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"Seeley, Tim, author"
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Etiology and Antimicrobial Resistance of Culture-Positive Infections in Ugandan Infants: A Cohort Study of 7000 Neonates and Infants
Epidemiological evidence about the etiology and antimicrobial resistance of neonatal infections remains limited in low-resource settings. We aimed to describe the etiology of neonatal infections in a prospective observational cohort study conducted at two hospital sites in Kampala, Uganda.
Babies admitted to either unit with risk factors or signs of sepsis, pneumonia, or meningitis had a blood culture, nasopharyngeal swab, and lumbar puncture (if indicated) collected. Basic demographics were collected, and babies were followed up until discharge or death to determine admission outcome. Blood cultures were processed using the BACTEC system and identification confirmed by matrix-assisted laser desorption/ionization time-of-flight mass spectrometry. Cerebrospinal fluid was processed using standard microbiological testing and swabs were processed using the multiplex real-time polymerase chain reaction assay. Antimicrobial susceptibilities of bacterial isolates to World Health Organization-recommended first-line antibiotics (ampicillin or benzylpenicillin and gentamicin) were assessed using e-tests.
A total of 7323 infants with signs or risk factors for sepsis had blood cultures, 2563 had nasopharyngeal swabs, and 23 had lumbar punctures collected. Eleven percent of blood cultures and 8.6% of swabs were positive. Inpatient mortality was 12.1%, with 27.7% case fatality observed among infants with Gram-negative bloodstream infections.
(14.8%),
spp. (10.3%), and
spp. (7.6%), were notable contributors to Gram-negative sepsis, whereas Group B
was the predominant Gram-positive pathogen identified (13.5%). Almost 60% of Gram-negative pathogens were ampicillin- and gentamicin-resistant.
Our study demonstrates high levels of antimicrobial resistance and inpatient mortality from neonatal sepsis in the first months of life in Uganda. This underscores the pressing need for revised, context-specific antimicrobial treatment guidelines that account for the evolving landscape of antimicrobial resistance in neonatal sepsis.
Journal Article
Grayson. Volume 2, We all die at dawn
\"Grayson and Helena Bertinelli, a.k.a. Huntress, join together and take on some of their toughest foes yet. Dick is on a mission to stop Paragon from using the body parts of a dead villain to create something far more sinister, he goes toe-to-toe with the Midnighter, and he and Helena battle foes from their past--the Fist of Cain. Plus, a tie-in to FUTURES END!
Book
HIV Exposure and Neonatal Sepsis: A Descriptive Etiological Study
Low- and middle-income countries lack data on culture-confirmed sepsis in HIV-exposed infants, despite the reported heightened risk of infectious morbidity. This study describes culture-confirmed sepsis and antibiotic resistance patterns among HIV-exposed children in a large etiological cohort study in Kampala, Uganda.
This was a prospective birth cohort study based at 2 Ugandan sites, as part of the Progressing Group B Streptococcal Vaccines (PROGRESS) study. Any infant with risk factors, signs, or symptoms of infection presenting before 3 months of age had a blood culture and nasopharyngeal swab taken to determine the etiology of neonatal and young infant sepsis.
Among 4492 blood cultures, 460 were obtained from HIV-exposed infants. Nine infants (1.9%) had positive blood cultures. The most frequently isolated organisms were
, group B
, and
, and these organisms demonstrated resistance to the common antibiotics (aminoglycosides, penicillins, and cephalosporins) used for management of suspected sepsis. A higher proportion of the exposed babies died vs HIV-unexposed (15.8 vs 11.2;
= .005). Nasopharyngeal swabs were collected from 114 infants, with 7.9% positive for at least one virus or bacterium.
Future work is needed to investigate why mortality among HIV-exposed infants persists despite maternal antiretroviral treatment. Antimicrobial resistance is an increasing concern in this setting.
Journal Article
Blockbuster
\"Dick Grayson, also known as Nightwing, has adopted Bludhaven as his home, and it's his mission to keep the streets safe from the high-tech weapons that are suddenly pouring in...even if it puts his newly stable relationship with his girlfriend Shawn in jeopardy. But for the super-strong criminal known as Blockbuster, Bludhaven isn't just an adopted home--it's in his veins. So when he reaches out to Nightwing to help him rid the streets of these deadly weapons, will Dick find himself with a powerful new ally...or walking into a deadly trap? Plus, Dick's former identity as Grayson, Agent of Spyral comes back to pay a visit in the form of Huntress!\"-- Provided by publisher.
Book
Community Perceptions of Neonatal Infection in Uganda
We investigated awareness of neonatal infections among a population of pregnant women and other community members in Kampala, Uganda. We explored perceived causes of neonatal infections and perceptions of appropriate treatments.
We conducted focus group discussions (FGDs) and in-depth interviews (IDIs) with 97 participants: 25 community leaders who took part in 3 FGDs, 12 pregnant women who took part in IDIs, and 60 pregnant women who took part in 8 FGDs, between November 2019 and October 2020. Data were analyzed thematically. This work formed part of the PROGRESS study, an observational cohort study undertaken in Kampala, Uganda, between November 2018 and April 2021.
Beliefs about causes, signs, symptoms, and treatment of infants with suspected infections impacted health-seeking behavior. Some illnesses were perceived to be caused by environmental factors while others were believed to have social or behavioral causes, such as the promiscuity of the male partner causing infections or the mother being bewitched. Local herbs and traditional remedies were the most preferred method of treatment and were commonly relied on to address various health issues rather than conventional medicines. Notably, no participant mentioned vaccines as a way of preventing infections.
Pregnant women and community members' understanding of the causes and treatment of neonatal illnesses were diverse, including environmental, social-behavioral, and supernatural causes, while both conventional and traditional remedies were perceived as appropriate treatments and sought accordingly. Understanding community perceptions and practices around neonatal infections is key to improving neonatal health interventions and outcomes.
Journal Article
Nightwing. Vol. 5, Raptor's revenge
\"As Raptor's influence expands and his plans grow more sinister, Nightwing must rally the city and the Run-Offs and hope that Blockbuster's hatred of him doesn't outweigh his loyalty to the people of the Blèudhaven. Nightwing rejected Raptor's offer to be his new protâegâe. And since he escaped prison months ago, Raptor has been making his plans to show Nightwing that if he didn't want Raptor as a mentor--he will get him as the worst enemy he's ever had. Now Raptor is back in Blèudhaven with secrets and a plan that will tear the city apart--and could put Nightwing out of commission forever\"-- Provided by publisher.
Book
Rapid Point-of-care Testing to Inform Intrapartum Treatment of Group B Streptococcus –Colonized Women in Uganda
Maternal Group B
(GBS) rectovaginal colonization is an important risk factor for invasive disease in neonates, yet availability of culture-based methods for detection is limited in low-resource settings. We evaluated the diagnostic performance of the HiberGene (HG) GBS loop-mediated isothermal amplification (LAMP) assay for the rapid detection of GBS in rectal/vaginal swabs collected from women in Uganda. This work forms a part of the PROGRESS GBS study.
In phase 1, 1294 rectal and vaginal swabs were collected from pregnant women and inoculated in enrichment (Lim) broth, which was then tested using the HG GBS LAMP assay (
gene target) and culture on chromogenic agar. In phase 2, 166 swabs from nonpregnant women were tested directly (without the enrichment step). For samples with discordant results, an additional method of testing against multiplex real-time polymerase chain reaction assay was used.
Overall, the HG GBS LAMP assay detected more GBS-positive samples (31.3%; 452/1445) than culture-based methods (13.3%; 192/1445). Multiplex polymerase chain reaction-tested results were concordant with LAMP results in 96.3% of cases. The sensitivity and specificity of the LAMP assay, after adjusting for the tiebreaker results of discordant samples, were 94.4% (95% confidence interval, 86.2-99.4) and 99.0% (95% confidence interval, 94.3-100), respectively.
The results of this study demonstrate high sensitivity and specificity of the HG GBS LAMP assay for the detection of GBS rectovaginal colonization in our setting. Given its rapid turnaround time, the HG GBS LAMP assay could appropriately be used to screen women for GBS rectovaginal colonization during labor to enable provision of intrapartum antibiotic prophylaxis.
Journal Article
Justice League vs. Suicide Squad
\"The first major crossover of the Rebirth era starring the biggest heroes and villains in comics, this action-packed epic JUSTICE LEAGUE VS. SUICIDE SQUAD features an all-star creative team, including writers Joshua Williamson, Tim Seeley, Rob Williams and Si Spurrier, with superstar artists Jason Fabok, Tony S. Daniel, Jesus Merino, Fernando Pasarin, Robson Rocha, Howard Porter, Scot Eaton, Riley Rossmo, Christian Duce, Giuseppe Cafaro and more! The members of the Justice League are Earth's most powerful and famous superheroes ... but they aren't the only team in town. The Suicide Squad strikes from the shadows and does the jobs too dirty for superheroes to handle. Under the iron fist of Director Amanda Waller, these monsters and maniacs have operated in total secrecy ... until now. Batman is on their trail and the Squad's existence isn't something he or the Justice League can tolerate. It must be shut down. But while the heroes and antiheroes are distracted fighting each other, twisted mastermind Maxwell Lord assembles a nightmarish army of DC's deadliest villains to take out both teams!\"-- Provided by publisher.
Book
Seroprevalence of Cytomegalovirus Among Pregnant Women at Kawempe National Referral Hospital, Uganda: A Cross-sectional Study
Maternal primary cytomegalovirus (CMV) infection is associated with abortion and congenital anomalies. In Uganda, the burden of maternal CMV infection is not well studied. This study thus assessed the seroprevalence and factors associated with CMV infection among pregnant women at Kawempe National Referral Hospital in Kampala. This work forms a part of the PROGRESS study, an observational cohort study undertaken in Kampala, Uganda, between November 2018 and April 2021.
We conducted a cross-sectional study between September 2020 and January 2021 among the 639 pregnant women admitted to the labor ward at a government hospital. Sociodemographic, medical, obstetric, and socioeconomic data were collected. Blood samples from study participants were drawn and analyzed for the presence of CMV immunoglobulin G (IgG) and IgM using enzyme-linked immunosorbent assay-based quantitative assays. Further analysis of all IgM-positive samples was conducted using CMV IgG avidity assays. All infants had a nasal polymerase chain reaction (PCR) on the first day of life to investigate CMV positivity. Logistic regression was performed to determine the factors associated with CMV infection.
Seroprevalence of CMV IgG among the 637 women was universal (100%), and that of CMV (IgM) was 5.8% (37/637). CMV (IgM) was associated with being low socioeconomic status (odds ratio, 3.44; 95% CI, 1.05-11.32;
= .04). Transmission risk was low, and no infant had a positive PCR for CMV at birth.
Universally, by the time women in Kampala conceive, they will have been exposed to CMV. Women of lower socioeconomic status were more likely to have recent CMV infection than their more affluent counterparts, highlighting the need for screening guidelines in this setting.
Journal Article