.Chromosomal changes have been reported in 40-50% of CLL patients2waldensterommacroglobolinemy (MW), acute lymphocytic leukemia (ALL), and mantle zone lymphoma (MZL) which can be helpful in malignancies prognosis. Chromosomal aberrations are significant parameters to predict result, survival rate, and find treatment strategies for each patient1,3.Del 6q is seen in lymphoid malignancies such as multiple myeloma (MM),19. In 1990, Tuliusson et al used conventional cytogenetic techniques to determine the role of chromosomal abnormalities in the prognosis of malignancies. More than 50% of CLL patients had clonal chromosomal abnormalities in this karyotype banding analysis5. More than 30 years ago before propagation of molecular methods, no chromosomal changes were assumed, but nowadays their prognostic roles are approved12. Further advantages of this method have been mentioned in the discussion part of current manuscript.In 2000, Dohner et al. introduced Interphase fluorescent in Situ Hybridization (I-FISH) technique as a method to detect chromosomal abnormalities. This technique detected chromosomal disorders in 80% of patients The aim of this study was to detect cytogenetic abnormalities of CLL patients by I- FISH method, and determine the relevance of clinical signs and genomic types of abnormalities in North-East of Iran.9 /L in peripheral blood or bone marrow, and positive markers of CD5, CD19, CD20 and CD23 as the results of immunophenotype study. This case series study was conducted at Cancer Molecular Pathology Research Center, Mashhad University of Medical Sciences during 2014-2016. All studied individuals were new cases and had not taken any treatment. Forty-eight CLL patients including 38 men and 10 women with mean age of 58.7±5 and 64.9±1, respectively were enrolled in this case - series study. CLL diagnosis was done by two expert hematopathologists based on the following criteria: lymphocytosis of 5× 10Conventional cytogeneticPeripheral blood or bone marrow heparinized specimens were cultured in 5 ml completeculture medium consisting of RPMI-1640 medium (Gibco-USA) supplemented with 10% fetal bovine serum , 1% penesterep antibiotic  and 1% L-glutamine  . The cultured samples were incubated in 37°C for 24 hours without any mitogens.Harvesting and slide preprartion were done according to the standard cytogenetic methods  (0.075 M KCL). Treatment and fixation were done using Carnoy's fixative. Six slides were prepared for each cultured sample. FISH analysis was done for all slides.Interphase fluorescent in situ hybridization20. Olympus BX41 florescence microscope (Japan) and video test software (version 3.1) were used for imaging procedure and the results were reported according to ISCN 2013. To indicate del 17p13, del 13q14, del 11q22, del 6q21 and trisomy12, dual-color probes and their control probes were purchased from Kreatech Company and were used according to the manufacturer’s instructions. The control probs were as follows: Chromosome 12 centromere for trisomy 12, 13q14 (DLEU) for 13q34 and reverse, centromere 17 for 17p13 deletion (p53) centromere11 for 11q22 (ATM) and centromere 6 for 6q21. Slides and probes were co-denatured at 77°C with thermo-rite  and hybridized at 37°C for 16 hours. A total of 200 nucleuses were counted to determine cut-off values for FISH analysis according to the Smoley's research. The upper limits of normal cut off were set at 6% for 6q- , 2%, 0.5, 2 and 5% for 11q- , +12, 13q14 and 17p- , respectivelyStatistical analysisThe data were analyzed using SPSS package .P values less than 0.05 were considered statistically significant. Forty-eight samples obtained from patients were analyzed using cytogenetic culture and FISH technique. Sex ratio was 4.5 . Patients were 45 to 71 years old with mean age of 58.7±5 and 64.9±1 in male and female groups, respectively. Laboratory findings are cited in I- FISH was done for del 17p, del 13q14, del11q, del 6q and trisomy 12 on 24-hour unstimulated culture. Analysis demonstrated that 20 out of 48 male patients do not have any chromosomal aberrations. 13.63% of cases had del 17p, 40.90% had del 13q14 and 9.09% had del 11q , 2 and 337.50% of lymphadenopathies were seen in more than one site. Cervical lymphadenopathy was the commonest type among patients. Spleen assessment demonstrated splenomegaly in 54.54% of cases. The youngest patient, 45 years old, had no lymphadenopathy and splenomegaly; no chromosomal changes were seen in this case. WBC count was the highest in del 13q14, but the lowest count was seen in del11q. The highest hemoglobin concentration was seen in cases with del 17p, while anemia was more obvious in cases with del13q14. It is necessary to note that only one patient who was a 65-year-old female had del13q14 and del17p abnormalities together.It is evident that not only confidence interval for hemoglobin concentration is broader in men but also the reduction is more common in men. More clinical and laboratory information are presented in In an effort to evaluate clinical signs, Rie staging was determined for patients, but due to limited information on sites of lymphadenopathies, Binet staging was not defined. Clinical and laboratory findings of whole patients are described in  Cytogenetic methods are recognized as practical methods to detect chromosomal abnormalities. There are two reasons for using I- FISH for B- CLL diagnosis; first, long deletion sites in chromosomes makes it impossible to design a primer and to perform RT - PCR; second, B cells did not stimulate as well as T Cells in culture, and a proper karyotype will not be gained. Because of these restrictions, I FISH is a practical technique to detect chromosomal disorders in B-CLL malignancies.4,9. Some aberrations can affect clinical course and disease outcome. It's believed that chromosomal abnormalities can be available as prognostic markers6, 9, 13, 14,16. As mentioned earlier, CLL chromosomal aberrations can be detected in more than 80 % cases4. Similarly, we had 19 men and 5 women in the present study (ratio 3.8).Gender ratio is in favor of male, since, many B-CLL patients are men in Teimori et al’s study and women were unwilling to take part in their study is the reason5. In two other studies conducted by Calin et al (2002) and Klein et al (2010) deletion of 13q14 region associated with favorable prognosis was detected in relatively 50% of CLL patients. MiR-15a and miR16-1 are located in this deleted region and have been described to affect tumor suppressor activity of CLL21,22. Alongside these microRNAs, other genes such as DLEU7 are located in 13q region. It can impress tumor suppressor activity and different clinical courses of disease. Overall, 13q deletions induce biological heterogeneity of CLL cases; it has been proved by gene expression profiling and miRNA analysis23,24. In the current study, like other surveys we detected del13q14 in 40-90% of patients. Based on the obtained results, WBC count was high among del13q14 patients (P>0.05), anemia was more obvious among del13q patients and del13q14 was higher in women (60% vs. 31.56%).Del 13q34 and 13q14 are known as the most common types of abnormalities in studied population of Berkova's research. Our results is similar to the mentioned findings10. Meanwhile, normal karyotype frequency was 41.66% among our studied population, while it was 18% in Hartmutet al.’s study 6. Contrary to Hartmut Dohner's findings, none of the patients with del13q14 had splenomegaly (it was observed in more than 50 % of Hartmut's study participations with mutation noted above) the lymphadenopathy occurred mostly in cervical lymph nodes, and most of lymphadenopathies were observed in abdomen site6,25,26.The minimal deleted region including 11q22 ATM gene has been studied frequently in cases of CLL with del(11q), but it has been detected in 8-30% of 11q-patients27.This finding shows that other genes have important role in 11q deletions. One of these genes is BIRC3, which is located near ATM gene28. However, the study by Rose-Zerilliet et al. indicates that ATM mutations compared to BIRC3 deletion, are more effective on progression-free survival and overall survival in 11q-deleted patients who are treated with first–line therapy29. CLL patients with del(11q) are identified by large and multiple lymphadenopathies and have poor prognostic factors such as unmutated IGHV genes. Although Patients with del11q have generally accelerated disease progression, chemo immunotherapy treatment may overcome the adverse prognostic impacts of del11q on untreated patients30.Moreover, 9.09% of our study participants with del11q and the lowest WBC count had cervical lymphadenopathy.Deletion of the long arm of chromosome 11 is seen in 5-20% of CLL patients6. Frequency of this anomaly is nearly 10-20%, which is similar to the results achieved by our study (13.63%).As it has been discovered, ATM is affected by Del 11q22-q2331.In another study, it was detected in 30% of patients32-33.Deletion of short arm of chromosome 17 is one of the most common acquired abnormalities which is frequent after treatment, and can also be seen in other hematologic abnormalities such as diffuse large B-cell lymphoma, non-Hodgkin's lymphomas or mantle cell lymphoma5. CLL patients with 17p deletion are classified into the highest-risk group having the shortest overall survival. According to the clinical point of view, new studies show clinical heterogeneity in 17p CLL patients based on manifestations of this abnormality as an early event (de novo) ,or most frequently, as a secondary change34. Patients with an early del17p have shown longer overall survival, but those with acquired 17p have significant decreased survival35. Patients with del17p have unusual immunophenotype with strong CD20, CD79b, FMC7, surfaceIg, expression of CD38, ZAP70, and unmutated IGHV. The above-mentioned factors suggest poor prognosis in cases del17p36-38. Similarly, in our study, patients with del17p have also atypical immunophenotype with higher intensity of CD20 and CD19.Deletion of 17p is observed in 3-8% of CLL patients in Delgao’s study39. It seems that this difference is due to frequency of studied population.Baliakas et al. evaluated 1001 European CLL patients; of who 65% had aberrant karyotype. Chromosomal translocations such as 13q, 14q, 18q, 17p, 5q and 11q were assessed. They were reported in 32% of studied individuals; of whom 71.87% had just one aberration and 22.08%, 4.37% and 1.56% had 2, 3 and40. Other studies have reported that patients with anomaly of short armof chromosom17 will inactive a tumor suppressor protein, p53, which affects disease prognosis. It has been reported in 5.2% of cases studied by Berkova in Czech in 200915, and 9.09%of cases in this study. These mentioned mutations are not rare and result in disease progression41,42.One study suggests that allogeneic stem cell transplantation is the best strategy for patients with del17p, who are not in complete remissionStatistical analysis of our patients’ data revealed a significant correlation between age and splenomegaly . According to the results of this study, splenomegaly is less frequent in younger patients. There was a significant correlation between chromosomal changes and age in such patients . I-FISH is known as the gold standard manner to assess genomic changes in B-CLL, and is more time- saving in laboratory usage, especially in clinical diagnosis procedures. As mentioned earlier, 13q14 deletion was the most common abnormality and normal karyotype was the less frequent type among our studied populations. It is suggested to perform similar study on B-CLL cases in a larger population to discover between patients' age and chromosomal aberrations. One of the limitations of this study was IGH mutation which is necessary to apply as a discriminative tool for CLL and mantel cell lymphoma.


Staphylococcus aureus and antimicrobial susceptibility patterns among janitors working at Mekelle University, Tigray, Northern Ethiopia.The objective of this study was to determine the prevalence of methicillin-resistant S. aureus and MRSA in the present study were 17.97% (69/384) and 6.25% (24/384) respectively. Although not statistically significant, the prevalence of MRSA among janitors working in the medical area  was two times higher than the non-medical area . Janitors who had more service year and who were unable to read and write were found with high isolates of MRSA. Nasal carriage of MRSA among janitors who work in the hospital and who were hospitalized in the last 3 months and those who had exposure to wastes and body fluids were 13 (37.1%) and 10 (38.5%) respectively. Majority of the isolates of S. aureus were sensitive to ciprofloxacin , doxycycline , erythromycin , chloramphenicol  and cefoxitin . Sixty-seven of the 69 (97%) were resistant to penicillin. Of the 69 isolates of S. aureus, 22 (31.9%) showed multidrug resistant. Fourteen were resistant to three antimicrobials, 2 were resistant to four antimicrobials, and 7 were resistant to five antimicrobials.The overall prevalence of  Staphylococcus aureus, a Gram-positive spherical-shaped bacterium, predominantly colonizes the skin and nasal mucosa of healthy individuals globally [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC172932) [S. aureus occurs mostly through contact with fluids from infected skin abrasions [S. aureus range from simple skin infections to fatal bacteremia and pneumonia [S. aureus contributes to one-third of surgical site infections and close to a quarter of ventilator-associated pneumonia [S. aureus skin and soft tissue infections associated hospitalization has increased from 39 to 51% in hospitals of USA [globally . Approxineumonia . BetweenS. aureus (MRSA) first recognized from hospitalized patients in 1960 [With the emergence of methicillin-resistant  in 1960 , the tre in 1960 . Until 1 in 1960 –13 setti in 1960 . In Paki in 1960 . The nas in 1960 .S. aureus and MRSA respectively [S. aureus and MRSA respectively [Thirty-four (28.8%) and 15 (12.7%) healthcare workers in Dessie-Ethiopia had their anterior nares colonized with ectively . Eighty-ectively .At Mekelle Hospital-Ethiopia, the nasal and hand carriage of MRSA among healthcare workers was 20.3% .In Ethiopia, as to our knowledge, despite its importance, there is no published data that indicates the prevalence of MRSA and antimicrobial susceptibility patterns among janitors of any institution.Therefore, this research project assessed the prevalence of MRSA and its antimicrobial susceptibility patterns among janitors working in Mekelle University; with a view to providing information to aid the design of appropriate prevention strategies.Mekelle University is one of the largest Universities in Ethiopia. It has more than 30 thousand first-degree, second-degree and third-degree annual students in the five campuses . It condA total of 384 janitors  were recruited to participate in the study. The sample size was calculated using single proportion formula . Simple random sampling technique was used to select 384 study participants. Study participants who had nasal bleeding at the time of data collection were excluded because rolling of swab may aggravate bleeding.Trained data collectors were recruited to collect the socio-demographic, clinical and other factors from consenting participants using a standardized questionnaire. The questionnaire could be self-administered (for literate participants) or interview-administer (for participants unable to read and write their mother language).S. aureus was confirmed by golden yellowish colonies, Gram stain and a biochemical test using slide coagulase test [Using aseptic procedures, trained study assistants took nasal swab samples from both anterior nares of the study participants which were transported to Mekelle University College of Health Sciences department of medical microbiology laboratory within 30 min of collection. Upon arrival, specimens were inoculated on to Mannitol salt agar  and incubated at 37 °C for 24 h. After incubation, the presence of ase test , 22.S. aureus were subjected to antimicrobial susceptibility tests using the Kirby Bauer disk diffusion method as described by CLSI [S. aureus were picked from the nutrient agar to make a suspension that was standardized to 0.5 McFarland standards. Using sterile applicator cotton swab, standardized suspensions were swabbed on to the Muller Hinton agar. The antimicrobial discs were placed then on the Muller Hinton agar within 20 min using aseptic technique. The Muller Hinton agar plates were incubated at 35 °C for 18 h. After this, the diameter of the “zone of inhibition” around the antibiotic discs was measured using calipers and reported as sensitive, intermediate and resistance [Isolates identified as  by CLSI . Six antsistance –23.S. aureus was confirmed by 30 μg cefoxitin disc. A “zone of inhibition” of ≤ 21 mm was considered as methicillin-sensitive and a “zone of inhibition” of > 22 as methicillin-resistant.Methicillin resistance S. aureus, ATCC-25923) and negative controls (Escherichia coli-ATCC-25922) [Each lot and shipment of the medium was checked for expiration dates prior to use as part of quality control. The performance of the media and antibiotic discs were evaluated using positive controls  years and all (100%) were female. The majority  were aged 18–24 years. The majority were single (81.8%), had attained a high school education; grade 9–12 (53.1%) and lived with children aged < 15 years (52.6%).Majority (63%) had served as a janitor for less than 1 year, in a non-medical area (73.1%), did not suffer from allergic rhinitis (95.3%), had not had a skin infection (97.1%), nor a wound infection (94.8%), nor been hospitalized (64.3%) in the 3 months preceding the interview. The majority (73.2%) reported no history of exposure to waste and body fluids (Table S. aureus was cultured from 69 (17.97%) of the samples. Of the 69 isolates, 25.2% (26/103) were recovered from janitors that worked in medical areas and 15.3% (43/81) from those that worked in non-medical areas of the University  were among janitors working in medical areas where as 14/43 (32.6%) was working in non-medical areas. The overall prevalence of MRSA was 6.25% (24/384) (Table Among participants with positive isolates (n = 69), 24 (34.8%) had methicillin resistant S. aureus isolates were subjected to antimicrobial susceptibility tests against seven antimicrobials. Majority of the isolates of S. aureus were sensitive to ciprofloxacin , doxycycline , erythromycin , chloramphenicol  and cefoxitin . Sixty-seven of the 69 (97%) were resistant to penicillin. About one-third 24 (34.8%) of the isolates were resistant to cefoxitin. Of the 45 methicillin susceptible S. aureus, 2 (4.4%), 5 (11.1%), 6 (13.3%), 6 (13.3%) and 43 (95.6%) were resistant to ciprofloxacin, doxycycline, erythromycin, chloramphenicol, and penicillin respectively  isolates showed MDR. Fourteen were resistant to three antimicrobials, 2 were resistant to four antimicrobials, and 7 were resistant to five antimicrobials ; among participants that had served as janitors for more than 2 years compared to those who had served for less than 1 year and for between one and 2 years (62.5% vs. 39.5% and 11.1% respectively)  and 10 (38.5%) respectively (Table S. aureus and MRSA in this study were 69 (17.97%) and 24 (6.25%). This is lower than the study carried out among hospital personals in Pakistan [The overall prevalence of Pakistan  and schoPakistan , but simPakistan .Staphylococcus aureus was found to be colonized in 26 (25.2%) janitors working in medical and 43 (16%) in non-medical area, whereas MRSA revealed from 10 (9.7%) in medical and 14 (4.9%) non-medical area. This is higher than the study carried out in Taiwan [Above 85% of the janitors working in the university were youth (18–24 years). The other below 15% was above 24 years and was found to be with high carriage of MRSA 4 (40%). This is comparable with the study among prisoners in Jimma-Ethiopia . Above 7None of the participants were presented with underlying diseases except eighteen participants with allergic rhinitis and one of whom having allergic rhinitis had MRSA which is not statistically significant. This is different from a study conducted in Taiwan . JanitorMRSA isolates were 100% resistant to penicillin and cefoxitin which is similar to the study reported from Jimma . 24 (100Six of the isolates of MRSA (8.6%) were resistant to five antimicrobial drugs and the resistant patterns were cefoxitin/erythromycin/doxycycline/penicillin/chloramphenicol.S. aureus was isolated from both medical and non-medical area. Even though there was no statistically significant difference, the proportion of MRSA isolated from the medical area was two times higher than the non-medical area. Participants who were unable to write and read and those who have at most service year were presented to acquire more MRSA and have the statistically significant difference.Methicillin-resistant More than 30% of confirmed MRSA isolates were resistant to most of the antimicrobial drugs tested in the present study; however, no resistance was recorded from ciprofloxacin.Janitors who were unable to write and, having more services and serving in the hospital should get awareness on the impact of MRSA and its transmission especially in relation to the hospital patients during cleaning of in-patient rooms.This study limited to conduct the MRSA gen as well as some additional antimicrobial agents.


This study tested the hypothesis that slightly increased BMI at young age is a risk factor for future hypertension in Japanese men by historical cohort study.Hypertension is developed easily in Asian adults with normal body mass index (BMI)  which included 17,059 person-years of observation. Subjects were 22 (22–22) years old at graduated college, and 49 (45–53) years old at first follow-up investigation. During the period, 120 men developed hypertension. The prevalence rates of hypertension for lowest to highest BMI categories were 9.4%, 14.6%, 16.1%, 17.5%, 30.3%, and 29.3%, respectively (p<0.001 for trend), and their hazard ratios were 1.00 (reference), 1.80 (95%CI: 0.65–4.94), 2.17 (0.83–5.64), 2.29 (0.89–5.92), 3.60 (1.37–9.47) and 4.72 (1.78–12.48), respectively (p<0.001 for trend). This trend was similar after adjustment for age, year of graduation, smoking, current exercise status and current dietary intake.Slightly increased BMI at young age is a risk factor for future hypertension in Japanese men. In addiucasians , 8. For ucasians .2) in middle age (around 50 years old) is recognized as a risk for development of hypertension in Asians [2) also increases the risk of hypertension later in life.In contrast, in Asian countries, the prevalence of overweight subjects at young age is very low and most of patients with hypertension have normal weight . Howevern Asians –15. Howe2) within the normal range at 20 years of age increased the risk of future hypertension in Japanese[Only two studies addressed this research question. Heianza et al. reported that a slight increase in BMI . All data were anonymized before analysis to ensure privacy of the participants. Along with the questionnaire, we sent a letter of informed consent approving the collection and use of the athletic test data for research purpose. This study was carried out in accordance with the principles outlined in the Declaration of Helsinki.2) and used for each analysis.This college undergo standardized medical and physical examinations annually since 1971. We used the height and body weight recorded in the physical examination conducted at the college student. Then, average BMI during college student was calculated as weight in kilograms divided by the square of height in meters . Before the primary analysis, we performed preliminary analysis after categorizing the participants into quartiles  by BMI at college age to see the rough trend of the association between BMI at young age and hypertension. We defined the lowest BMI group (Q1 or BMI<20.0 kg/m2) as the reference category. The cumulative incidence rate of hypertension according to the BMI categories was compared by χ2 test. Hazards ratios and 95 percent confidence interval (95% CI) relating BMI to risk of hypertension were constructed with the Cox proportional hazards analysis. The unadjusted and multivariable-adjusted relative risks were computed. In the Model 1, the adjusted data included age , year of graduation , and smoking . In addition, several factors in middle age, such as low physical activity and over nutrition were reported as risk factor of elevated blood pressure [For primary analysis, the participants were categorized for six categories , Q2: 21.5 , Q3: 22.4  and Q4: 23.9 . The median BMI for all study participants and for each category were within the normal range, while 36 participants (5.7%) were overweight (BMI ≥25 to <30 kg/m2) and only five (0.8%) were obese (BMI ≥30 kg/m2). Almost all of the participants had participated in a college sports club. Highest BMI group (Q4) was high percentage of individuals who participated in power sports, on the other hand, lowest BMI group (Q1) was high percentage of individuals who participated in endurance sports. The percentages of smokers was comparable among the groups.Before the primary analysis, we performed preliminary analysis after categorizing the participants into quartiles  by BMI at college age . Median The follow-up period of this study was 27-year (interquartile range: IQR: 23–31 years), which included 17,059 person-years of observation. The median age at the time of the follow-up questionnaire was 49 years (IQR: 45–53 years), where 120 men had developed hypertension, with unadjusted cumulative incidence of hypertension of 18.9%.To examine the relationship between BMI and development of hypertension, we evaluated the rate of incidence and hazard ratios in the Q1 , Q2, Q3 and Q4 (highest BMI group). The prevalence rates of hypertension in Q1 to Q4 were significantly different among the groups, the highest BMI group included the highest rate of hypertension. Compared with men in the lowest group of BMI (Q1), men in the highest group of BMI (Q4) were at 2.5 times increased risk of hypertension . The tre2), men in the BMI category of 23-24kg/m2 or over 24kg/m2 had ~3 or ~4 times higher risk of hypertension, respectively , while only 37 participants (5.8%) were overweight (BMI ≥25.0 to <30.0 kg/m2) and only five (0.8%) were obese (BMI ≥30.0 kg/m2). In these subjects, we found BMI ≥23kg/m2 at young age might be cut-off value of increased risk of future hypertension. This cut-off value was similar to previous report showing that subjects with BMI ≥23kg/m2 at 20 years old have ~2 times higher risk of hypertension in middle age, compared with subjects with BMI <23.0 kg/m2 [Our results demonstrated that for Japanese male college athletes, slightly increased BMI at young age is a risk factor for future hypertension. Median BMI of this study participants was 22.0kg/m.0 kg/m2 .What is the mechanism through which the normal BMI at young increases the chance of hypertension in later life? Although our study did not investigate the exact mechanism, background data may help in the interpretation of our results. At least in adults, the body composition profile of Asians differs from that of Caucasians and African-Americans. Asians have a higher body fat content and more visceral adipose tissue, compared with Caucasians and African Americans of similar BMI , 27, 28.The present study has several limitations. First, the participants are not representative of all Japanese men and small cohorts. The study subjects were alumni of only one university department and almost all subjects were former college athlete, although they came from all over Japan. In addition, female alumni were not included because they were not registered at the college in 1971. Second, alumni without data of either the physical examination while at college or follow-up questionnaire were excluded. These exclusions limited the generalization of the results. Third, self-selection bias could have occurred because the participants who answered the follow-up questionnaires may have been those who were the healthiest. Finally, recall bias was possible because the questionnaire was cross-sectional and participants needed to recall their medical background. However, our previous studies have used the same method–20 and eIn conclusion, our data suggested that the slightly increased BMI at young age is a significant risk factor for future hypertension in Japanese men.


Papillomaviridae family. The prevalence of HPV genotypes may vary according to the region and the population studied. Quilombo communities are ethnic and racial groups with difficult access to health services compared to the general population in Brazil. The aim of this study was to identify specific HPV types correlating with sociodemographic/behavioral characteristics and cervical smear cytological abnormalities in Quilombola women.Human papillomavirus (HPV) is a member of the Linear Array HPV Genotyping Test kit by Roche Molecular System®. The association between HPV types and cytological diagnosis was investigated according to the different age groups.This cross-sectional study included 395 Quilombola women users of the Unified Health System of the Municipalities of Maranhão for the screening of cervical cancer. The samples were analyzed for the presence of cytological abnormalities by conventional methods and tested for 37 HPV genotypes using polymerase chain reaction with primers PGMY09/11 followed by reverse line blot hybridization performed with the HPV infection was detected in 12.6% (50/395) of the women. Infections by high-risk HPV types were more frequent. Genotypes 68 (26.0%); 58 and 52 (20.0%); 31 (10.0%) and 62 (8.0%) were the most prevalent. The highest prevalence (42.0%) of HPV infection occurred in women diagnosed with high-grade squamous intraepithelial lesion. There was a statistically significant association between HPV infection and the detection of cytological abnormalities in all age groups except in women over 60 years. There was a statistically significant association between the municipality of origin and the number of partners with HPV infection.It is important to incorporate new cervical cancer screening techniques incorporating the cervical-vaginal cytology. For further studies, it is necessary to determine the level of knowledge of Quilombola population on health-related issues including HPV infection and cervical cancer. This will contribute to the continuous improvement of healthcare coverage among the population and enhance the implementation of cancer care in the state of Maranhão. Cervical cancer (CC) is the third most common cancer among women worldwide, with approximately 528,000 new cases per year, being responsible for the death of 266,000 women each year . AccordiPapillomaviridae family, genus Papillomavirus. It is an icosahedral virus, non-enveloped, and about 55 nm in diameter. The genome consists of a double-stranded circular DNA, containing approximately 7900 base pairs ’ (ASC-H), 11 (33.3%) women with ‘ASC-US, 10 (30.3%) women with HSIL, and 7 (21.2%) women with LSIL.p < 0.001).The overall prevalence of HPV was 12.6% (50/395). In Table Among the HPV types, the most prevalent genotypes were 68 26.0% - 13/50), 58 and 52 with 20.0% (10/50) each, 31 (10.0% - 5/50) and 62 (8.0% - 4/50). Only 6.0% (3/50) of the cases were positive for HPV-61  compared with the low oncogenic risk type (22.0% -11/50). Among those diagnosed with an abnormality, the prevalence of HPV infection was 24.0% (12/50). The highest prevalence was reported with HSIL (42.0%), followed by LSIL (21.0%) and ASC-US (21.0%). In all diagnoses, simple infections were more frequent than multiple (Table 9/50 compp = 0.02), 31–40 years (p = 0.0009), 41 to 50 years (p = 0.03) and 51 and 60 years (p = 0.0003). Only among HPV-positive women, aged over 60 years, were there no statistically significant association with the detection of cytological abnormalities (p = 0.12).Table p < 0.0001). The remaining sociodemographic variables  showed no significant association with HPV positivity.In Table p = 0.01).The behavioral predictors of HPV, at the univariate level, are shown in Table In Brazil, the Black population experience higher cancer mortality rates compared to the general population. This is probably a consequence of inequities in the social, economic, political, and health factors. This population is faced with unequal experiences at birth, in life, during illness and in death . QuilombThe overall prevalence of HPV can vary depending on the technique used, as well as the population and the region studied. In this study, the prevalence of HPV infection in Quilombola women was 12.6% by hybridization technique. Different results were found in various studies including Akarolo-Anthony et al. (2014), which showed an overall prevalence of 37% in Nigerian women , and WatSome women had multiple HPV infections in this study, and these occurred more frequently with HPV 68, with a total of 71 HPV types among HPV positive women, and among these, 50 (69.4%) were of high oncogenic risk. Of the 25 HPV types found in this study, HPV 68 was the most prevalent (26.0%), followed by HPV 58 and 52 (20.0%) and HPV 31 (10.0%).A study conducted in France showed HPV 16 to be most prevalent, followed by HPV 53 and 31 . Study iGoldman et al. (2013) observed that the presence of HPV 68 occurred at a rate four times higher, than expected, in multiple infections. Thus, this indicates the existence of an interaction between HPVs of high oncogenic risk, especially between types 31/68, 51/68 and 33/58. These authors suggested that some virus genotypes act as co-factors in the infection by other types, demonstrating a new possible risk factor .Considering the prevalence of HPV in women with different cytologic findings in this study, age group (particularly less than 30 years) showed important influence on HPV positivity and the detection of cytologic abnormalities. Thus, these results indicate that HPV testing is useful in women over 30 years, who are more likely to be carriers of significant cervical lesions. According to Akarolo-Anthony et al. (2014), the age group most affected by HPV infection were those aged less than 30 years, while a decline were shown in women over 45 years of age, thus corroborating the findings of this study . In FijiIn a study by Foliaki et al. (2014), the positivity for at least one HPV genotype was 24.0% among 1244 women studied, however, HPV 16 was the most prevalent genotype, while HPV 68 was present in only 3 (0.2%) of the infected women. From the HPV positive cases, 70.1% had only one viral genotype, while 29.9% had multiple infections. HPV genotypes most often involved in multiple infections were of the high oncogenic risk .p < 0.001). Marks et al. (2015) found a much higher prevalence (43.8%) of HPV infection among women diagnosed with inflammation, 36.5% diagnosed with ASC-US, 80.9% of women diagnosed with LSIL and 71.5% of women with the diagnosis of HSIL [Among the 33 women who had cytological abnormalities, 36.4% were HPV positive. Among those diagnosed with inflammation, 10.4% were HPV positive. For ASC-H, ASC-US, HSIL and LSIL, HPV infection rate were 40.0%, 18.2%, 60.0% and 28.2% respectively. There was a statistically significant association between the presence of cytological abnormalities in cervical smears and the presence of HPV  than those of low oncogenic risk (22.0%). This has important implications for the clinical care of women with the high oncogenic risk. For those diagnosed with an abnormality, the prevalence of HPV infection was 24.0%, and was highest with HSIL (42.0%).p < 0.0001). Akarolo-Anthony et al. (2014), in studying Nigerian women, also found no association between sociodemographic factors  and HPV infection [In relation to sociodemographic factors and HPV infection, only the municipality of origin was significantly associated with positivity for HPV (nfection . This map = 0.01). Work carried out in Guinea by Keita et al. (2009) also demonstrated a significant association between the number of partners and HPV infection [In this study, there was significant association with HPV positivity only in relation to the number of partners (nfection .A limitation of the study is the approach used for the collection of data on risk factors used to determine how HPV was acquired and maintained, since the statistical associations were made solely based on the information reported by women. Therefore, another limitation is that the study lacks an adequate comparison group.This study provides a regional estimate on the prevalence of HPV infection among Quilombola women. It highlighted the higher prevalence of HPV type 68. This virus type can contribute to an increase in cervical carcinogenesis related to specific HPV genotypes.It is believed that the findings of this study can foster the development of strategies aimed at enhancing the health of the Quilombola women towards the prevention and management of specific HPV infection in view of the particularities of this group. Greater knowledge, on the part of women, on the mode of HPV acquisition, risk factors and the frequency of HPV infection in different age and population groups are crucial. This is because, such knowledge would contribute to a greater perception of their risk of developing cervical preneoplastic lesions and therefore influence their continued adherence to screening strategies. It may also encourage changes in HPV risk behavior and lifestyle.


Matrix metalloproteinases and tissue inhibitors of metalloproteinases could be promising biomarkers for establishing prognosis during the development of sepsis. It is necessary to clarify the relationship between matrix metalloproteinases and their tissue inhibitors. We conducted a cohort study with 563 septic patients, in order to elucidate the biological role and significance of these inflammatory biomarkers and their relationship to the severity and mortality of patients with sepsis.A multicentric prospective cohort was performed. The sample was composed of patients who had sepsis as defined by the International Conference 2001. Serum procalcitonin, creatinine, urea nitrogen, C-Reactive protein, TIMP1, TIMP2, MMP2 and MMP9 were quantified; each patient was followed until death or up to 30 days. A descriptive analysis was performed by calculating the mean and the 95% confidence interval for continuous variables and proportions for categorical variables. A multivariate logistic regression model was constructed by the method of intentional selection of covariates with mortality at 30 days as dependent variable and all the other variables as predictors.Of the 563 patients, 68 patients (12.1%) died within the first 30 days of hospitalization in the ICU. The mean values for TIMP1, TIMP2 and MMP2 were lower in survivors, MMP9 was higher in survivors. Multivariate logistic regression showed that age, SOFA and Charlson scores, along with TIMP1 concentration, were statistically associated with mortality at 30 days of septic patients; serum MMP9 was not statistically associated with mortality of patients, but was a confounder of the TIMP1 variable.It could be argued that plasma levels of TIMP1 should be considered as a promising prognostic biomarker in the setting of sepsis. Additionally, this study, like other studies with large numbers of septic patients does not support the predictive value of TIMP1 / MMP9. Sepsis is a complex, multisystemic, and variable clinical process, produced by pathogenic microorganisms causing a deleterious systemic response in the host . In the Matrix metalloproteinases (MMPs) are proteinases that participate in Extracellular Matrix (ECM) degradation; the activities of MMPs are accurately regulated at the level of transcription and activation of precursor zymogens . Tissue Matrix metalloproteinases (MMPs) and tissue inhibitors of metalloproteinases (TIMPs) could be promising biomarkers for establishing prognosis during the development of sepsis . SpecifiConsidering this, it is necessary to clarify the relationship between matrix metalloproteinases and their tissue inhibitors (TIMPs). Importantly, given the complex pathophysiology of sepsis, and after many isolated biomarker studies, it is recommended that current studies should take into account a set of biomarkers and their association with severity scales such as APACHE and SOFA and other outcomes . TherefoAn analytical prospective cohort multicentric study was performed, which included for health centers in the city of Bucaramanga (medium size city in Colombia). The ethics committee of the Autonomous University of Bucaramanga  and each of the four participating institutions approved the study, Ethics committee of the chicamocha clinic, Ethics committee of Los Comuneros clinic, and the ethics committee of “Fundación Oftalmologica de Santander/Clinica Carlos Ardila Lulle” (FOSCAL)). The population studied was composed of patients over the age of 18 who had sepsis  for quantification of serum procalcitonin, creatinine, urea nitrogen, C-reactive protein, TIMP1, TIMP2, MMP2 and MMP9; each patient was followed until death or up to 30 days, with a registration of their vital signs and other parameters for calculating APACHE II, SOFA and Charlson scales.Blood samples were obtained from five clinics in the city. Venous blood samples were collected in serum separator tubes and into tubes containing ethylenediaminetetraacetic acid (EDTA).Once the samples were obtained, they were left to stand at room temperature for 30 minutes and subsequently centrifuged at 1000g for 15 minutes. Serum samples were removed and stored at ≤ -20° C. The biomarkers analyses were carried out in the facilities of the Specialized Clinical Laboratory of Bucaramanga and the facilities of the Autonomous University of Bucaramanga.The levels of MMP9, MMP2, TIMP1 and TIMP2 were determined with the use of human Quantikine Immunoassay kits (R & D Systems). The procedure was performed according to the manufacturer's instructions. The functional scale range for the MMP9 assay was set from 0.25 to 16 ng / mL, for MMP2 from 0.78 to 50 ng / mL, for TIMP1 from 0.156 to 10 ng / mL, and for TIMP -2 from 0.156 to 10 ng / mL.ProBNP concentrations were obtained through a quantitative electrochemiluminescence immunoassay designed for use in the Elecsys and cobas immunoassay analyzers. The procedure was performed according to the manufacturer's instructions. The functional scale range set by the manufacturer of the test was 0.02 to 100 ng / mL and its functional sensitivity was 50 pg / mL.ROCHE (electrochemiluminescent assay)—the test "Elecsys BRAHMS PCT, COBAS was used for the quantitative determination of PCT. The procedure was performed according to the manufacturer's instructions. The scale range established by the manufacturer was 0.02 to 100 ng / mL and its functional sensitivity is ≤ 0.06 ng / mL.Clinical data presented by the test indicate that a value lower than 0.5 ng / mL represents a low risk of severe sepsis and / or septic shock and a value higher than 2.0 ng / mL represents a high risk of severe sepsis and / or septic shock.A distribution analysis of the continuous variables was conducted using graphical tests (with the command pnorm in stata13) and it was concluded that continuous variables had an approximately normal distribution. the test used to compare survivors and non survivors was a test of mean difference (performed in stata 13 by the command ttest). A descriptive analysis was performed by calculating the mean and the 95% confidence interval for continuous variables and proportions for categorical variables (Performed in stata 13 by the command prtest).A receiver operating characteristic (ROC) analysis or ROC curve was performed for MMPs and TIMPs as predictors of mortality. Bivariate analysis with univariate logistic regression .A multivariate logistic regression model was constructed by the method of intentional selection of covariates, which is a backwards method described in the book of Hosmer and Lemeshow “Applied Logistic Regression” . initialGraphic tests of the normality of the variables were performed and it was found that the variables followed an approximately normal distribution; therefore, means with their respective confidence intervals were used.In Of the 563 patients, the mean age was 57.6 years, ranging from 18 to 101 years. 52.0% of participants were men (95% CI 48.1–55.8). The mean age of men was 55.9 years (95% CI 53.8–57.9), the mean age of women was 59.5 years (95% CI 57.4–61.5), P = 0.0171. 68 patients (12.1%) died within the first 30 days of hospitalization in the ICU.53.3% (95% CI 42.8–63.5) of non-survivors were men, while 51.7% (95% CI 47.6–55.8) of survivors were men, P = 0.7797. The mean age of non-survivors was 68.5 years (95% CI -71.9 65.1) and the mean age of survivors was 55.9 years (95% CI 54.3–57.5), P = <0.0001.The mean values for SOFA, APACHE and Charlson scores was lower in survivors than in non-survivors, P = <0.001 (1.7 (95% CI 1.5–1.9) vs 4.7 (95% CI 3.8–5.6), 9.4 (95% CI 8.9–9.9) vs 16.8 (95% CI 14.9–18.8) and 1.6 (95% CI 1.4–1.7) vs 2.7 (95% CI 2.1–3.3) respectively).The mean values for C-reactive protein, procalcitonin, creatinine and blood urea nitrogen (BUN) were higher in survivors than non-survivors  vs 166.6 (95% CI 135.2–198.0) P = 0.0142, 6.1 (95% CI 4.6–7.6) vs 11.1 (95% CI 5.6–16.7) P = 0.0289, 1.3 (95% CI 1.2–1.5) vs 1.7 (95% CI 1.4–2.0) P = 0.0550 and 22.4  vs 37.6  P = <0.0001 respectively).The mean values for TIMP1, TIMP2 and MMP2 were lower in survivors than non-survivors (294.8 (95% CI 273.1–316.6) vs 497.5 (95% CI 411.8–583.2) P = <0.0001, 71.8 (95% CI 68.8–74.9) vs 87.3 (95% CI 76.1–98.4) P = 0, 0009 and 229.8 (95% CI 223.3–236. 4) vs 265.7 (95% CI 243.9–287.6) P = 0.0003, respectively), MMP9 was higher in survivors than in non-survivors  vs 651.7 (95% CI 511.1–792.3) P = 0.0002 respectively).The mean values of MMP9 and MMP9/TIMP1 ratio were higher in survivors vs non-survivors and the difference was statistically significant with an alpha of 0.05.No statistically significant differences were found in gender, MMP2/TIMP2 ratio and serum creatinine when comparing survivors with non-survivors at 30 days.The central point represents the mean and whiskers represents the 95% confidence interval.The bivariate analysis was performed using logistic regression with a single independent variable against survival at 30 days. Results shown in The different variables analyzed in the study are shown in A logistic regression model was built with a purposeful selection of covariates  which shCurrently mortality remains very high in sepsis and even more so in septic shock. In addition, diagnosis and course definition are complex due to the multiple factors involved . CurrentMMPs and TIMPs are important in maintaining the balance of extracellular matrices in different tissues . SpecifiOur most prominent results include the finding of predictive values of MMP9 and TIMP1 plasma levels for mortality in septic patients enrolled in this study. It is worth mentioning that the number of patients enrolled in this study is higher than previous ones , 16, 30.These results differ from those of Lorente et al., 2009 , who obsLike our study, other studies , 16, 31 Lorente et al. 2014, found a significant relationship between mortality and elevated levels of TIMP1/MMP9 ratio in the first, fourth and eighth day of the study. Furthermore, they presented three multivariate prediction models of mortality that include TIMP1/MMP9 ratio, diabetes and SOFA score measured at the first, fourth and eighth day .Our study and Wang et al. 2014, which both involve a significant amount of septic patients , didn't corroborate the findings of Lorente et al. 2014, related to the predictive value of TIMP1/MMP9 ratio.Here, we observe in the bivariate model, a significant relationship between MMP9/TIMP1 ratio and mortality, however, in the multivariate model, a significant relationship was not found. Likewise, Wang et al, 2014, didn't find a significant difference between MMP9/TIMP1 ratio values and the different degrees of sepsis severity, or between survivors and non-survivors .Also, the triple model  and a confounding variable (MMP9). Consequently, the predictive significance of both TIMP1 and MMP9 were striking, considering they were even superior to the APACHE II score and procalcitonin (PCT). Similar to ours, the multivariate model by Lorente et al., , showed So what is the biological substrate of these findings? Part of the answer is described in the pathophysiological role of MMP9 in myocardial dysfunction , vasculaTaking everything into account, our study presents a multivariate model with five variables, four significant variables which include TIMP1, and MMP9 as a confounding variable with potential use in clinical practice. Therefore, and considering the size of the patient population and the multivariate prediction model of mortality used here, it could be argued that plasma levels of TIMP1 should be considered as a promising prognostic biomarker in the setting of sepsis. Additionally, this study like other studies with large numbers of septic patients does not support the predictive value of TIMP1/MMP9 ratio. Further studies are required to better define the pathophysiological role of TIMP1 and how it could be a therapeutic target.S1 File(DTA)Click here for additional data file.S2 File(DTA)Click here for additional data file.S3 File(XLS)Click here for additional data file.S4 File(SAV)Click here for additional data file.


The increasing caseload of non-communicable diseases (NCDs) in displaced populations poses new challenges for humanitarian agencies and host country governments in the provision of health care, diagnostics and medications. This study aimed to characterise the prevalence of NCDs and better understand issues related to accessing care among Yazidis and other minority groups displaced by ISIS and currently residing in camps in the Kurdistan Region of Iraq.The study covered 13 camps managed by the Kurdish Board of Relief and Humanitarian Affairs. A systematic random sample of 1300 households with a total of 8360 members were interviewed between November and December 2015. Respondents were asked whether any household members had been previously diagnosed by a health provider with one or more of four common NCDs: hypertension, diabetes, cardiovascular disease and musculoskeletal conditions. For each household member with an NCD diagnosis, access to health care and medications were queried.Nearly one-third of households had at least one member who had been previously diagnosed with one or more of the four NCDs included in this study. Hypertension had the highest prevalence , followed by musculoskeletal conditions , diabetes  and cardiovascular disease . Individual NCD prevalence and multimorbidity increased significantly with age. Of those with an NCD diagnosis, 92.9% (CI: 88.9–95.5) had seen a health provider for this condition in the 3 months preceding the survey. In the majority of cases, care was sought from private clinics or hospitals rather than from the camp primary health care clinics. Despite the frequent access to health providers, 40.0% (CI: 34.4–46.0) were not taking prescribed medications, costs being the primary reason cited.New strategies are needed to strengthen health care provision for displaced persons with NCDs and ensure access to affordable medications. Health care for displaced populations has traditionally focused on maternal and child care and treatment of communicable diseases . While tDuring the summer of 2014, the so-called Islamic State of Iraq and Syria (ISIS) subjugated Nineveh governorate in Northern Iraq. Nineveh has historically been home to most of Iraq’s minority groups, including Yazidis, Assyrian and Chaldean Christians, Sabaean-Mandaeans, Turkmen, Shabak and Kaka’i. As ISIS militants seized cities, towns and villages across the governorate, they systematically attacked civilians based on religious identities, committing mass atrocities and forcing about one million people to flee their homes . Most meTo manage this large population influx, a Board of Relief and Humanitarian Affairs (BRHA) was established in January 2015 as a new governmental body within Duhok’s governmental structure . By the Ensuring access to adequate health services is a persisting concern in BRHA camps. Each camp is equipped with a Primary Health Care Clinic (PHCC) staffed with doctors and medical auxiliaries. These provide preventive and basic curative services under the management of Duhok’s Directorate of Health and partner NGOs. However, most PHCCs lack medical specialists and do not stock medications for NCDs , 7. Thisk was determined as the ratio of camp size to sample size. A random number from 1 to k was used to identified a starting household and every kth household was selected thereafter.This study covered 13 BRHA camps –Bajed Kandala, Bardarash, Bersive, Chamisku, Dawdiya, Essian, Garmawa, Karbato, Khanke, Mamilian, Rwanga, Shariya and Sheikhan– hosting Yazidis and other groups displaced by the ISIS expansion in Nineveh governorate during the summer of 2014. Maps were available for all camps, and all shelters –tents or prefabricated caravans– within camps were numbered. A stratified systematic random sample of 100 households per camp was selected, yielding a total of 1300 households. For each camp, a sampling interval The field team consisted of four pairs of local Yazidi interviewers –one male and one female– and one survey supervisor. The interviewers were given a 3-day training session concerning the questionnaire, sampling methods, data collection using tablets, interview techniques and basic principles of human subjects’ protection. A pilot survey was conducted in October 2015 to finalise the questionnaire and provide the interviewers with the opportunity to practice interviews with the target population. Fieldwork took place in November and December 2015.Interviews were conducted with the household head or a responsible adult in the household. Where possible, efforts were made to involve household adults other than the primary respondent in the interview if questions pertained to them, so as to improve the accuracy of response. The interviewers obtained verbal informed consent from all participants after reading a consent form outlining the purpose of the survey, its confidentiality and the voluntary nature of participation. If no suitable informant was present in the household, an attempt was made to revisit the household later on the same day. In case of non-contact or refusal to participate, the interviewers were instructed to conduct an interview with the household living in the next nearest tent or caravan. To protect the anonymity of respondents, no unique identifiers were recorded.The questionnaire included a specific section on NCDs. Respondents were asked whether any household members, including both children and adults, had been previously diagnosed by a health provider with one or more of the four most common NCDs in the region: hypertension, diabetes, cardiovascular disease and musculoskeletal conditions –11. The Data were collected with tablets using the Magpi platform . The analysis was performed using Stata 14 , adjusting for sampling design . The preOf the 1300 selected households, 93 7.2%) were replaced with households living in the next nearest shelter because a responsible adult was absent (6.5%) or refused to participate in the survey (0.7%). The interviewed households included a total of 8360 members (Table % were rep < 0.001). The most commonly diagnosed conditions among older adults were hypertension and musculoskeletal conditions. Hypertension prevalence rose from 4.4% (CI: 3.2–5.9) among those aged 30–44 to 23.9% (CI: 19.8–28.5) among those aged 45–59, and reached 32.1% (CI: 26.3–38.4) among those aged 60 and above. Similarly, prevalence of musculoskeletal conditions was 4.2% (CI: 3.1–5.9) among those aged 30–44, rising to 12.3% (CI: 9.1–16.5) among those aged 45–59 and to 22.4% (CI: 16.6–29.6) among those aged 60 and over : from 15.9% (CI: 9.6–25.3) among those aged 30–44, to 42.4% (CI: 33.8–51.4) among those aged 45–59 and 55.8% (CI: 45.7–65.5) among those aged 60 and over. There was no significant difference between men and women in the likelihood of reporting NCD multimorbidity (p = 0.339).The prevalence of NCD multimorbidity was high, with 38.5% (CI: 33.0–44.2) of individuals having two or more conditions. The most common co-morbid conditions were hypertension and diabetes. The likelihood of having two or more NCDs increased significantly with age (p < 0.001): 88.3% (CI: 80.3–93.4) , ranging from 39.5% (CI: 33.0–46.4) of persons with hypertension to 7.7% (CI: 2.7–20.0) of those with cardiovascular disease.The reported access to health care was high for all conditions. Among persons with hypertension 97.1% CI: 93.5–98.7) had seen a health provider for this condition in the 3 months preceding the survey. For diabetes it was 97.9% (CI: 94.1–99.3), and for cardiovascular disease it was 94.7% (CI: 85.8–98.2). The frequency of having seen a health provider in the past 3 months was significantly less among those with musculoskeletal conditions (.5–98.7 hp < 0.001). Adherence to prescribed medications was associated with type of health facility visited (p < 0.001). Those who had sought care in hospital were 3.2 (CI: 1.6–6.3) times more likely to take medications as prescribed than those who had sought care in the camp PHCC .Having seen a health provider for their NCD in the past 3 months was considerably more frequent than currently taking prescribed medications for their condition Fig. . The adhHCC Fig. . There wThe high prevalence of NCDs in displaced populations in the Middle East region constitutes an emerging challenge for humanitarian response . New strAfter having experienced increasing persecutions in recent years, religious minorities in Iraq –especially the Yazidis– were subjected to an unprecedented brutality by ISIS during the summer of 2014 . Since tThe study showed a high burden of NCDs among Yazidis and other IDPs in BRHA camps. An estimated 19.4% CI: 17.0–22.0) of households had at least one member who had been previously diagnosed with hypertension, 9.7% (CI: 8.0–11.7) had at least one member with diabetes, 6.3% (CI: 4.8–8.1) had at least one member with cardiovascular disease, and 13.5% (CI: 11.4–15.8) had at least one member with musculoskeletal conditions. These estimates are similar to those found by previous studies of displaced populations in the region. Surveys among Iraqi refugees in Jordan and Syria found prevalence of 19.6% CI: 18.3–21.0) and 19.6% (CI: 18.0–21.3) for hypertension, 9.1% CI: 8.2–10.1) and 7.6% (CI: 6.6–8.7) for diabetes, 6.7% (CI: 5.9–7.6) and 7.8% (CI: 6.8–9.0) for cardiovascular disease, and 18.5% (CI: 17.2–19.9) and 16.6% (CI: 15.1–18.2) for musculoskeletal conditions [.1 and 7..0–22.0 o.3–21.0 aOverall, 92.9% (CI: 88.9–95.5) of those reporting an NCD diagnosis had seen a health provider for their condition during the 3 months preceding the survey. This contrasts with the situation in central Iraq, where IDPs in informal settlements were reported to experience serious difficulties in accessing care . The numDespite the relatively good access to health providers, 40.0% (CI: 34.4–46.0) of those with an NCD diagnosis were not taking prescribed medications, mainly blaming high costs. Those who sought care in the camp PHCC –or a private clinic– were much less likely to be taking medications as prescribed than those who sought care in hospital. It is likely that persons with more serious conditions sought care from hospital specialists, and their conditions may have been more advanced. This is a potential cause for concern as undertreatment or treatment interruptions risk development of complications. Impairment resulting can further limit function and increase dependency on other household members. As the economic situation of IDP households remains tenuous, identifying means to improve ready access to NCD medications at an affordable cost is critical.The increasing financial crisis in the Kurdistan Region has resulted in the Ministry of Health reducing funding to BRHA camps. This is likely to affect the availability of health services. Delays and reduction in government employees’ salaries may weaken motivation among health providers. Doctors are likely to reduce the proportion of their time spent in public sector health facilities to further supplement their income through increased hours in private clinics . AdditioNCDs are common among displaced Yazidis and other minorities residing in BRHA camps. Although most displaced persons with an NCD diagnosis had seen a health provider for this condition in the 3 months preceding the survey, about 40% were not taking prescribed medications, mainly due to costs. Health status and access to care are likely to deteriorate in the coming months, as funding for the public sector declines and the economic situation of displaced households becomes even more tenuous. New strategies are needed to provide high quality NCD management at the primary health care level in the camps and ensure access to affordable medications.


Campylobacter is a major foodborne pathogen frequently associated with human bacterial gastroenteritis in the world. This study was conducted to determine the prevalence and antibiotic resistance of Campylobacter spp. in the beef food system in Malaysia. A total of 340 samples consisting of cattle feces (n = 100), beef (n = 120) from wet markets and beef (n = 120) from hypermarkets were analyzed for Campylobacter spp. The overall prevalence of Campylobacter was 17.4%, consisting of 33% in cattle fecal samples, 14.2% in raw beef from wet market and 7.5% in raw beef from the hypermarket. The multiplex-polymerase chain reaction (PCR) identified 55% of the strains as C. jejuni, 26% as C. coli, and 19% as other Campylobacter spp. A high percentage of Campylobacter spp. were resistant to tetracycline (76.9%) and ampicillin (69.2%), whilst low resistance was exhibited to chloramphenicol (7.6%). The MAR Index of Campylobacter isolates from this study ranged from 0.09 to 0.73. The present study indicates the potential public health risk associated with the beef food system, hence stringent surveillance, regulatory measures, and appropriate interventions are required to minimize Campylobacter contamination and prudent antibiotic usage that can ensure consumer safety. Campylobacter is a major bacterial pathogen that causes foodborne infections around the world quinolones  and 120 fresh beef samples from wet markets (n = 6) in Selangor, Malaysia. All collected samples were immediately transported to the laboratory in ice and processed within the same day of sample collection.A total of 100 fecal samples were collected from apparently healthy beef cattle in three different farms, while purchased 120 chilled beef samples from hypermarkets  CO2 and 5–6% (v/v) O2 generated by the Anaerocult C system (Merck KGaA) in an anaerobic jar.Control samples were prepared only with supplemented Bolton broth and inoculated with Campylobacter colonies was based on ISO method that includes  assay.After incubation, a loop full of the enriched sample was streaked in duplicates onto modified charcoal-cefoperazone-deoxycholate agar  with CCDA selective supplement contained Cefoperazone and Amphotericin B (Merck KGaA) and incubated microaerobically  for 48 h at 42°C. Presumptive identification of des ISO, ,b; oxidaCampylobacter cells were counted using the MPN method with triplicate of three 10-fold dilution series prepared by transferring 100 μL of homogenized sample into 900 μL of Bolton broth base (Merck KGaA) supplemented with Bolton broth selective supplements. A control tube was prepared with supplemented Bolton broth and inoculated with C. jejuni ATCC 33221 and C. coli ATCC 33559. The MPN tubes were incubated at 42°C for 48 h under microaerophilic conditions generated by the Anaerocult C system (Merck KGaA) in an anaerobic jar.Bacterial DNA was extracted from the enriched sample tubes and presumptive bacterial colonies using boiled-cell method ; 1 U Taq Polymerase ; 1 μL of 10 mM deoxynucleoside triphosphate (dNTP) mix ; 1 μM of forward and reverse primer  and 5 μL of template DNA.The PCR was carried out in 25 μL reactions, and each reaction contained 5 μL of 5 × PCR buffer ; 3 μL of 25 mM MgClThe cycling conditions were set as follows on the VeritiTM 96-Well Thermal Cycler , initial denaturing at 94°C for 4 min followed by 33 cycles of denaturing at 94°C for 1 min, annealing at 50°C for 1 min and extension at 72°C for 1 min followed by final extension at 72°C for 5 min.C. coli (ATCC 33559) and C. jejuni (ATCC 33560) were used as the positive controls, while PCR mixture without DNA template was used as the non-template control.A 5 μL of all PCR amplicons were horizontally electrophoresed through a 1.25% agarose gel stained with ethidium bromide in 1 × Tris-acetate-EDTA (TAE)  buffer at 90 V for 40 min. The agarose gel was visualized under ultraviolet (UV) light transilluminator  and photographed. In each gel a positive control, non-template control and a DNA-molecular marker (100-bp ladder)  were included. The DNA extracted from Antimicrobial susceptibility tests were conducted using following antimicrobial impregnated disks ; ampicillin , cephalothin , chloramphenicol , ciprofloxacin , enrofloxacin , erythromycin , gentamicin , norfloxacin , nalidixic acid , sterptomycin , and tetracycline  according to the standard Kirby- Bauer disk diffusion method  broth at 42°C under microaerophilic conditions for 24 h and the turbidity of the suspension was adjusted to 0.5 McFarland standard , intermediate (i) and resistant (r) were based on CLSI recommendations . The results were considered statistically significant at P < 0.05 at 95% confidence level.The difference in prevalence level between the two detection methods (MPN_plating and MPN_PCR) and various sample types obtained from cattle, wet market and hypermarket were analyzed using Pearson chi-square test (XCampylobacter spp. were detected in 8% (8 of 100 samples) of the cattle feces samples and 1.6% (4 of 240) of the beef meat samples and all presumptive isolates were confirmed as Campylobacter spp. by PCR.Presumptive Campylobacter spp. in cattle and beef meat samples determined by using the MPN-plating is presented in Table Campylobacter spp. in 3.5% of the total samples  than the C. coli in fecal samples.The prevalence of es Table . CampyloC. jejuni and the remainder as C. coli (34%). Campylobacter spp. were detected only in 2% of the beef samples from wet and hypermarket by the MPN-plating method. The MPN-plating found C. jejuni and C. coli in 0.8% of beef samples from wet and hypermarket  between the wet and hypermarkets. However, the prevalence of Campylobacter spp. in fecal samples was significantly higher (P ≤ 0.05) than that in beef samples.The majority (66%) of isolates were identified as Campylobacter spp determined by using the MPN-PCR method is presented in Table Campylobacter spp. was detected in 59 (17.4%) of the total 340 examined samples. Detection of Campylobacter spp. by MPN-PCR method was significantly higher (P ≤ 0.05) comparative to the MPN-plating  than the C. coli in fecal samples.The MPN-PCR method detected Campylobacter was detected in a total of 17/120 (14.2%) beef from wet markets and in 9/120 (7.5%) beef from hypermarkets (Table Campylobacter detected in beef samples from wet market (55%) was C. jejuni and remainder was C. coli (20%) and other Campylobacter spp. (25%). Similarly, at the hypermarket, C. jejuni was the most prevalent (67%) while C. coli and other Campylobacter spp. were detected in 22 and 11% of the beef samples respectively. The prevalence of Campylobacter spp. was statistically not significant (P ≤ 0.05) between the wet and hypermarkets.ts Table . The preCampylobacter concentration in cattle and beef was enumerated using the MPN method  and ampicillin (69.2%). Least resistance was observed for chloramphenicol (7.6%), cephalothin (15.4%), ciprofloxacin (15.4%) and gentamicin (15.4%).Eleven antimicrobials named under the different antimicrobial groups were employed in this study to determine the resistance of ls Table . AntimicCampylobacter species that were isolated from the current study indicate in Table Campylobacter species exhibited 7 different antibiotic resistant patterns with MAR index ranging from 0.09 to 0.73. The highest MAR index was 0.73 and showed S, E, En, Na, Nor, Te, C, Amp resistant pattern. Meanwhile, lowest MAR index of 0.09 was demonstrated in isolates that indicate resistance to Te or Amp   was the predominantly isolated organism in cattle followed by C. coli (31.7%), and other thermophilic Campylobacter spp. The prevalence of C. jejuni and C. coli detected in this study was consistent with previous studies  comparatively C. jejuni was detected in 35.8% samples. Similarly, C. jejuni was detected in 35.2% cattle feacal samples with a high prevelance of C. coli (72.9%)  level in rectal swabs collected from cattle from Ibadan, Oyo State, Nigeria. A study conducted in Michigan, USA reported 69.2% prevalence level for C. jejuni  detected in this study needs to be further characterized. Differences in the reported prevalence level can be resultant due to geographical location, sample size and method of analysis.The overall prevalence of thermophilic 3% Table . FindingCampylobacter species detected in beef in this study was in agreement with recent studies. The Campylobacter prevalence of fresh beef samples from Poland was 10.1% in Korsak et al.  comparative to beef from hypermarkets (7.5%) can be associated with the availability of fresh meat in the wet markets in Malaysia. Fresh meat is sold without chilling in the wet markets as it is considered fresh and succulent since it retains moisture. This may facilitate the survival of Campylobacter on raw red meat. Further, the low hygienic conditions in the wet markets . Further this study was in line with Nielsen  state, in which the bacteria cannot be cultured using conventional culture methods . Campylobacter isolated from raw beef in Iran demonstrated the highest resistance to tetracycline  plasmid  plasmid; however Campylobacter isolates from Malaysia need further investigation on prevalence and resistance profile of tet (O) plasmid. Similar to findings from the current study, the majority of the Campylobacter strains from food animals in Tanzania were resistant to ampicillin (70.3%)  and nalidixic acid (94.6%) in Hong et al.  and chloramphenicol (4.5%) in the g et al. . DiscrepCampylobacter isolates from broilers in Malaysia (Saleha, Campylobacter isolates reported to have a MAR less than 0.2. A bacterium that has a MAR index less than 0.2 has been identified to be isolated from animals that antimicrobials were seldom used. While, if the strain has a MAR index greater than 0.2 considered to be originated from producing animals that have a high potential for contamination (Marian et al., Campylobacter isolates from cattle and beef of this study may be associated with low frequency of antibiotic usage in cattle compared to poultry in Malaysia. However, multiple antibiotic resistances associated with isolates from cattle and beef exacerbate the public health concern associated with Campylobacter infections.In the current study multiple antibiotic resistances was detected only in 53.8% of the isolates. Slightly higher multiple antibiotic resistance was observed in  Saleha,  and beef Saleha, . The preCampylobacter in the beef food system in Malaysia. Therefore, implementation of good hygienic practices at the farm, slaughterhouse, and retail level can minimize the Campylobacter contamination. Furthermore, the presence of multiple antibiotic resistant Campylobacter spp. urge the prudent use of antimicrobials in animal husbandry, farmer awareness and application of good veterinary practices to minimize the likelihood of emerging superbugs.Based on the findings of this study indicate the importance of considering the potential public health risk associated with JP and AA conducted the experiment. TT and DS did the data analysis. JP prepared the manuscript. NJ, N-AA-M, JH, DB, YR, YN, MN, and SR supervised and assisted in the preparation of the manuscript. NJ and N-AA-M provided consumables.The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.