Background Bedaquiline and delamanid offer the possibility of more effective and less toxic multidrug-resistant tuberculosis (MDR-TB) treatment. With this treatment, however, some patients, remain at high risk for an unfavorable treatment outcome. The endTB observational study is the largest multicountry cohort of patients with rifampin-resistant/MDR-TB treated in routine care, according to WHO guidance, with delamanid-and/or bedaquiline-containing regimens. We report frequency of sputum culture conversion within six-months of treatment initiation and risk factors for non-conversion. Methods We included patients with a positive baseline culture who initiated a first endTB regimen prior to April 2018. Two consecutive negative cultures collected > 15 days apart constituted culture conversion. We used generalized mixed models to derive marginal predictions for the probability of culture conversion in key subgroups. Findings 1,109 patients initiated a multidrug treatment containing bedaquiline (63%), delamanid (27%) or both (10%). Of these, 939 (85%) experienced culture conversion within six months. In adjusted analyses, patients with HIV had a lower probability of conversion (0•73 [95% CI: 0•62, 0•84]) than patients without HIV (0•84 [95% CI: 0•79, 0•90]; p=0•03). Patients with both cavitary disease and highly positive sputum smear had a lower probability of conversion (0•68 [95% CI: 0•57, 0•79]) relative to patients without either (0•89; 95% CI: 0•84, 0•95; p=0•0004). Hepatitis C infection, diabetes mellitus/glucose intolerance, and baseline resistance were not associated with conversion.

Background Drug-resistant tuberculosis (DR-TB) is considered to be a public health threat and is difficult to cure, requiring a lengthy treatment with potent, potentially toxic drugs. The novel antimicrobial agent bedaquiline has shown promising results for patients with DR-TB, improving the rate of culture conversion and reducing TB-related mortality. However, increasing numbers of cases with acquired bedaquiline resistance (ABR) have been reported in recent years. Methods This systematic review aimed to assess the frequency of ABR and characteristics of patients acquiring it. Studies showing data on sequential bedaquiline drug-susceptibility testing in patients treated with a bedaquiline-containing regimen were included. The databases CENTRAL, PubMed and Embase were manually searched, and 866 unique records identified, eventually leading to the inclusion of 13 studies. Phenotypic ABR was assessed based on predefined MIC thresholds and genotypic ABR based on the emergence of resistance-associated variants. Results The median (IQR) frequency of phenotypic ABR was 2.2% (1.1%–4.6%) and 4.4% (1.8%–5.8%) for genotypic ABR. Among the studies reporting individual data of patients with ABR, the median number of likely effective drugs in a treatment regimen was five, in accordance with WHO recommendations. In regard to the utilization of important companion drugs with high and early bactericidal activity, linezolid was included in the regimen of most ABR patients, whereas the usage of other group A (fluoroquinolones) and former group B drugs (second-line injectable drugs) was rare. Conclusions Our findings suggest a relevant frequency of ABR, urging for a better protection against it. Therefore, treatment regimens should include drugs with high resistance-preventing capacity through high and early bactericidal activity.

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IntroductionSelf-medication is an important public health problem, with varied prevalence across the world. The high prevalence of self-medication in India is one of the important factors contributing to the development of antimicrobial resistance. Self-medication without medical guidance can lead to inappropriate, incorrect, or undue therapy, missed diagnosis, delays in appropriate treatment, pathogen resistance, and increased morbidity. The growing trend of self-medication can be attributed to various factors like the urge for selfcare, sympathy toward sick family members, inaccessible health services and nonavailability of drugs, time and financial constraints, ignorance, misbeliefs, extensive advertisement and availability of drugs in places other than drug shops. MethodologyThe present community-based descriptive cross-sectional study was conducted in an urban field practice area of a tertiary health care center (UHTC) in Central India. Individuals above 18 years of age and present at home at the time of the house-to-house survey comprised the study participants. A total of 400 participants were enrolled in the study. Data were collected using a predesigned and pretested questionnaire by the faceto-face interview technique. ResultsThe prevalence of self-medication in the area was 60 % (240). The most widely used drugs for selfmedication were analgesics (159; 66.25%) and antipyretics (142; 59.16%). Common ailments for which selfmedication was used frequently were fever, body aches, common cold, and cough. It was observed that female participants were twice more likely to self-medicate as compared to male participants (Odds Ratio (OR): 2.04; Prevalence (p) = 0.014, Confidence Interval (CI) 95% = 1.15-3.62). Additionally, those having education above the high school level had more chances of self-medicating than those educated less than high school (OR: 1.25; p≤0.014, CI 95%=1.05-1.50). The commonest reasons for resorting to selfmedication as per the findings of the present study are that it saves time and the condition was not serious enough to warrant a physician's consultation.

This essay explores the relevance of postcolonial theory to migration. In so doing, it begins with the premise that, by definition, the postcolonial must be considered in the light of migration. For, above all, the postcolonial is about dislocation. In turn, if migration is a major issue in many national and regional debates and policies, then this is largely because of the influx of migrants to the West from the less affluent countries of Asia, Africa, and Latin America; in other words, from postcolonial nations, whereby issues of class, race, ethnicity, and religion feature prominently, as do questions of national purity and contamination, inside and outside, self and other. Equally, it is important to note that postcolonial theory is not always the sole theoretical inroad to the study of migration: many migrants, especially those who are skilled, economically secure, and welcome in their host countries, do not share the struggle or the deep historical dislocation of the postcolonial. However, those many millions of immigrants who cross borders and live tenuous lives in inhospitable circumstances do share the context of the postcolonial, for, ultimately, this issue is one of class, subjugation, and exploitation. The larger backdrop here is that of the history of globalization, a process whose roots go back to colonial ventures and whose impact at a planetary level is sharply on the increase, with often dire consequences that range from the social to the environmental. The parity between the postcolonial and the migrant brings to light the crucial question of persisting empire in the age of globalization. At the heart of this ongoing process are the ideology and practices of capitalism.

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ObjectivesThis study was conducted to explore the epidemiology and microbiological pattern of the cholera outbreaks that occurred in Zimbabwe from 2018 to 2019.Study setting and designThis descriptive study used secondary data of 9971 out of 10 730 suspected cases from the Zimbabwean National Diseases Surveillance system and microbiology data of 241 out of 371 patients from the National Microbiology Reference Laboratory in Harare, for the period 5 September 2018 and 3 January 2019. Descriptive analysis was performed to describe the characteristics of the outbreak in terms of person, place and time.ResultsA cumulative total of 10 730 suspected, 371 laboratory-confirmed cholera cases and 68 deaths were reported in Zimbabwe through the situation analysis report (sitrep). The attack rate during the outbreak was 174.6 per 100 000 with a case fatality rate of 0.63%. Most cases seen were among adults from Harare province. Antimicrobial sensitivity testing results showed that a multidrug resistant strain ofVibrio choleraeO1, Ogawa serotype was responsible for the outbreak. The treatment of cases was changed from the standard recommended medicine ciprofloxacin to azithromycin as confirmed by the antimicrobial sensitivity test results. Strategies employed to contain the outbreak included mass oral cholera vaccination in the hotspot areas of Harare, provision of improved and appropriate sanitation measures, provision of safe and adequate water, chlorination of water and improved waste management practice.ConclusionsThe recurrence of a cholera outbreak is a global concern, especially with the emergence of multi-drug resistant strains of the causal organism. Improving water, sanitation, hygiene infrastructure, health system strengthening measures and inter-sectoral collaboration in responding to the cholera outbreak was key to controlling the outbreak.

In 1999 EMI distributed Las 3000 Viviendas: Viejo Patio, an anthology of amenco music produced by Paco Ortega through his own company Dulcimer Songs. The project show-c ased the music of a community of gypsies relocated to Las Tres Mil Viviendas during the Franco regime in Spain from their traditional barrio of La Triana in Seville. Although retaining a predominantly oral culture, these gitanos had also begun to assimilate other musical forms and to adapt their creative and performance styles to new technologies. The disk produced by Paco Ortega circulated in the inter national market as yet another example of "world music." It included a variety of amenco forms, from the traditional to the more recent, performed by the inhabitants of Las Tres Mil Viviendas, ranging from the elderly to the very young, and was intended to represent the collective lives of the community. This combination of elements raises several questions about the creation and circulation of such cultural products in a globalised cultural economy. Hence, the purpose of this essay: to identify some of the issues that surface and to consider them in relation to the production and circulation of Las 3000 Viviendas: Viejo Patio.