Background. Giardia duodenalis causes sporadic or epidemic infections in humans. The parasite comprises assemblages A-H with A and B subdivided further into AI-IV and BI-IV subassemblages. Attempts aimed at linking these genotypes with sources and gastrointestinal manifestations of the infection are largely unexplored in rural communities. Methods. In this cross-sectional study, G. duodenalis infection was genotyped and associated with sources, and gastrointestinal signs and symptoms of the disease among residents of Busia County, a rural setting in western Kenya. Demographic and clinical information were captured using standardized forms. Stool specimens were obtained from the patients and used for genotyping at glutamate dehydrogenase and triose-phosphate isomerase loci using the polymerase chain reaction and restriction fragment length polymorphism. Results. Assemblage B (63.6%) was the most prevalent G. duodenalis infection, while A (20.5%) and mixed A/B (15.9%) were also detected. Among the subassemblages, AI (5.7%), AII (8.0%), AIII (3.4), BIII (30.7%), and BIV (17.0%) were diagnosed including the mixed AII/BIII (15.9%), BIII/BIV (15.9%), AI/AIII (2.3%), and AI/AII (1.1%) infections. Binary logistic regression indicated associations for assemblage A with stomach upset, history of nitroimidazole treatment, and residing in a homestead with cattle and B with years, history of eating outdoors, vomiting, steatorrhea, and residing in a homestead with cattle, goats, and poultry ( for all). Among the subassemblages, associations were found for AI with residing in a homestead having cattle and history of nitroimidazole treatment, BIII with residing in a homestead having cattle and poultry, and BIV with steatorrhea ( for all). Altogether, this study illustrates that G. duodenalis assemblage B and subassemblage BIII are the most predominant and are linked to years, gastrointestinal manifestations, and living in a homestead with domestic ruminants and poultry. Conclusion. Targeted mass prophylactic treatment of domestic animals and utilization of gastrointestinal presentations, years, and a history of nitroimidazole use are useful in the diagnosis and prevention of giardiasis among residents of rural communities.

Introduction. Depression is the most common mental health disorder worldwide with a lifetime prevalence of approximately 10% in the general population. Our objective was to assess the knowledge, attitudes, and practices among healthcare workers (HCWs) regarding depression care. Methods. We conducted a cross‐sectional study among consenting healthcare workers in two medium‐sized hospitals in Kenya. Data on demographic characteristics, knowledge, attitude, and practice of depression were collected through a self‐administered structured questionnaire. The Revised Depression Attitude Questionnaire was incorporated into the questionnaire. Knowledge and attitude scores were computed, where higher scores suggested higher knowledge or more positive attitudes. Descriptive and regression analyses were used to assess associations, and a p value of < 0.05 was considered significant. Results. Among the 316 HCWs approached, 303 (95.9%) consented and were enrolled. Almost two‐thirds (64.0%) of the respondents were female, and 58.4% were between 18 and 29 years old. HCWs were categorised into three: nurses, clinicians (doctors/clinical officers), and nonclinicians (other healthcare workers). The median knowledge score among respondents was 9 out of 10. Nonclinicians scored significantly lower (β = −0.5, p < 0.011) on the knowledge score compared to clinicians. Only 9.3% of the respondents strongly agreed or agreed that they were confident in assessing the risk of suicide in patients with depression. The median attitude score among respondents was 65 out of 110. The attitude score was positively associated with the knowledge score (β = 0.78, p = 0.001), and respondents with professional experience of 5‐14 years had higher attitude scores compared (β = 1.7, p = 0.023) to those with fewer than 5 years. Among clinicians and nurses, 40.3% reported that they rarely or have never been screened for depression. Conclusions. HCWs demonstrated good knowledge of depression’s symptoms and causes but lacked confidence in pharmacological management, with gaps in regular screening and comprehensive care practices, particularly among nonclinicians and less experienced staff. Focused training for these groups could enhance the early detection and treatment of depressed patients.

Objectives. Staphylococcus aureus is one of the most common pathogens attributed to hospital infections. Although S. aureus infections have been well studied in developed countries, far less is known about the biology of the pathogen in sub-Saharan Africa. Methods. Here, we report on the isolation, antibiotic resistance profiling, whole genome sequencing, and genome comparison of six multi-drug resistant isolates of S. aureus obtained from a referral hospital in Kakamega, Western Kenya. Results. Five of the six isolates contained a 20.7 kb circular plasmid carrying blaZ (associated with resistance to β-lactam antibiotics). These five strains all belonged to the same sequence type, ST152. Despite the similarity of the plasmid in these isolates, whole genome sequencing revealed that the strains differed, depending on whether they were associated with hospital-acquired or community-acquired infections. Conclusion. The intriguing finding is that the hospital-acquired and the community-acquired isolates of S. aureus belonging to the same genotype, ST152, formed two separate sub-clusters in the phylogenetic tree and differed by the repertoire of accessory virulence genes. These data suggest ongoing adaptive evolution and significant genomic plasticity.

Autophagy dysfunction is a hallmark of type 1 diabetes. However, the precise molecular mechanism of proteinuria-induced dysfunctional autophagy remains unclear. Herein, we investigated the role of programmed cell death 4 (PDCD4) in the regulation of autophagy in the pathogenesis of diabetic kidney disease (DKD) in vivo and in vitro. RT-qPCR, immunohistochemistry (IHC), and western blotting demonstrated an upregulation of Pdcd4 mRNA and protein in streptozotocin (STZ)-induced DKD rats, as compared to the control. In addition, IHC and western blotting of a unilateral ureteral obstruction mouse model showed an upregulation of PDCD4 in the disease group, as compared to their respective controls. IHC analysis of kidney biopsy samples of human DKD patients showed an upregulation of PDCD4 compared to the control. Western blotting of the STZ-induced DKD rat tissues displayed a low microtubule-associated protein 1A/1B-light chain 3 (LC3)-II, as compared to the control. It was found that albumin overload in cultured PTECs upregulated the expression of PDCD4 and p62 and decreased the expression of LC3-II and autophagy-related 5 (Atg5) proteins. The knockout of Pdcd4 in cultured PTECs could reduce albumin-induced dysfunctional autophagy, as evidenced by the recovery of Atg5 and LC3-II protein. The forced expression of PDCD4 could further suppress the expression of the crucial autophagy-related gene Atg5. Evidence suggests that endogenous PDCD4 promotes proteinuria-induced dysfunctional autophagy by negatively regulating Atg5. Therefore, PDCD4 may be a potential therapeutic target in DKD.

Staphylococcus aureus is one of the most common pathogens associated with hospital infections. Although S. aureusinfections have been well studied in developed countries, far less is known about the biology of the pathogen in sub-Saharan Africa. Here, we report on the isolation, antibiotic resistance profiling, whole genome sequencing, and genome comparison of six multi-drug resistant isolates of S. aureus obtained from a referral hospital in Kakamega, western Kenya. Five of the six isolates contained a 20.7-kb circular plasmid carrying blaZ (associated with resistance to b-lactam antibiotics). These five strains all belonged to the same sequence type, ST152. Despite the similarity of the plasmid these isolates, whole genome sequencing revealed that the strains differed, depending on whether they were associated with hospital-acquired or community-acquired infections. The most striking difference was the larger number of horizontally-acquired genomic islands (GIs) in the nosocomial isolates. The data indicate that adaptation to the hospital environment may also be linked with mutations in the uvrAB genes.

Reference intervals (RIs) are used in the interpretation of clinical laboratory data to help doctors reach a medical decision point. However, due to a variety of reasons, RIs varies significantly between various populations. This study aimed at establishing transferrin, and IUBC reference intervals that can be used locally for the interpretation of iron indices at MTRH. A cross sectional study was conducted at Moi Teaching and Referral Hospital, 290 healthy volunteers were enrolled in the study where their transferrin and IUBC were examined. The non-parametric approach was used to determine reference values with a 95% confidence interval. The Sigma diagnostics approach was used to verify the established Ris. IBM SPSS version 23.0 was used to conduct the statistical analysis. Mann-Whitney U tests were used to compare genders for significant differences. The established reference intervals for Transferrin: males: 2.13–4.01 g/L, females, 2.08–4.04 g/L; UIBC: males, 20.50–64.08 umol/L, females: 20.07–64.21 umol/L. Comparisons between genders for significant differences were done using Mann-Whitney U tests, revealing no significant gender-based differences between transferrin and UIBC exhibited. The established reference intervals in this study are age and sex-specific for routinely used transferrin and IUBC catering for the adult population of Uasin Gishu County aged 18–64 years. The result will assist the clinicians in reaching an informed medical decision.