The use of ultrasound (US) outside the radiology department has increased the last decades, but large studies assessing the quality of bedside US are still lacking. This study evaluates surgeon-performed US (SPUS) and radiologist-performed US (RPUS) with respect to biliary disease and appendicitis.Between October 2011 and November 2012, 300 adult patients, with a referral for an abdominal US, were prospectively enrolled in the study and examined by a radiologist as well as a surgeon. The surgeons had undergone a 4-week-long US education. US findings of the surgeon and of the radiologist were compared to final diagnosis, set by an independent external observer going through each patient’s chart.Among 183 patients with suspected biliary disease, 74 had gallstones and 21 had acute cholecystitis. SPUS and RPUS diagnosed gallstones with a sensitivity of 87.1 versus 97.3%. Specificity was 96.0 versus 98.9%, and the accuracy 92.3 versus 98.2%. The sensitivity, specificity and accuracy for acute cholecystitis by SPUS and RPUS were: 60.0 versus 80.0%, 98.6 versus 97.8% and 93.9 versus 95.6%, respectively. Among 58 patients with suspected appendicitis, 15 had the disease. The sensitivity, specificity and accuracy for appendicitis by SPUS and RPUS were: 53.3 versus 73.3%, 89.7 versus 93.3% and 77.3 versus 86.7%, respectively.SPUS is reliable in diagnosing gallstones. Diagnosing cholecystitis and appendicitis with US is more challenging for both surgeons and radiologists.The study was registered at clinicaltrials.gov. Registration number: NCT02469935. The use of ultrasound (US) outside the radiology department, often referred to as point-of-care ultrasound (POCUS), has increased in the last decades as more compact and portable scanners have become available . At StocWe, and others, have demonstrated that SPUS can detect gallstones with high diagnostic accuracy –7. UsingThree hundred patients, referred to the radiology department at Stockholm South General Hospital, for any diagnostic abdominal US examination, were enrolled between October 2011 and November 2012, and informed consent was obtained. Exclusion criteria were age <18 years, inability to communicate with the examiner and referrals concerning metastases of the liver or contrast-enhanced examinations.Enrolled patients received one US examination by the study surgeon as well as the standard US examination by the on-duty radiologist. The examining surgeon and radiologist were blinded to each other’s findings, and examinations were done right after one another when possible, and always within 6 h from each other. The surgeon took a short history from the patient and then performed the US, following a standardized protocol. Each examination took the surgeon approximately 15 min (10–20) to perform. The on-duty radiologist performed a standard care US focusing on the individual referrals, and each examination took approximately 10 min (5–15). Among the radiologists, the major part of the scans was done by US-specialized radiologists with several years of training . The surgeons used a portable US machine of the model LOGIQ e with a convex (1.6–4.6 MHz) or linear (5–13 MHz) transducer, GE Healthcare, WuXi, China. The radiologists used Philips iU22 with a convex C5-1 or a linear L12-5 transducer.Patients with suspected biliary disease and/or suspected appendicitis were considered eligible for inclusion. Suspected biliary disease was defined as patients presenting with pain in the right upper quadrant (RUQ) and/or tenderness in the RUQ during physical examination and/or with a referral to the radiology department regarding gallstones and/or cholecystitis.Suspected appendicitis was defined as patients presenting with pain in the right lower quadrant and/or tenderness in the right lower quadrant and/or with a referral to the radiology department regarding appendicitis.The final diagnosis was set by an independent external observer, a senior consultant surgeon, based on discharge diagnosis, operation logs and pathology reports from each patient’s chart. Findings of gallstones, acute cholecystitis and/or appendicitis were marked with “Yes” or “No” for each patient and each diagnosis in a separate protocol. The diagnosis of acute cholecystitis was set using the Tokyo Guidelines 2013 (TG13) criteria [Six study surgeons, five residents in their final years and one specialist in surgery, attended a 1-week course on US physics, technique, anatomy and hands-on training, led by specialists in US, followed by 3 weeks of training in the radiology department. The training has been thoroughly described previously . After cThe Ethical Review Board at Karolinska Institutet, Stockholm, Sweden, approved the study (2011/1025-31/1).p value <0.05 (two tailed) was considered statistically significant. Analyses were done in IBM SPSS Statistics, version 23. We used the efficient score due to Wilson to calculate the 95% confidence intervals (CI) of sensitivity, specificity and accuracy [We calculated sensitivity, specificity, overall accuracy, positive predicted value (PPV), negative predicted value (NPV), positive likelihood ratio (LR+) and negative likelihood ratio (LR−) for SPUS and RPUS in detecting gallstones, cholecystitis and appendicitis, respectively. Final diagnosis, defined above, was set as reference standard. We calculated the inter-observer agreement between surgeons and radiologists for each of the three diagnoses using Cohen’s kappa. The sample size of 300 patients comes from a power calculation in a previous study designed to detect a difference between SPUS and RPUS in detecting gallstones . We usedaccuracy , 15. CI accuracy , 17.n = 183) and/or appendicitis (n = 58) and were included for further analysis  was missing in two cases (no radiology or operation was performed), leaving 170 comparable cases. Sensitivity was 87.1% , specificity 96.0% (90.1–98.4%) and accuracy 92.3% (87.4–95.5%). Positive likelihood ratio (LR+) was 21.8 (8.30–57.2), and negative likelihood ratio (LR−) 0.13 (0.07–0.25) , specificity 98.9% (94.1–99.8%) and accuracy 98.2% (94.8–99.4%). LR+ was 89.5 (12.7–629) and LR− 0.03 (0.01–0.11) .One hundred and sixty of the patients were examined both by surgeon and radiologist. Inter-observer agreement (Cohen’s kappa) between surgeon and radiologist regarding gallstones was 0.79 (good agreement). There was no systematic difference between surgeons and radiologists in how often the diagnosis was set , specificity 98.6% (95.1–99.6%) and accuracy 93.9% (89.1–96.7%). LR+ was 43.2 (10.4–179) and LR− 0.41 (0.24–0.69) , specificity 97.8% (93.8–99.3%) and accuracy 95.6% (91.1–97.8%). LR+ was 36.8 (11.8–115) and LR− 0.20 (0.09–0.49) .One hundred and fifty-two of the patients were examined both by surgeon and radiologist. Cohen’s kappa regarding cholecystitis was 0.61 (good agreement). There was no systematic difference between surgeons and radiologists in how often the diagnosis was set (9/L), and four had a C-reactive protein (CRP) more than 30 (mg/L). Two patients had a temperature higher than 37.5 °C. All of the patients presented either with pain or tenderness in the RUQ. Three of these 10 patients fulfilled the criteria of acute cholecystitis according to TG13 at the time of the scanning, but all of them fulfilled the criteria later during their hospital stay. Four of the patients were not fasting at the time of the scanning, and information about fasting was missing in one case. The rest of the patients had been fasting for at least 6 h. Four of the patients had BMI >30, of which two had BMI >35.Ten patients with acute cholecystitis were missed either by the surgeon or the radiologist or both. Characteristics of the false negative cases are presented in Table Totally, four false positive cases were noted. SPUS and RPUS agreed in positive finding in one patient. That patient presented with neither pain, nor tenderness in the RUQ. Laboratories were elevated with WBC count of 14 and CRP 48, and both surgeon and radiologist noted a thickened wall of the gallbladder, suggesting acute cholecystitis. This patient did not fulfill the TG13 criteria, and the final diagnosis was choledocholithiasis. The other false positive case from SPUS was diagnosed at discharge with gallstones. This patient presented with pain and tenderness in the RUQ and had a “slightly thickened gallbladder wall” according to the radiologist. Laboratories were completely normal, and the patient did not fulfill the TG13 criteria for acute cholecystitis. RPUS had two more false positive cases, one with normal laboratories, finally discharged with gallstones. The other one had no gallstones on RPUS, but acute cholecystitis according to the same examiner. Laboratories were normal also in this case and neither of these cases fulfilled the TG13 criteria. Information about fasting was missing in all of the false positive cases. None of the false positive cases had BMI >30.Among the 58 patients analyzed regarding appendicitis, there were 15 confirmed cases. Final diagnoses for all 58 patients are shown in Table Surgeons examined 44 of the 58 patients in concerns of appendicitis. Sensitivity was 53.3% (30.1–75.2%), specificity 89.7% 73.6–96.4%) and accuracy 77.3% (63.0–87.2%). LR+ was 5.16 (1.60–16.6) and LR− 0.52 (0.30–0.91) , specificity 93.3% (78.7–98.2%) and accuracy 86.7% (73.8–93.7%). LR+ was 11.0 (2.79–43.4) and LR− 0.29 (0.12–0.66) .Forty-one of the patients were examined both by surgeon and radiologist. Cohen’s kappa regarding appendicitis was 0.41 (moderate agreement). There was no systematic difference between surgeons and radiologists in how often the diagnosis was set . The high specificity and likelihood ratio though show that the examination still has a diagnostic value.Hence, our study shows that it is more complicated to diagnose both cholecystitis and appendicitis with US, compared to gallstones. Although some studies, with exceptionally fine results for SPUS and RPUS regarding these diagnoses, have been presented , our resAlthough this study focuses on the diagnostic accuracy of SPUS with respect to gallstones, cholecystitis and appendicitis, we also chose to compare the surgeon’s bedside examination (with a portable machine) to the radiologist’s examination (with a high end machine) for each diagnosis to get an approximation of the overall difficulty in examining these patients. RPUS is since many years accepted as the gold standard for diagnosing gallstones. It is also the recommended examination to confirm cholecystitis . LimitatRPUS for appendicitis is looked upon differently compared to acute cholecystitis. Most clinicians are aware of the problem with sensitivity and consider RPUS an adjunct to the clinical examination with the possibility to confirm but not exclude the diagnosis , 10. OurThe included patients in our study represent a wide range of different diagnoses causing acute abdominal pain. The prevalence of each of the studied conditions well represents the normal range of differential diagnoses seen at the ED , 21, 22,Another strength with our work is that we have elucidated the accuracy of not only SPUS, but also RPUS in the study. This allows us to compare SPUS to standard care in the cohort. It also lets us draw general conclusions about US examinations for the diagnoses studied. The inclusion of gallstone diagnosis, although studied before, also strengthens the study. If not included, relative low accuracies for cholecystitis and appendicitis could be conferred to low US proficiency. The accuracies for RPUS and SPUS for the detection of gallstones now contradict such reasoning.SPUS is reliable in diagnosing gallstones. Diagnosing cholecystitis and appendicitis with US is more challenging for both surgeons and radiologists. We believe that SPUS could be used as an adjunct to the clinical examination with the possibility to confirm but not exclude these diagnoses. Further studies are needed to elucidate the difficulties with bedside US in cholecystitis and appendicitis.


Fetal growth has been known to be associated with particulate matter (PM) air pollution during gestation. Given that regular working may deviate outdoor air pollution exposure, the association between air pollution and fetal growth restriction can be different across maternal working status. This study was to assess possible effect modification by maternal employment in the association between exposure to PM during pregnancy and fetal growth restriction.10 and PM2.5) regulatory monitoring data for 2001–2012 and 2008–2012, respectively, and birth certificate data for 2002–2012, we computed maternal exposures with district-level averages of PM10 and PM2.5 during one year before birth, entire pregnancy, and the 1st, 2nd and 3rd trimesters. The outcomes of fetal growth restriction were assessed by small for gestational age  as well as low birth weight  at term. We performed logistic regression to examine the association between PM and each of fetal growth restriction outcomes adjusting for individual risk factors. For effect modification by maternal employment, we estimated adjusted odds ratio (OR) of SGA or LBW for interquartile (IQR) increases in PM10 or PM2.5 stratified by employed and non-employed mothers. We also computed relative excess risk due to interaction (RERI) to investigate additive interaction.Using hourly PM less than or equal to 10 and 2.5 μm in diameter (PMP < 0.001). SGA occurred in 12.7% of employed and 12.8% of non- employed (P = 0.124) mothers. For non-employed mothers, we observed increased odds of SGA per IQR increase in PM10 for one year before birth : 1.00–1.04, P = 0.028). ORs of SGA for full pregnancy period and the 3rd trimester were also positive but did not reach statistical significance. We did not observe positive association for PM2.5. RERI was not significant both for PM10 and PM2.5.Among 824,011 singleton term births, 34.0%  were employed and 66.0%  were non-employed mothers. Proportions of LBW were 1.5% in employed and 1.6% in non-employed  contains supplementary material, which is available to authorized users. Fetal growth is assessed by comparing birthweight of the newborn with expected weight for the baby’s gestational age. Specifically, low birth weight   and smalFetal growth restriction is mostly caused by utero-placental dysfunction leading to inadequate supply of nutrients and oxygen to support normal growth of the fetus , 7. FemaAmong the physical environment, particulate matter (PM) air pollution is recognized as a risk factor for preterm birth and fetal grown disorders . Previou10 and PM2.5) exposed during the entire period of pregnancy which was not evident for the 1st or 2nd trimester  were defined as SGA. Gestational age is based on the physician’s final estimate of gestation using ultrasound taken early in pregnancy and the mother’s date of the last menstrual period. SGA was referred in weeks, rounding off to the nearest completed week [ were def10 and PM2.5 concentrations measured at maximum 40 regulatory air pollution monitoring sites in Seoul during 2001–2012 from the National Institute of Environmental Research as described in previous studies [2, at least one urban background site is located in each of the 25 districts . We did not included two additional sites in two gu’s because these sites operated for a few years. Because relatively small numbers (6–20) of monitoring sites measured PM2.5 before 2007, the analysis for PM2.5 was restricted to births between 2008 and 2012.We obtained hourly PM studies , 38. Brigu level, the PM concentration measured at a single monitoring site in each gu was assigned to all mothers residing in the same gu. To compute the five metrics, we calculated the 24-h daily averages for days on which > 75% of hourly measurements (18 h) were available at each site. The application of this inclusion criterion for day resulted in exclusion of 6.9% of days for 11 years and at 25 monitoring sties. Then, we averaged daily concentrations over each of the following five pregnancy periods: one year before birth, whole pregnancy, and the 1st, 2nd and 3rd trimesters. To use exposure estimates consistently for a fixed time period, the 1st, 2nd and 3rd trimesters were defined as 0–13+ 6, 14+ 0–27+ 6, and 28+ 0–36+ 6 weeks, respectively. To derive representative exposure estimates in each period, we computed one year exposures for mothers using the sites with more than 9 months of daily data and three trimester-exposures for those with at least 75% of the data during each trimester available. All 25 urban background sites met the inclusion criteria for each of the five periods.Using hourly PM measurement data, we computed five exposure metrics corresponding to five antenatal periods at the mothers’ home addresses. Because mothers’ home addresses are available at the We used directed acyclic graphs (DAGs) analysis to examine potential confounders and effect modifiers in the association between air pollution and LBW or SGA  to assess additive interaction [We used chi-square test  and student t-test (for continuous variables) to assess the difference in individual characteristics as well as fetal growth restriction between employed and non-employed mothers. For the association between PM and fetal growth restriction at term (SGA and LBW), we conducted logistic regression using five exposure metrics after adjusting for individual characteristics separately by employed and non-employed mothers. Individual characteristics included birth date (birth year and month), infant sex, maternal education, maternal age, parity (first childbirth or not), birth season, and gestational age. Non-linear association between birth date and term LBW was adjusted by natural cubic spline with 11 degrees of freedom (df) (1 df per year). Odds ratio (OR) for each birth outcome was estimated per interquartile range (IQR) increase in PMeraction .gu-specific exposures with those of spatially constant exposures, based on daily average PM concentrations over Seoul. Second, we applied mixed models to account for correlation of fatal growth restriction within each of the eight district groups (downtown and areas 1 to 7) and examined the robustness of primary results. These eight district groups were classified based on geographical proximity of 25 districts [Our additional analyses investigated the sensitivity and variation of our primary results. First, we investigated whether the difference in the association between employed and non-employed mothers is enlarged, when exposure assessment is spatially coarse as frequently used in previous studies of air pollution and birth outcomes , 42. Foristricts . The anaThis study was reviewed and approved by the Institutional Review Board of Seoul National University (IRB No. E1503/002–001).10 concentrations of mothers during one year prior to birth, full pregnancy, the 1st, 2nd, and 3rd trimesters were 57.8 (standard deviation = 9.9), 57.3 (10.8), 58.2 (16.5), 57.2 (16.2), and 56.6 (16.6) μg/m3, respectively. PM2.5 concentrations for births in 2008–2012 were 29.1 (6.7), 28.9 (7.0), 29.3 (8.7), 28.8 (8.5), and 28.4 (8.5) μg/m3. PM10 concentrations for 1 year prior to birth were moderately correlated with those during the three trimesters (0.44 to 0.62), whereas the correlations of PM10 concentrations between trimesters were weak (− 0.09 to 0.26)  and outcome  with adjustment for covariates.In our study population of 824,011 singleton term births, SGA and LBW comprised 11.2%  and 1.5% , respectively. The mean PMβ = − 0.005, P < 0.001). The proportion of employed mothers increased from 23.6% in 2002 to 44.7% in 2012. Whereas percentage of LBW increased from 1.4% in 2002 to 1.7% in 2012 (P for trend < 0.001 for both), percentage of SGA was consistent over time   were employed and 66.0% 544,155) were non-employed (Table 55 were n3 (IQR in the full pregnancy period) increase in PM10 for one year before birth was associated with 2% increase in odds of SGA : 1.00–1.04, P = 0.028). The positive association of PM10 for the full pregnancy period and the 3rd trimester with SGA did not reach statistical significance. RERIs indicating additive interaction by maternal employment did not show statistical significance. ORs of LBW were also higher in non-employed mothers than employed mothers, but RERIs were not significant.ORs of SGA and LBW were generally higher in non-employed mothers than employed mothers Table . ORs of 3 increase of PM10 during one year before birth in non-employed mothers remained significant.The positive association was not found when we used coarse exposure assessment applying citywide Seoul-mean concentration. ORs were lower both for SGA and LBW than those in our primary analysis using district-means and became negative for some exposure periods. Our findings were similar, when we applied mixed models to account for additional variability at the district group level  or province was 8–25% during the same period of our study period (2003–2012) [There are other several limitations in this study. First, there is possible information bias because we did not verify mothers’ self-reported working status during pregnancy. Some of the mothers classified as employed might have taken maternity leave during pregnancy and some of the unemployed might have left their job just before birth. As a retrospective study of birth registry data, we could not assess the duration of employment during pregnancy for each mother. Future studies based on prospectively collected data could minimize this possible misclassification bias. Second, because we used the administrative data, some key individual confounders related to smoking intensity, previous pregnancy history, and type of LBW  were not available. As there were previous findings of associations between exposure to PM air pollution and smoking intensity, smoking might have confounded air pollution-related health effect . Conside03–2012) . Relocat03–2012) , the imp03–2012) .Exposure to high ambient PM air pollution during one year before birth tended to increase the risk of SGA at term in non-employed mothers living in Seoul, Korea. Despite potential difference due to mothers’ health status, socioeconomic condition, and exposure misclassification related to their employment status, there was no evidence of effect modification by maternal employment in the association between PM concentration and fetal growth restriction. Futures studies using refined metrics would be helpful to confirm this finding.Additional file 1:Table S1. Correlation coefficients between a pair of the five metrics of mothers’ PM10 concentrations corresponding to the five antenatal periods of 824,011 singleton term births in Seoul, Korea, for 2002–2012. Table S2. Odds ratios (OR) and 95% confidence intervals (CI) for small-for-gestational age (SGA) and low birth weight (LBW) at term per interquartile-increase in PM10* from mixed models that account for correlation of fatal growth restriction at the district group, by employment status in 824,011 singleton term births in Seoul, Korea for 2002–2012. Table S3. Odds ratios (ORs) and 95% confidence intervals (CIs) for small-for-gestational age (SGA) and low birth weight (LBW) at term per interquartile-increase in PM2.5* from mixed models that account for correlation of fatal growth restriction at the district group, by employment status in 386,483 singleton term births in Seoul, Korea for 2008–2012. Figure S1. Map of urban background and urban roadside sites of the regulatory air quality monitoring network in Seoul. Figure S2. Directed acyclic graph of individual characteristics that potentially confound the association between residential PM concentration (“exposure”) and fetal growth restriction (“outcome”). Figure S3. Average concentrations of PM10 and PM2.5 between employed and non-employed mothers by five different antenatal periods of singleton term births in Seoul, Korea. (A) PM10 (B) PM2.5. (DOCX 659 kb)


Polymerase chain reaction for detecting Babesia spp. antigen was carried out on 58 of the samples. Of the 100 dogs, 78% were DEA 1.1 positive and 22% were DEA 1.1 negative. A significantly (p = 0.02) higher proportion of females (90.5%) were DEA 1.1 positive than males (69.0%). The probability of sensitisation of recipient dogs following first-time transfusion of untyped or unmatched blood was 17.2%, and an approximately 3% (2.95%) probability of an acute haemolytic reaction following a second incompatible transfusion was found. Babesia spp. antigen was found in 6.9% of the samples. No significant relationship  was found between DEA 1.1 positivity and Babesia spp. antigen presence. Despite a low probability of haemolysis after a second incompatibility transfusion, the risk remains present and should not be ignored. Hence, where possible, blood typing for DEA 1.1 is recommended. A survey of DEA 3, 4, 5 and 7 in various breeds is also recommended.A study was carried out to determine the prevalence of blood group antigen dog erythrocyte antigen (DEA) 1.1 in mixed breed dogs in rural Chinamhora, Zimbabwe. DEA 1.1 is clinically the most important canine blood group as it is the most antigenic blood type; hence, DEA 1.1 antibodies are capable of causing acute haemolytic, potentially life-threatening transfusion reactions. In this study, blood samples were collected from 100 dogs in Chinamhora, and blood typing was carried out using standardised DEA 1.1 typing strips with monoclonal anti–DEA 1.1 antibodies (Alvedia Canine blood groups are genetically attributed characteristics that remain the same throughout an animal’s life  dogs from 27 resource poor villages using two dip tanks in the Chinamhora area were used. The villages were conveniently selected. The area of Chinamhora was divided into two sections, with two dip tanks, Mawu  and Munyawiri , approximately 30 km apart being regarded as central points for each of the two sections. The Mawu dip tank section included 14 villages and blood was collected from 51 dogs, whereas the Munyawiri dip tank section included 13 villages and blood was collected from 49 dogs.Using a protocol developed by the University of Zimbabwe veterinary teaching hospital, only clinically healthy dogs were included in the study. Briefly, a physical examination was performed that included heart and lung auscultation, temperature, pulse rate, abdominal palpation and mucus membranes evaluation. Dogs were only included in the study if the physical examination was considered normal. From this, a total of 100 dogs were selected. The ages of the dogs were classified as paediatrics (≤ 6 months), adolescents (6–18 months), adults (> 18–84 months), seniors (> 84–120 months) and geriatrics (> 120 months) according to Fortney .About 2 mL of blood was collected from the cephalic vein and placed in a tube containing ethylene diamine tetra-acetic acid (EDTA) as an anticoagulant and stored at 4 °C prior to analysis. Age and sex of the dogs were recorded during blood sample collection.® LAB DEA 1.1 test kits  were used to determine the blood group (DEA 1.1 status) according to the manufacturer’s instructions. The system is based on the migration of red blood cells on a paper strip that has previously been specially treated, under the influence of a buffer flux moving along because of capillary action. A monoclonal antibody specific to the DEA 1.1 antigen has been incorporated on a 1 mm length in the strip. This antibody will retain positive DEA 1.1 red blood cells. It is characterised by the presence of a red band on the mid-portion of the strip (in front of ‘DEA 1.1’ as written on the kit). When the test is negative, the red control band, located on the upper part of the strip (written ‘C’ on the kit), has to appear, ensuring the test has run successfully. If not, then the test must be repeated .The AlvediaBabesia marker. Genomic DNA extraction was done using a Qiagen DNA extraction or purification flexigene® kit following the manufacturer’s instructions (https://www.qiagen.com). PCR targeting the 18s ribosomal RNA subunit of Babesia antigen was done using reverse line blot (RLB) primers  F2 (5’-GAC ACA GGG AGG TAG TGA CAA G-3’) and RLB-R2 (biotin-5’-CTA AGA ATT TCA CCT CTG ACA GT-3’) with a size of 450–560 base pairs . The PCR products were then analysed in a 1.5% agarose gel prepared in TBE 1X (pH 8.3) and stained with ethidium bromide to a final concentration of 0.5 µg/mL. Roche molecular weight maker VIII or XIV was loaded into the first and last wells of the gel. Eight microlitres of the sample was loaded in the wells in between. Electrophoresis was run at a constant voltage of 120V in TBE 1X. After 1 h of electrophoresis, the gels were viewed on a UV Transilluminator.Of the EDTA samples collected, 29 female and 29 male dog samples were chosen at random and then subjected to DNA extraction and subsequent polymerase chain reaction (PCR) amplification for Babesia infection status was created in Microsoft Excel. The prevalence of DEA 1.1 and Babesia infection was determined as the number of positives divided by the total number of samples. The probability of a dog becoming sensitised from first-time transfusion of blood that was not typed or cross-matched was calculated using the following formula: % DEA 1.1 negative × % DEA 1.1 positive/100 . A database including age, sex, DEA 1.1 status and Ethical approval for use of dogs and for all protocols in this study was obtained from the Ethical and the Higher Degrees committees of the Faculty of Veterinary Science, University of Zimbabwe. The purpose of this study was well explained to the owners of the dogs attending two dip tanks in the studied area, who all expressed consent to participate in the study. Standard operating procedures were followed for collection of blood samples. It was ensured that dogs were subjected to minimal, pain-free handling during blood collection.p > 0.05) of DEA 1.1 positivity according to location . However, female dogs (90.5%) had a significantly (p = 0.02) higher DEA 1.1 positivity than male dogs (69.0%)  .The age distribution of the 100 sampled dogs is shown in  (69.0%) . No sign (69.0%) . The pro%, 4/58) . There wet al. http://www.alvedia.com), thus reducing the possibility of false negative and false positive reactions.This study investigated the prevalence of DEA 1.1 in dogs from Chinamhora, Goromonzi district in Zimbabwe using a laboratory test previously reported to be accurate . However, the prevalence was similar to that found in a study done by Madhavan et al. (et al. et al. et al. et al. The respective lowest and highest type DEA 1.1 positivity frequencies have been reported as 29% (Wriensendorp, Albert & Tempelton . et al.  also repn et al. , who recet al. et al. et al. et al. In practice, DEA 1.1 negative dogs are considered the preferred donors (Hohenhaus Babesia spp. antigen in apparently healthy animals is using PCR (Costa-Junior et al. Babesia spp. antigen was low, and this agrees with earlier observations (Adaszek, Martinez & Winiarczyk Babesia spp. present in the studied dogs were not identified. Blood types could be related to some diseases. DEA 7 has been reported to be associated with a significant protective effect in Cocker Spaniels with immune-mediated haemolytic anaemia (Miller et al. Babesia spp. antigen. However, the small sample size of Babesia spp. antigen-positive dogs could have cofounded the association with DEA 1.1 positivity. Further studies are required to determine the Babesia spp. present in dogs in the country and also to assess the role of blood type in babesiosis.The best method of evaluating the presence of Babesia spp. antigen was low. Despite a low probability of haemolysis after a second incompatibility transfusion, the risk exists and should not be ignored. Hence, where possible, blood typing for DEA 1.1 is recommended.In conclusion, this study is the first to show the prevalence of blood type DEA 1.1 in a mixed breed rural dog population in Zimbabwe. DEA 1.1 frequency was high, whereas the presence of


The CFR increased with age but there were limited difference by risk status, except in those aged 45 to 64 years. Adults ⩾65 years with at least one risk factor have much higher rates of CAP and IPD suggesting that additional risk factor-based vaccination strategies may be cost-effective.Community-acquired pneumonia (CAP) results in substantial numbers of hospitalisations and deaths in older adults. There are known lifestyle and medical risk factors for pneumococcal disease but the magnitude of the additional risk is not well quantified in Australia. We used a large population-based prospective cohort study of older adults in the state of New South Wales (45 and Up Study) linked to cause-specific hospitalisations, disease notifications and death registrations from 2006 to 2015. We estimated the age-specific incidence of CAP hospitalisation (ICD-10 J12-18), invasive pneumococcal disease (IPD) notification and presumptive non-invasive pneumococcal CAP hospitalisation , comparing those with at least one risk factor to those with no risk factors. The hospitalised case-fatality rate (CFR) included deaths in a 30-day window after hospitalisation. Among 266 951 participants followed for 1 850 000 person-years there were 8747 first hospitalisations for CAP, 157 IPD notifications and 305 non-invasive pneumococcal CAP hospitalisations. In persons 65–84 years, 54.7% had at least one identified risk factor, increasing to 57.0% in those ⩾85 years. The incidence of CAP hospitalisation in those ⩾65 years with at least one risk factor was twofold higher than in those without risk factors, 1091/100 000  1060–1122) compared with 522/100 000 (95% CI 501–545) and IPD in equivalent groups was almost threefold higher (18.40/100 000 (95% CI 14.61–22.87)  Streptococcus pneumoniae [S. pneumoniae has been declining [Community-acquired pneumonia (CAP) is a frequent cause of hospitalisation in older adults with a substantial proportion of the burden caused by eumoniae –4. In theumoniae  and simieumoniae , althougeclining . The 30-eclining  and 11.1eclining .It is known that both CAP hospitalisation and mortality increase with age and with the presence of various comorbidities and risk behaviours , 10 inclIn Australia, the Pharmaceutical Benefits Advisory Committee recently recommended 13-valent pneumococcal conjugate vaccine (PCV13) as a replacement for the existing 23-valent pneumococcal polysaccharide vaccine (PPV23) for all adults aged 65 years and over . In addiIn order to assess the impact of risk factors on pneumococcal-related diseases, we used a large population-based cohort study of older Australian adults (The Sax Institute's 45 and Up Study ) with dehttps://www.saxinstitute.org.au/our-work/45-up-study/).The Sax Institute's 45 and Up Study is a population based prospective cohort study conducted in New South Wales (NSW) Australia. It consists of approximately 267 000 participants aged ⩾45 years at enrolment. Participants were randomly selected from the Department of Human Services  enrolment database between 1 January 2006 and 31 December 2008. A baseline questionnaire was used to collect data on demographics, social characteristics, personal health behaviours and general health-related data, with written consent obtained for data linkage of participants questionnaire information to administrative health databases. Further details of the 45 and Up Study are published  and avaiFor each individual enrolled, the baseline data were linked to various datasets by the Centre for Health Record Linkage (CHeReL) using probabilistic matching . DatasetThe APDC dataset contains records of all hospitalisation events in NSW with the principal and up to 49 secondary diagnoses coded using the International Classification of Diseases 10th Revision, Australian Modification (ICD-10-AM). It also contains data on admission and discharge dates. Data were available from 1 July 2001 until 30 June 2015. The NCIMS dataset contains all notifications of certain infectious diseases (including IPD onset dates) and adverse events following immunisation required under the Public Health Act 2010 . The NSWS. pneumoniae identified at a sterile site. Only hospital admissions and notifications that occurred after enrolment in the 45 and Up Study were included. We also excluded those with a CAP hospitalisation 30 days prior to recruitment to ensure events post-recruitment (up to 30 days) were not re-hospitalisations. Deaths from CAP were identified if a participant had a death registration within 30 days following a CAP hospital separation.The main outcomes investigated were incidence rates of first CAP hospitalisation following study enrolment and CFR following hospitalisation for CAP. We also examined various groupings deemed likely to represent non-invasive pneumococcal CAP and IPD notifications. Episodes of CAP were identified if there was a linked hospital record where the principal diagnosis field had ICD-10-AM codes J12–J18, whereas for identification of presumptive pneumococcal CAP, only codes J13  and J18.1 (lobar pneumonia) were used . PresumpWe defined risk groups for pneumococcal-related disease a priori according to the Australian Immunisation Handbook  as theseAlcoholism, smoking, heart disease, diabetes and asthma were identified based on self-report in the 45 and Up Study recruitment questionnaire. Risky alcohol consumption  was defined as drinking >28 drinks per week for men and >14 drinks per week for women based on Australian guidelines . CurrentNon-cancer immunosuppressive conditions, renal disease, chronic respiratory disease  and liver disease were identified based on having a linked APDC hospital admission record with a relevant ICD-10-AM diagnosis code prior to recruitment as first  or second (diagnosis_code1) diagnosis field (see supplementary Appendix 1 Table S1). The haematological disorders included non-cancer haematological conditions and haematological cancers. The haematological cancer and other cancers group were defined as having a linked cancer registry record with a relevant ICD-10 diagnosis code and a diagnosis date before recruitment (see supplementary Appendix 1 Table S1).For demographic analyses, we stratified participants into the age groups of 45–64, 65–74, 75–84 and ⩾85 years based on their age at recruitment. However, for incidence and fatality rates, the attained age at event  was used. For each age strata we further disaggregated participants by risk group before calculating CAP hospitalisation incidence and CFRs. Where data were missing for one risk factor and no other risk factors were present, the subjects were categorised into a ‘missing data’ group and included in analyses. Due to the small numbers of IPD cases and hospitalisations specifically coded as pneumococcal CAP, for reporting IPD and presumptive pneumococcal CAP hospitalisation rates for each age strata we combined all risk factors into one single ‘any risk’ group (those with at least one of the pre-defined risk factors).Since most risk factor information was only available at baseline, the hospitalisation incidence was calculated by dividing the number of first episodes since recruitment by the person-years at risk . Using fFor calculation of the CFR of hospitalised CAP, the number of deaths in the 30-day time window after separation was divided by the total number of CAP hospitalisations for that group. It is important to note that for incidence of CAP hospitalisation, only the first episode of CAP hospitalisation for each subject was used to estimate incidence, whereas for the CFR calculation, deaths after any CAP hospitalisation episode (first or subsequent) were included.Epi and Epitools were used to calculate person years at risk by age group and confidence intervals around estimates outcomes respectively.All data preparation including identification and extraction of risk groups, calculation of incidence and CFR were completed in the R programming language. The R packages Our total study population included 266 951 participants of which 53.6% were female. At recruitment, 61.3% were aged 45–64 years, 21.7% were 65–74 years, 13.8% were 75–84 years and 3.1% were aged 85 and over. Among participants, 44.2% had at least one designated risk factor identified, 52.9% had no risk factors identified and 2.9% had missing data for at least one risk factor. The largest risk group was heart disease (11.9% of participants) followed by non-haematological cancers (10.2%), asthma (10.2%) and diabetes (9%). Further details are provided in Within the cohort, over 1 850 000 person-years, 8747 participants had a CAP hospitalisation, 157 an IPD notification and 305 a presumptive non-invasive pneumococcal CAP hospitalisation. The distribution of first episodes of CAP hospitalisation among risk groups, further stratified by age, is summarised in The incidence of IPD notification for the 65–74 years age group was threefold higher (15.88/100 000 (95% CI 11.12–21.99)) in those with at least one risk factor compared with those without (5.15/100 000 (95% CI 2.74–8.81)), resulting in a RR of 3.08 (95% CI 1.63–5.81). The RR for the same comparison within those aged 75–84 years was similar 3.22 (95% CI 1.41–7.38) with incidence rates of 18.24/100 000 (95% CI 12.12–26.36) and 5.65/100 000 (95% CI 2.27–11.65) but the RR was substantially lower in those aged 85+, 1.55 (95% CI 0.69–3.39), with rates of 28.50/100 000 (95% CI 16.52–45.39) and 18.23/100 000 (95% CI 8.33–34.60). The overall IPD incidence rates per 100 000 were 10.11, 12.20 and 23.65 for those aged 65–74, 75–84 and 85+ respectively.For non-invasive pneumococcal CAP (J13 + J18.1-IPD), we summarise hospitalisation data in vs. 15.1% (95% CI 12.8–17.7) in the ‘no-risk’ group. Persons with heart disease risk group had the highest number of CAP-associated deaths  compared with 5.4% (95% CI 3.8–7.3) in the ‘no-risk’ group, a combined CFR of 6.2% (95% CI 5.3–7.3) . The CFRd deaths , accountIn this study we quantified the incidence and RR of CAP and pneumococcal-related outcomes among pre-defined risk groups in a large cohort of older Australians. Comparing those with at least one risk factor to those without, we found large differences in the incidence of  CAP hospitalisation and IPD but limited differences in fatality rates following CAP hospitalisation. For example, in those ⩾65 years the incidence of CAP hospitalisation in the ‘any risk’ group was twice that of the rate in the ‘no-risk’ group. However, while the point estimates for CFR by age were always higher in those with at least one risk factor, the differences based on risk status were relatively small and did not reach statistical significance in any of the age groups ⩾65 years. This suggests the CAP risk factors analysed here substantially increase the probability of severe CAP requiring hospitalisation but that once hospitalised they have limited further impact of subsequent mortality outcomes in those aged over 65 years.The incidence rate of CAP hospitalisation varied significantly within individual risk groups. For instance, in the 65–74 year age group the incidence varied from 2808/100 000 (95% CI 2453–3200) for those with COPD to 436/100 000 (95% CI 368–512) for those in the risky alcohol consumption group. The relatively low incidence in the alcohol risk group could be related to the definition based on alcohol consumption rather than alcoholism. It is important to note that risk groups with high incidence overall sometimes have low impact on total number of CAP hospitalisations. For instance, in the 65–74 age group, the renal disease risk group RR was 4.38 (95% CI 3.37–5.75) compared with no-risk group but due to small numbers of individuals with this risk factor it resulted in only 56 hospitalisations. We did not focus in more detail on individual risk factors as the relevant policy question is around whether to provide additional vaccines to high-risk groups as a whole.et al. reported RR for all-cause CAP in ⩾65 age group to be 3.0 (95% CI 3.0–3.0) when the at-risk group was compared with no-risk counterparts [et al., a retrospective analysis of insurance data that included outpatient claims whilst we only examined hospitalisations. Our findings more closely resemble that of a multi-centre prospective German study  for those aged over 60 years that reported a RR for all-cause CAP of 2.5 (95% CI 2.4–2.5) in at-risk groups [et al. estimated the proportion of those with risk factors among adults hospitalised with CAP and reported that 23.7% and 13.1% of those hospitalised had heart disease and diabetes respectively [Only a small number of international studies provide outcomes related to CAP risk factors that are comparable with our main outcomes. A US study by Shea terparts . In our k groups . Many ofectively . In our et al. found 30 day mortality rates following CAP hospitalisation of 4% in low risk, 10.4% in medium risk (presence of other chronic conditions) and 29.1% in high risk (i.e. immune-compromised) patients [et al., the 30 day mortality rate for CAP hospitalisation was estimated to be 18% in those aged ⩾65 years. In comparison, for the ⩾65 year age group, we estimated a CFR of 10.76% following CAP hospitalisation. One potential reason for the differences between studies could be the differences in the populations between the two studies  and in the inclusion criteria for CAP .There have been a number of studies that have estimated mortality following CAP. Using data from the CAPiTA study, a randomised placebo-controlled trial of PCV13 in the Netherlands, Vissink patients . In one patients  by SkullOur analysis using the 45 and Up Study prospective cohort has several advantages over previous published studies. It had a large sample size (~265 000 at recruitment) long duration of follow-up (10 years) and linkage to several health datasets. However, there are also several limitations to our study. First, the cohort population is known to be healthier compared with the general population , probablSeveral other limitations in the study relate to the identification of risk factors. In the case of risk factors which are identified through hospitalisation (APDC) data, we only examined data back to 2001 and only used the principal or second diagnosis field, this may underestimate the prevalence of those risk factors. Also, all risk factors were measured only at baseline and we did not examine the change of hospitalisation codes used for identification of risk factors during 14 years of follow-up. Therefore the influence of risk factors that develop following recruitment may lead to some unknown bias in our results. Finally, the identification of pneumococcal CAP was limited by the ICD coding data available, with it likely that the majority of pneumococcal CAP cases are included in the ‘pneumonia not specified’  category. A lesser potential bias in presumptive pneumococcal CAP ascertainment in our study is that while lobar pneumonia (ICD code J18.1) is strongly associated with pneumococcal infection , 27, somOlder adults with at least one pneumococcal risk factor had substantially higher rates of CAP and pneumococcal-related outcomes. This may make further vaccination targeted at this group cost-effective. For example, if additional dose/s of pneumococcal vaccine were deemed not to be cost-effective in all adults (above a given age) they may still be cost-effective in those with risk factors. However, the immune response to vaccination, particularly in patients with cancer or other causes of immune-suppression, may be sub-optimal and would need to be considered. The results from this study can be used to help inform pneumococcal vaccination policy in high-risk adults both within the Australian context and in comparable international settings.


Surgical site infections (SSIs) are a common complication following breast surgery procedures, despite being considered a clean surgery. The prevalence of SSIs can be minimised with the appropriate use of antibiotic prophylaxis as outlined in the Australian Therapeutic Guidelines (eTG). The aims of this study were to evaluate adherence to the eTG for antibiotic prophylaxis in breast surgery procedures at a Western Australian teaching hospital following an update of the guidelines in 2014 and examine the impact of prophylactic antibiotics on SSI incidence and length of hospital stay.A retrospective cross-sectional study which reviewed medical records from a random sample of 250 patients selected from 973 patients who underwent breast surgical procedures between February 2015 and March 2017.p = 0.131) or SSIs (p = 0.306).Overall adherence to current eTG occurred in 49.2% (123/250) of operations. Pre-operative and post-operative antibiotics were prescribed in 98.4% (246/250) and 11.2% (28/250) operations respectively. Adherence rates to three specific elements of the eTG  were 91.6% (229/250), 53.6% (134/250) and 86.4% (216/250) respectively. For the 14.4% (36/250) patients with relevant drug allergies, there was zero adherence to the eTG. Overall recorded SSI prevalence was low at 5.2% (13/250). The mean length of stay in patients (2.3 ± 1.7 days) was not influenced by level of eTG adherence (p =  < 0.001). The level of detected SSIs in this study was low. Further improvement is necessary with respect to prescribing appropriate antibiotic dosages and for those with allergies.These data demonstrate a significant improvement in overall adherence to the eTG from 13.3% to 49.2% ( Surgical site infections (SSIs) are a common complication following breast surgery procedures, despite being considered a ‘clean surgery’ . SSIs arThe prevalence of SSIs can be minimized with the appropriate use of pre-operative antibiotic prophylaxis . This haStaphylococcus aureus (MRSA)  which aim to promote the quality use of medicines by publishing evidence based standard protocols and up-to-date therapeutic information. In 2014 updates were made to the eTG and a new section on surgical prophylaxis of breast surgery was included in the guidelines. According to the current eTG, patients undergoing breast surgery should receive pre-operative cefazolin 2 grams intravenously (IV) within 60 min, ideally 15 to 30 min before surgical incision. For patients with immediate hypersensitivity to penicillin, vancomycin 15mg/kg IV, started 30 to 120 min before surgical incision at a rate 10mg/min is recommended . Vancomys (MRSA) . Post-ops (MRSA) .Prior to the update, prescribers would follow the protocol for ‘Head, Neck and Thoracic’ procedures . The 201The aims of this study were to evaluate adherence to the eTG for antibiotic prophylaxis in breast surgery procedures at a Western Australian teaching hospital since the 2014 eTG update and to examine the impact of prophylactic antibiotics on SSI incidence and length of hospital stay.The study was approved by the Sir Charles Gairdner Group Human Ethics and Research Committee (QI:14155) as a quality improvement activity to enhance the safety of medicines use. Approval of this piece of research included the option to publish the data with a waiver of individual patient consent. Ethical approval was also granted by the Human Research Ethics Committee at Curtin University, Perth, Western Australia (HRE2017-0189).This retrospective cross-sectional study was conducted at Sir Charles Gairdner Hospital (SCGH) in Perth, Western Australia. A total of 973 patients who underwent a breast surgery procedure between February 2015 and March 2017 at SCGH were identified by the Pharmacy Department at SCGH using Medicare breast surgery codes by means of an electronic database. The search involved identifying patients with International Classification of Disease (ICD-10) codes. C50 was used as well as Australian Medicare Benefits Schedule principle procedures codes 31,500 to 31,566 which formed a list of patients not ordered by date, code or medical record number. Patients with missing important information such as patient treatment, detailed antibiotic use and type of surgery were excluded. In Australia, Medicare is a Commonwealth government universal health care system that provides citizens with access to many health services at minimal cost, including free treatment in public hospitals. The Medicare Benefits Schedule is a listing of the Medicare services subsidized by the Australian government.A sample of 250 patients was selected using an online randomiser . This sa® Spreadsheet. Data extracted included patient demographics , the code of the surgeon who performed the procedure, the patients’ ward, the procedure type, surgery time, any pre-operative or post-operative antibiotics given , adverse drug reactions for both pre- and post-operative antibiotics, signs of infection and the patient’s length of stay in the hospital.De-identification of patient and prescriber details was performed during data collection to ensure confidentiality throughout the study. For this study details gathered from the medical records were entered into a password protected Microsoft Excelp-value. A p-value <0.05 was taken to indicate a statistically significant association in all tests.In order to calculate adherence to the current version of the eTG, four characteristics of pre-operative antibiotics recorded for each patient  were assessed against the current guidelines, which recommend the use of cefazolin 2 grams (IV) within 60 min, ideally 15 to 30 min before surgical incision . To be cA total of 250 patients were analysed in this study. Most, 98.8% (247/250), were females . The 14.n = 120; 23.0%) and wide local excision . All male patients received a unilateral mastectomy with one male patient also receiving a sentinel node biopsy. There was no statistically significant association between any particular operation and development of a SSI.There were 25 different types of breast procedures recorded . Many paThere was missing information on specific adherence elements for 10.4% (26/250) of patients, which related to timing of antibiotic administration. These patients were classified as non-compliant with respect to timing. Management of 123 patients (49.2%) was found to be compliant with the eTG . The 95%p < 0.001, Chi-square test). In the current study, 5.2% (13/250) of patients developed a reported SSI after surgery. No statistically significant relationship was found between adherence to the eTG and SSIs . Of the patients who had received appropriate pre-operative antibiotic treatment, 6.5% (8/123) developed a reported SSI, while 4.9% (5/103) of the patients who did not receive appropriate treatment developed an SSI.Adherence to the eTG was found to be significantly improved since the study by Jaber et al. reported 13.3% compliance (p = 0.3144) nor SSI occurrence (p = 0.596). A significant relationship was found between using cefazolin and a decreased length of stay (p = 0.037), with 87.8% (201/229) of those who were given cefazolin staying 1-2 days, compared to 71.4% (15/21) of those who were not taking cefazolin. There were 4.6% (10/216) patients with a length of stay less than three days who developed a SSI, whilst 8.8% (3/34) of those who stayed longer than two days developed a SSI.On average patients stayed at the hospital for a mean (±standard deviation) of 2.3 ±1.7 days . With this length of stay divided into short (0–2 days) vs longer (3 or more days), no significant association was found between level of adherence and length of stay  with prescriber adherence to the eTG ranging from 25 to 100%. Similarly, between prescribers and developing an SSI (p = 0.748) with individual SSIs rates for prescribers ranging from 0-14.3%. No significance was found between prescribers and whether they gave pre-operative antibiotics with the rates of pre-operative antibiotic given to patients for each prescriber ranging between 90.7% and 100%. A statistically significant association was seen between prescribers and whether post-operative antibiotics were given (p<0.05) with 11.2% (28/250) in patients having received post-operative antibiotics despite not being specified by the eTG. A majority of patients who received post-operative antibiotics  were prescribed cefalexin, however other antibiotics including clindamycin , dicloxacillin , cefazolin , flucloxacillin , amoxicillin  amoxicillin with clavulanic acid  were also prescribed.A total of seven surgeons were recorded in this study. There was no statistically significant relationship found between prescribers and level of adherence (p < 0.001) than the 13.3% (20 operations) reported by This is the first study conducted since the introduction of the new eTG in 2014. The adherence level of 49.2% (123 operations) was higher . A recent study by Yang et al. also reported that there was no significant difference between SSIs and cefazolin administration in patients who underwent breast procedures such as a mastectomy, whereas development of SSIs with and without prophylactic pre-operative antibiotics was 7.2% and 4.2% respectively . As mentioned previously there is a lack of clinical studies which support the use of antibiotic prophylaxis which may have influenced prescribers in the present study. The lack of consensus of antibiotic prophylaxis has also been reported by breast surgeons in the United Kingdom, following nationwide surveys.  compared to the previous study conducted by Jaber et al. which used a sample size (n = 150). The results should be generalisable to this hospital but may not reflect practice elsewhere.The strength of this study was a larger sample size (n = 250) which restricted the ability to identify large numbers of SSIs. Patients might seek treatment for SSIs from their general practitioners or other hospitals without returning to SCGH which may raise the incidence of SSIs recorded within this study cohort. A further limitation was that detailed examination of SSIs and the causative factors such as pathogens, appropriate hand washing and other procedures, were beyond the scope of this study. Also, missing information within 26 patient medical files regarding adherence, specifically the timing of antibiotic administration meant these patients were excluded from the overall compliance assessment.Limitations of this study included the sample size (There was a significant improvement in adherence to surgical antibiotic prophylaxis guidelines in breast surgery from 13.3% to 49.2% compared to a similar study conducted by


Some patients need multiple leukapheresis procedures to achieve the necessary number of CD34+ cells, but this can cause a high volume of stem cell product that cannot be given in a single day. Whether or not the number of infusion days affects engraftment has not been studied before. We aimed to evaluate the impact of reinfusion of stem cells on multiple days on engraftment results.High-doses of melphalan treatment with autologous stem cell transplantation in multiple myeloma (MM) remains a major treatment modality in suitable patients. A minimal dose of 2x10Demographic features, CD34+ cell doses, neutrophil and platelet engraftment days, hospitalization days, and number of infusion days of 149 autologous transplantations of 143 MM patients were evaluated retrospectively.6/kg (range: 1.5-31x106/kg). CD34+ cells were reinfused in 1 day in 80.5% (n=120) of the patients, 2 days in 18.2% of the patients (n=27), and 3 days in 1.3% of the patients (n=2). For 29 patients, reinfusion was applied in more than 1 day because of the high volume of stem cell product. We did not see any dimethyl sulfoxide toxicity, cardiac arrhythmia, or volume overload complications. Hypertensive attacks during infusion were easily controlled by furosemide treatment. In the group with multiple infusions, the infused CD34+ cell numbers had a mean of (4.8±2.8)x106/kg, and in the single infusion group the mean was (8.1±5.5)x106/kg. There were no statistical differences between the two groups regarding platelet and neutrophil engraftment days . There was no statistical difference between the two groups for hospitalization days .The data of 143 MM patients who were transplanted were analyzed retrospectively. Median age was 55±8.5 (range: 26-70) years with a male/female ratio of 91/58. Hospitalization days for all patients were 24±6 (range: 14-50) days. Mean CD34+ cell number was (7.5±5.3)x10In cases with a high volume of stem cell product to acquire adequate stem cells, reinfusion can be safely applied across multiple days without any delay in engraftment. High-dorecovery ,10.The aim of our study was to examine the effect of CD34+ reinfusion on multiple days on engraftment results in MM patients. We evaluated the demographic features, infused CD34+ cell doses, neutrophil and platelet engraftment days, hospitalization days, and number of infusion days in 149 ASCTs of 143 MM patients retrospectively.Between February 2009 and September 2017, 143 patients with MM underwent ASCT at the Dokuz Eylül University Hospital Division of Hematology. Data were collected from the electronic and patient files of the medical archives retrospectively. Baseline patient characteristics are shown in Transplant details including mobilizing agents, CD34+ cell doses, neutrophil and platelet engraftment days, hospitalization days, and number of CD34+ reinfusion days were analyzed. The data were examined according to the number of CD34+ cell reinfusion days. The neutrophil and platelet engraftment days, hospitalization days, and collected CD34+ cell count of the patients for whom CD34+ cells had been reinfused in one day were compared to those of the patients for whom CD34+ cells been reinfused on multiple days. At the time of transplant, only 11.4% (n=17) of patients had complete response (CR). The majority  had achieved a very good partial response (PR), while 28% (n=42) of the patients had reached PR and 3% (n=4) had refractory or progressive disease. Second autologous transplantations were planned for six patients because of progressive disease.2 for one day with mesna and granulocyte colony-stimulating factor  in 133 patients (89.3%), G-CSF alone in 7 patients (4.7%), and plerixafor plus G-CSF in 9 patients (6%) for mobilization. Apheresis was initiated when  the CD34+ cells of peripheral blood samples increased to >10 µL. Each sample was tested by flow cytometric analysis for the proportion of cells expressing CD34. The minimum goal CD34+ stem cell dose as a target for collection was >2x106 CD34/kg for all autologous transplantations.Peripheral blood stem cells were collected in 1-4 apheresis procedures (mean: 1.7), following mobilization regimens. We used intravenous cyclophosphamide at 2.4 g/m2 for 124 patients (83.2%) and at a reduced dose of 140 mg/m2 for 25 patients (16.8%) due to reduced creatinine clearance (<50 mL/min). Patients received G-CSF once a day starting on day 1 after the infusion of stem cells until the time of engraftment.The regimen for conditioning consisted of melphalan for all patients. Melphalan was given at a dose of 200 mg/mData were entered and analyzed using SPSS 21.0. Descriptive statistics were used for baseline characteristics, transplant-related factors, and posttransplant results. Differences in the distribution of variables between patient subsets were analyzed using the Pearson chi-square test/correlation test/t-test. All statistical analyses were performed at a critical significance level of  0.05, and p-values were reported.We analyzed 149 autologous transplantations of 143 MM patients between February 2009 and September 2017 retrospectively. Mean age was 55±8.5 (range: 26-70) years with a 91/58 M/F ratio. There were no significant differences in platelet engraftment days, neutrophil engraftment days, reinfusion days, hospitalization days, or infused CD34+ dose with regards to sex distribution .Patients were separated into two age groups: those aged younger than 60 years and those older. There was no significant difference between the two groups in terms of platelet and neutrophil engraftment days, multiple day reinfusion rate, hospitalization days, or infused CD34+ cell dose .When we analyzed all patients, hospitalization days were 24±6 (range: 14-50). Mean CD34+ cell count was (7.5±5.3)x106/kg (range: 1.5-31x106/kg). Platelet engraftment days were 13.9±3 (range: 9-30) and neutrophil engraftment days were 11.5±1.5 (range: 8-17).Higher reinfused CD34+ cell doses were associated with faster platelet and neutrophil engraftment (p=0.034 and p= 0.001). Hospitalization days decreased because of a better transplantation outcome with the higher reinfused CD34+ cell doses (p=0.001).6/kg in the multiple day infusion group and (8.2±5.5)x106/kg in the single day infusion group. The infused CD34+ cell count was found higher in the single day infusion group than in the multiple day infusion group (p=0.003). There were no statistical differences between the two groups in the case of platelet and neutrophil engraftment days  or hospitalization days  (CD34+ cells were reinfused in one day in 80.5% of patients (n=120), 2 days in 18.2% of patients (n=27), and 3 days in 1.3% of patients (n=2). For 29 patients, reinfusion was performed on more than one day, because of the higher volume of stem cell product and according to the tolerability of the patients. However, reinfusion of peripheral blood mononuclear cells cryopreserved with dimethyl sulfoxide (DMSO) can be associated with toxic reactions. We know that infusion of product containing more than 1 g/kg of DMSO per day can lead to increased DMSO toxicity. As a result, the days of reinfusion were determined according to the performance status of our patients, the amount of product they had, and the amount of DMSO contained in the products. There were also statistical differences between the two groups in terms of mobilization days. Mobilization days were found higher in the multiple day infusion group than in the single day infusion group . We did not see any DMSO toxicity, cardiac arrhythmia, or volume overload complications. Hypertensive crisis  was easily controlled by diuretic treatment at the during infusion. CD34+ cell levels were a mean of (4.8±2.8)x10r=0.050) .MM is a disease of the elderly. ASCT is an important treatment modality in symptomatic myeloma patients. Treatment options have expanded in the last decade with novel drugs, but ASCT still maintains its place in the treatment of myeloma. We offer the results of a retrospective analysis of MM patients with autologous transplantation in our center in the last decade. The median age was 55 years and there was male dominance in our study. The median age was relatively young in our study, similar to the study of O’Shea et al. .Recent population-based studies have shown increasing use of ASCT in elderly patients with MM . However6 CD34/kg for each autologous transplantation. The mean CD34+ cell number was (7.5±5.3)x106/kg in our study. The mean platelet engraftment days were 13.9 and the mean neutrophil engraftment days were 11.5 in our study. In other studies, the median time to neutrophil engraftment and the median time to platelet engraftment were reported as 9-14 days [In our study, ASCT was planned for transplant-eligible patients who had adequate stem cell collection. We mostly applied cyclophosphamide and G-CSF as the mobilization regimen. The target CD34+ stem cell dose for collection was >2x10-14 days  and 13.5-14 days , respect-14 days ,18,19.The collected stem cell product is mostly given as a single day infusion, but in some situations, the product can be reinfused on multiple days due to patient characteristics or concern about complications related to higher volumes.We chose multi-day reinfusion to overcome possible volume overload in older patients. DMSO toxicity could be another problem if the patient is given the infusion in a single day. Patients requiring multiple days to collect an adequate number of CD34+ cells may be at risk of exposure to serious doses of DMSO. Davis et al.  suggesteWe also observed that multi-day infusion of stem cells due to higher volumes was mostly done in patients older than 60 years. The ages of these patients were between 26 and 70 years; 39% of them were older than 60 years and 61% were younger than 60. On the other hand, the number of patients older than 65 years old was found to be 14%. In the Italian Group for Bone Marrow Transplantation-Working Group study, age over 65 was described as a poor mobilizing factor, like previous cytotoxic chemotherapy, radiotherapy, bone marrow involvement, and platelet count before mobilization . We did In our study, we also compared findings between two age groups . There were no significant differences in platelet engraftment days, neutrophil engraftment days, reinfusion days, hospitalization days, or infused CD34+ doses in these two groups. However, Sanchez et al.  found a In cases with high volumes of stem cell product to acquire adequate amounts of stem cells, reinfusion can be safely applied across multiple days without any delay in engraftment.


Introduction: Adequate sleep has a crucial role in enhancing cognitive skills especially memory retention. Poor night time sleep quality and the consequent daytime sleepiness affect physical and cognitive health of students and their academic performance. The aim of this study is to find whether or not poor academic performance is a consequence of poor sleep quality among Pakistani medical students.Methods: It was an observational, cross-sectional study conducted with undergraduate medical students. Pittsburgh Sleep Quality Index (PSQI) was used to assess the sleep quality. Academic performance was assessed by mean grade point average (GPA) of the students. The data were analyzed using the Statistical Package for the Social Sciences (SPSS) 22.0 .Results: There were 512 (64.24%) students with global PSQI score ≥5 indicating poor sleep quality. The mean GPA of poor sleepers was 2.92 ± 1.09 which was significantly lower than that of good sleepers (p < 0.0001). In the group of students who scored lower GPA (2.0-2.7), 28.2% had very bad subjective sleep quality, 29.05% had sleep latency of 16-30 min, 29.4% had sleep duration of <5-7 h, 27.8% had sleep efficiency of <85%, and 37.7% experienced daytime dysfunction almost every day.Conclusion: Medical students of Pakistan have poor sleep quality which has a negative impact on their academic performance. Adequate sleep is essential to refresh the students every day and help them in learning and memory processing. Medical students and their facilitators should comprehend the negative effects of sleep deprivation on student academics and should take adequate measures to improve the sleep quality of students. Adequate sleep of high quality and optimum duration facilitates memory processing and learning. It helps maintain concentration, executive cognitive functions, sensorimotor integration, and memory processing . Sleep pYoung and old adults are recommended to sleep for seven to nine hours every night . HoweverOne of the high-risk groups, established in the literature, for being affected by disorders of sleep are students -3, 5. A Literature has extensively reported high prevalence of poor sleep quality among medical students. However, not many researchers have studied the consequences of inadequate sleep quality. It has been proposed that sleep deprivation causes depression, agitation, apathy, and poor academic performance in students . ReducedAs stated earlier, studies have reported the frequency of poor sleepers among Pakistani medical students and its association with academic stress ; studiesIt was an observational, cross-sectional study conducted with undergraduate students in public medical university of Karachi, Pakistan. The study duration was from 1st January till 15th March 2019. Students of both genders, and all five years of education were included. With approximately 350 students in each batch, all 1750 MBBS students were invited, out of which 980 students responded. There were 183 incomplete responses which were excluded. Remaining 797 responses were included in the study (response rate: 45.54%).A structured questionnaire, consisting of two sections, was distributed. The first section comprised demographic information including gender, age, and GPA of every semester. The second part comprised Pittsburgh Sleep Quality Index (PSQI). PSQI is an efficient measure of the quality and pattern of sleep. It assesses sleep quality on seven components-subjective sleep quality, sleep latency, sleep duration, habitual sleep efficiency, sleep disturbances, use of sleeping medication, and daytime dysfunction. Its scores range from minimum zero to maximum 21. The combined score of all seven components is termed as “global score of PSQI.” Global PSQI score ≥5 signifies “poor sleep quality.” The PSQI has internal consistency and a reliability coefficient  of 0.83 for its seven components .The SPSS for Windows, version 22.0  was used to enter and analyze the data. Demographic data were categorized to calculate frequencies and percentages. All components of PSQI were categorized as mentioned by Smyth . Mean GPOut of the 791 students, 531 (66.62%) were females and 266 (33.37%) were males. Mean GPA was 3.08 ± 1.12 for the entire study sample. There were 241 (30.23%) students with GPA less than 2.71, 312 (39.14%) students with GPA 2.71-3.40 and 244 (30.61%) with GPA 3.41-4.00.Poor sleep quality was witnessed in 512 (64.24%) students. Their mean GPA was 2.92 ± 1.09. There were 285 (35.76%) students who were not poor sleepers and their PSQI score was <5. Their mean GPA was 3.31 ± 1.49. Poor sleepers had significantly lower mean GPA (p < 0.0001).All seven components of PSQI were compared with the average GPA of the students. Most of the students with lower GPA (2.0-2.7) had very bad subjective sleep quality (28.2%), sleep latency of 16-30 min (29.05%), sleep duration of <5-7 h (29.4%), and sleep efficiency of 75%-84% (27.8%). Most of these students experienced sleep disturbances once or twice a week (29.8%), had not used sleep medication in the past one month (87.14%), but experienced daytime dysfunction almost every day (37.7%). The comparison of their sleep quality parameters to groups with higher GPAs is shown in Table Adequate and efficient sleep plays a crucial role in learning and memory. It is important for students to sleep well in order to perform well in academics. The results of this study are very alarming. Most students with lower average GPA reported very bad subjective sleep quality, had a sleep latency of 16-30 min, sleep duration of <5-7 h, sleep efficiency of 75%-84%, and experienced daytime dysfunction almost every day.The study provides robust evidence regarding the association of sleep disturbances with declining pattern in mean GPA scores. However, the study has its limitations too. It has not taken into account or excluded other factors such as exam stress, exam difficulty, etc. that can contribute to poor academic performance. Also, it was conducted among students of only one medical college and cannot be generalized for the entire population. This is a cross-sectional study which only shows an association and, in no manner, has determined causality.Even with our best efforts, we could not find any local data published. However, there is substantial evidence from other countries regarding the delirious effects of sleep deprivation on students’ academic performance. Among Saudi medical students, sleep disturbances including insomnia, frequent awakenings, and falling asleep after 30 min of going to bed were common . SimilarPhilips in 2017 in his research stated that for every 10-point increase in sleep regularity index, a 0.10 increase in GPA has been observed. Furthermore, negative linear correlations have been observed between GPA and sleep onset time, wake time, and mid-sleep time . In SudaMedical students are continuously under high academic stress and pressure. Adequate sleep is essential to refresh them every day and help in learning and memory processing. Sleep disturbances are common in medical students and worsen their academic performance. Medical students and their facilitators should comprehend the negative effects of sleep deprivation on student academics and should take adequate measures to improve the sleep quality of students.


The aim of this study was to assess the magnitude, patterns and predictive factors of unhealthy practice among mothers during pregnancy, childbirth, postnatal and newborn care in Southern Ethiopia.Among the total participants, 29.0% mothers performed at least one unhealthy practice during pregnancy, childbirth, postnatal period and newborn care. This study identified the following harmful practices such as food prohibition (53.2%), home delivery (41.5%), discarding colostrum (18.6%), application of substance on the cord stump (12.1%), delayed breast feeding (28.4%), prelacteal feeding (43.0%) and early bathing (49.3%). Being grand multiparous , being illiterate  and lack of awareness on the effect of unhealthy practice  were independent predictors of outcome variable. Globally, about 287,000 women die from the complication of pregnancy, childbirth and postpartum . About 1Most of neonatal deaths are easily preventable . MaternaNeonatal health and survival can be improved by universal application of essential newborn care following delivery. These practices include cleanliness, delaying of first bath, thermal protection, breathing initiation, early and exclusive breastfeeding, eye care, immunization, and treatment of neonatal illness . HoweverThe time during pregnancy, childbirth and neonatal period is culturally very important time and existing behaviours are strong adherence to traditional practices. In addition to the practice of essential newborn care, successful behaviour change strategies should be also required , 10. In A community based cross-sectional study design.The study was conducted at Wonago town in Southern region of Ethiopia. It is located 380 km far from capital city of Ethiopia (Addis Ababa). The study was conducted from March 10 to April 9, 2018.All mothers gave birth within 3 years prior proceeding the study period in Wonago town during the study period.All sampled mothers who gave birth within 3 years prior proceeding the study period were included in the study. But, mothers who were seriously ill during data collection were excluded.The sample size of 297 mothers was determined by using a single population proportion formula with confidence interval 95%, margin of error 5%, prevalence of unhealthy practice 25.6%  and addiBased on Wonago town health administrative report, a total of 2015 mothers gave birth within 3 years prior proceeding the study period. Then, households (HHs) of the identified eligible population will be registered to create a sampling frame. Lastly, 297 mothers from Wonago Town were selected using a simple random sampling technique. When sampled mother was absent from their home on the data collection day, the re-visited the household was arranged.Unhealthy practice: is the cultural practice of reproductive health during pregnancy, childbirth, postnatal period and newborn care which bring a higher risk of morbidity and mortality for women and newborn.Untrained traditional birth attendant: is a birth attendant without receiving training on the basic mother–child care.Early bathing: is the practice of bathing a newborn before 24 h of birth.Delay breastfeeding: is the practice of breast feeding a newborn after 1 h of birth.Colostrum avoidance: is the practice of avoiding the first yellowish milk feeding (highly nutritious and protective the newborn from diseases).Prelacteal feeding: is the practice of feeding babies with culture specific foods immediately after birth other than breast milk.Neonates/Newborn: is a baby in the first 4 weeks of life.Grand multipara: mother who give birth five and more.The dependent variable was unhealthy practice. Any form of unhealthy practices was dichotomized as yes and no. Yes if the mother reported any one or more any form of unhealthy practices or No if any form of unhealthy practices were not reported. Then, Yes was computed and coded as ‘1’, while No was computed and coded as ‘0’ for logistic regression analysis.The independent variables were socio-demographic factors , knowing about the effect of unhealthy practice, place of birth and birth attendant were also assessed as explanatory variables.Data was collected using a structured interviewer-administered face to face interview. Questionnaire was initially prepared in English and translated into local languages (Amharic and Gedeogna) by reviewing different previous articles and back-translated to the English language by three native speakers to check its consistency. Data quality was managed by trained BSc. Midwifery data collectors and pre-test on 5% of sample size. Collected data was checked by daily supervision.The collected and coded data were entered into EpiData version 3.1 and then exported to SPSS version 21.0 statistical package for analysis. Firstly, univariable analysis was used to describe the continuous and categorical variables . Then, bivariable logistic regression was conducted to assess crude association between outcome and independent variables. Those significant variables at p-value < .25 during bivariable analyses were included in the multivariable analyses. Lastly, multivariable logistic regression was conducted to assess adjusted association by controlling the potential confounders. Adjusted odds ratio (AOR) was used to determine the strength of association between dependent and independent variables. Variables with p value < .05 at 95% confidence interval (CI) were declared as statistically significant in multivariable logistic regression analysis.A total of 297 mothers were enrolled in the study with a response rate of 97.6%. The mean (± SD) age of mothers in the study was 28 ± 6 years (ranged from 15 to 45 years). Majority (72.8%), (84.5%), (78.3%) and (73.1%) of the mothers were married, Christian, illiterate and rural. 141 (48.6%), 68 (23.4%), 61 (21.4%) and 19 (6.6%) of participants were Gedeo, Oromo, Guraghe and Amhara by ethnic group, respectively. Almost half (48.6%) of the mothers were farm produce respectively. One hundred twenty-nine (44.5%) of the mothers had a monthly income below 500 birr (Table Fifty (17.2%) of mothers had awareness on the effect of unhealthy practice. From all participants, 10 (3.4%), 13 (4.5%), 12 (4.1%), 9 (3.1%) and 6 (2.0%) mentioned malnutrition, bleeding, anemia, infections and obstructed labor, respectively.In this study, eighty-four (29%) of participants performed at least one unhealthy practice during pregnancy, childbirth, postnatal and newborn care.Regarding pregnancy, 46 (15.0%) of participants consumed craved foods and 154 (53.2%) of them had food prohibition. Concerning birth place and attendant, 120 (41.5%) of participants were assisted by untrained TBA at home and 80 (27.7%) of mothers applied abdominal massage with butter to facilitate labor.Regarding umbilical cord care, thirteen (4.5%) of respondents used unclean blade to cut umbilical cord and nineteen (6.6%) of them used unclean thread to tie umbilical cord. 22 (7.6%) of participants untied umbilical cord with thread whereas twelve (4.0%) of them tied umbilical cord with their leg. 35 (12.1%) of respondents applied substance (dry cow dung or ashes or powder) on the cord stump.Concerning breast feeding, 54 (18.6%) mothers discarded the colostrum (first yellowish milk) and 125 (43.0%) of them gave pre lacteal feeding . 208 (71.6%), 59 (20.4%) and 23 (8.0%) of mothers gave breast feeding the first time were within 1 h, within 24 h and after 24 h of delivery, respectively.Regarding initial time of bathing, 84 29.0%), 59 (20.3%) and 147 (50.7%) of mothers washed their babies within 1 h, within 24 h and after 24 h of birth, respectively. 179 (62%) of mothers kept their babies from sunlight exposure . The odd of unhealthy practice was 7.611 among illiterate mothers as compared to literate mothers . The odd of unhealthy practice was also 4.673 among mothers who have no information on the effect of unhealthy practice as compared to their counterpart  (Table From the total study subjects during study period, 29% of mothers performed at least one unhealthy practice during pregnancy, childbirth, postnatal and neonatal period. The frequency of home delivery in our study was 41.5%. This finding was greater than reported in other studies . HoweverThe frequency of food prohibition during pregnancy in our study was 53.2%. This finding is greater than other studies , 17. It Being grand multipara was more likely associated with unhealthy practice in our study. The reason could be elder mothers accepted as cultural practice from the past generation. Education status was more likely associated with unhealthy practice. This finding is observed in other study , 15. ThiThis study might have an implication maternal and child health care; by identifying the gaps it supports to reduce maternal and neonatal morbidity and mortality and to improve quality of reproductive health care.The magnitude of unhealthy practice was high in Southern Ethiopia. This study identified the following unhealthy practices such as food prohibition, home delivery, discarding colostrum, unhygienic cord cutting, delayed breastfeeding, prelacteal feeding and early bathing. Grand multipara, literate and lack of awareness on the effect of unhealthy practice were predictive factors of outcome variable.Community education and behaviour change messages are recommended to minimize unhealthy care during pregnancy, childbirth, postnatal and neonatal period.First, the nature of cross-sectional study design could not establish the cause and effect relationship. Secondly, there is no assessing of qualitative findings for possible triangulation. Lastly, there is possible recall bias among mothers relating to events happening in the past.


Wuchereria bancrofti and Onchocerca volvulus as prevalences of both infections move toward their respective elimination targets. The SD Bioline Onchocerciasis/LF IgG4 Rapid Test was used in 2 evaluation units (EU) to assess its performance as an integrated surveillance tool for elimination of lymphatic filariasis (LF) and onchocerciasis.Mali has become increasingly interested in the evaluation of transmission of both A cross sectional survey with SD Bioline Onchocerciasis/LF IgG4 Rapid Test was piggy-backed onto a transmission assessment survey (TAS) (using the immunochromatographic card test (ICT) Binax Filariasis Now test for filarial adult circulating antigen (CFA) detection) for LF in Mali among 6–7 year old children in 2016 as part of the TAS in two EUs namely Kadiolo-Kolondieba in the region of Sikasso and Bafoulabe -Kita-Oussoubidiagna-Yelimane in the region of Kayes.W. bancrofti CFA was 0.62%  [CI = 0.31–1.09]; while that of IgG4 to Wb123 was 0.19%  [CI = 0.04–0.50]. The number of positives tested with the two tests were statistically comparable (p = 0.09). In the EU of Bafoulabe-Kita-Oussoubidiagna-Yelimane, an overall prevalence of W. bancrofti CFA was 0%  and that of Wb123 IgG4 antibody was 0.06% , with no statistically significant difference between the two rates (p = 0.99).In the EU of Kadiolo- Kolondieba, of the 1,625 children tested, the overall prevalence of O. volvulus-hyperendemic district of Kolondieba. In the EU of Bafoulabe-Kita-Oussoubidiagna-Yelimane, an overall prevalence of Ov16-specific IgG4 was 0.18%  [CI = 0.04–0.47]. These 3 Ov16 IgG4 positives were from previously O.volvulus-mesoendemic district of Kita.In the EU of Kadiolo- Kolondieba, the prevalence of Ov16-specific IgG4 was 0.19%  [CI = 0.04–0.50]. All 3 positives were in the previously The SD Bioline Onchocerciasis/LF IgG4 Rapid test appears to be a good tool for integrated exposure measures of LF and onchocerciasis in co-endemic areas. After years of mass drug administration for lymphatic filariasis and onchocerciasis, many co-endemic countries need to demonstrate the interruption of transmission of these parasitic infections. This interruption of transmission is the key to stopping mass drug administration. One of the major challenges facing national programs is a reliable point of care diagnostic tool capable of detecting recent infection in children. To this end, the SD Bioline Onchocerciasis / LF IgG4 Rapid Test was used to evaluate the transmission interruption of lymphatic filariasis and onchocerciasis in previously endemic regions of Mali. This rapid diagnostic tool demonstrated good performance in 6 of districts in 2 “so-called’ evaluation units. There was very good overlap of the serological results obtained by the rapid diagnostic test (RDT) and previous endemicity profile of the different study districts for the two infections. We would argue that this RDT could be a single integrated approach for assessing transmission in areas where lymphatic filariasis and onchocerciasis are/were co-endemic. Approaches to onchocerciasis control and lymphatic filariasis (LF) elimination have proceeded along parallel but independent courses in Mali. For LF, annual mass drug administration (MDA) with albendazole and ivermectin began in 2004 and continued for 5 to 9 consecutive MDA campaigns. Onchocerciasis was originally highly endemic in five regions of Mali  as recommended by World Health Organization (WHO) were initiated in 2012 and are currently being performed in 22 evaluation units (EU). An EU includes one or several endemic districts based on geographic location, treatment coverage and population size .Loa loa infection, a filarial parasite that is absent in Mali . When assessed at the district level, the CFA prevalence was 0.69% [95% CI = 0.21–1.65] in Kadiolo and 0.57% [95% CI = 0.23–1.19] in Kolondieba. In the same EU, the overall prevalence of Wb123 IgG4 was 0.19% [95% CI = 0.04–0.50]; when assessed per district, the prevalence of IgG4 to Wb123 was 0.20% [95% CI = 0.0–0.97] in Kadiolo and 0.18% [95% CI = 0.03–0.60] in Kolondieba . For the Wb123 IgG4 antibody, only 1/1,700 (0.06% [95% CI = 0.0–0.28]) was found. This single positive was reported in the district of Bafoulabe; thus the local prevalence of Wb123 IgG4 was 0.21% [95% CI = 0.01–1.06]  were IgG4 positive to Ov16, but the upper 95% confidence level around this 0% prevalence was 0.59%.There was no statistical difference between the number positive (0/502) in Kadiolo, an O. volvulus-hypoendemic district and Kolondieba a previously O. volvulus-hyperendemic district  (p = 0.55). In the EU of Bafoulabe-Kita-Oussoubidiagna-Yelimane, an overall prevalence of Ov16-specific IgG4 of 0.18% [95% CI = 0.04–0.47] was recorded. These 3 individual Ov16 IgG4 positives were in the district of Kita among the 713 children tested, giving a prevalence of 0.42% for this district [95% CI = 0.10–1.14] , although there were no Ov16 positive children, the upper limit of the 95% CI exceeded 1%, suggesting that cut off point of antibody positivity for children should be raised above the 0.1% threshold. The comparison of positive cases of Ov16 between the previous O. volvulus-hypoendemic district (Yelimane) and the previous O. volvulus-mesoendemic district with 3 positives cases was similar (p = 0.99).Again it should be noted that in the CFA positive children were found primarily in the EU of Kadiolo-Kolondieba with 10 CFA positives detected using Binax Filariasis Now test in five different villages . No CFA Overall, single Ov16 or Wb123 IgG4-positive children were spread across 5 different villages of the 30 villages screened in Kadiolo–Kolondieba EU .O. volvulus and W. bancrofti as prevalences of both infections move toward their respective elimination targets. This reduction is due to the fact that the national lymphatic filariasis elimination program, since its creation, has distributed the required number of mass treatment campaigns with at least 5 consecutive rounds of albendazole and ivermectin treatment; thus TAS is ongoing in the different EUs  while the seroprevalence (antibodies) targeting the same parasite was 0.19% [95% CI = 0.04–0.50]. In the EU of Bafoulabe-Kita-Oussoubidiagna-Yelimane, the CFA prevalence was 0% [95% CI = 0.0–0.17] while the antibody seroprevalence was 0.06% [95% CI = 0.0–0.28]. The prevalences of LF infection measured using these two tests were comparable and with all the tests, the upper bounds did not reach the cutoff point of 2%  or antigen (CFA) testing, we suggest that the measurement of IgG4 to Wb123 might be preferable in decisions to stop MDA or in TAS following cessation of MDA as it allows the measurement of recent exposure. The challenge remains, however, to determine an acceptable prevalence threshold that would guarantee interruption of W. bancrofti transmission particularly since vector monitoring is not part of most LF elimination programs. In the Gambia, the recent use of the Wb123 IgG4 test suggests that this serological tool could be used to decide to stop MDA [Recent studies suggested that the Binax Filariasis Now test may overestimate the evalence ,17. Giveevalence , given tevalence  and givestop MDA . TherefoO. volvulus  assessment, the level of exposure to O. volvulus, as determined by the detection of the IgG4 antibodies to Ov16, the current prevalence estimates overlaid quite nicely with previous epidemiological profiles of the different study districts (Tables O. volvulus transmission level was above the current elimination threshold (0.1%) among the 6–7 year old, though the utility of this 0.1% target as a threshold is currently under debate [O. volvulus transmission  [Despite the application of the LF strategy for sampling of s Tables . All Ov1r debate ,21. The r debate . HoweverO. volvulus transmission potentials in subregions of countries such as Mali where many areas have undergone more than 24 years of CDTi with no or few epidemiological assessments [Within the context of onchocerciasis elimination, new data are needed to re-categorize essments . Moreoveessments . The seressments .Overall, the SD Bioline Onchocerciasis/LF IgG4 Rapid Test Wb123/Ov16 test, has 84% sensitivity and 98–99% specificity . As no aW. bancrofti and O. volvulus in children, with the potential to be used as a surrogate for interruption of transmission in a given focus as well as in post-MDA impact mesures in local populations in countries such as Mali. These data suggest that there is likely little or no transmission of either O. volvulus or W. bancrofti. Moreover, given the upper limits of the CI for Ov16 IgG4 in an O. volvulus-hypo-endemic region (and the fact that it does not differ from the hyper- and meso-endemic regions) a 0.1% threshold based on Ov-16-based IgG4 immunoassays may certainly be too conservative. Obviously, additional data underlying the utility of this POC test will be necessary if the elimination goals for both onchocerciasis and LF are to be achieved.Based on the present study using the SD Bioline Onchocerciasis/LF IgG4 Rapid Test in previously LF- and onchocerciasis co-endemic regions in Mali, this POC test appears to be a good tool for integrated measurement of exposure to