Tropical medicine and infectious diseases

Background: Endemic countries like India are burdened with the bludgeoning effects of tuberculosis. While pulmonary tuberculosis is more prevalent and communicable, diagnosis of extra pulmonary tuberculosis (EPTB) is more challenging. This was a retrospective study done for three consecutive years 2013 to 2015. The extra-pulmonary smear samples from patients suspected of tuberculosis were stained with Zeihl Neelsen stain and examined. Results: Based on ZN stain, EPTB was diagnosed in 13.4%, 9.5%, 10.6% suspected cases between 2013 to 2015 respectively. Highest positivity was seen among pus aspirates from lymph nodes in 13-25 years age group. New technological advances are being made all across the globe for faster and specific tuberculosis diagnosis. However in resource limited settings, reliance is often on the smear microscopy findings. Diligently observed smears increase chances of diagnosis and is often rewarding.

Isolated Amazonian peoples such as the Urarina in Peru remain atrisk of cultural and biological extinction from industrial exploitation and imported diseases. In the last seven years, many Urarina have died in epidemics of measles, cholera, pertussis, and malaria. The Peruvian government has encouraged oil exploration and logging in the Amazon without regard to Urarina rights, and the international treatypromotingindigenous rights that Peru ratified is not enforced. There are, however, two promising developments for indigenous survival. The first is the growing realization of biologists, ecologists, sociologists, and conservationists that conservation of biodiversity and global environmental protection are interconnected with indigenous rights. Secondly, the two declarations on the rights of indigenous peoples proposed by the Organization of American States and the United Nations are more specifically protective of indigenous rights than previous manifestos have been.

The germ tube production in serum is a rapid method for identification of Candida. Because of the time required to prepare human serum and inherent safety problems concerned with its use, many laboratories have started using non human serum germ tube media. The objective of this study was to evaluate different media for germ tube production of C. albicans and C. dubliniensis. 132 C. albicans and 30 C. dubliniensis isolates were tested for germ tube production in various media like horse serum, pooled human serum, human plasma, trypticase soy broth, egg white and peptone water. Out of 132 C. albicans, germ tube production was seen in 130 isolates in trypticase soy broth, 124 isolates produced germ tube in pooled human serum and horse serum. In case of C. dubliniensis (n=30), 27(90%) isolates produced germ tube in trypticase soy broth and pooled human serum. In horse serum 26 isolates showed germ tube test positive. Our study shows that trypticase soy broth is the best medium for testing germ tube production of C. albicans and C. dubliniensis. It is more stable, effective, less expensive and safe than other media.

vasculitis and perivasculitis which may involve the lungs, heart, liver, spleen, and CNS. Detection of O. tsutsugamushi by pooled antigen ELISA has shown very good sensitivity (94%) and specificity (91%). These organisms are spread to humans through the bite of the larval stage of trombiculid mites and cause a systemic disease. The neurological manifestations are similar in many respects to other rickettsial diseases in that headache is nearly always present. O. tsutsugamushi parasitizes endothelial cells in the periphery as well as in the brain, but it also can be found in macrophages of the liver and spleen. The mechanism of cellular invasion is not known, but binding to nonprofessional phagocytes may involve interaction between cell surface heparan sulfate proteoglycans and bacterial lectins. Infection of host cells triggers a response, including the activation of the transcription factors nuclear factor-κB (NF-κB) (in macrophages) and NF-κB and AP-1 (in endothelial cells), leading to subsequent expression of chemokine genes for MIP-1α/β, MIP-2, and MCP-1 in macrophages and MCP-1, IL-8, and RANTES in endothelial cells.

This study explores the intricate relationship between religion and economy through an in-depth quantitative analysis of the Maha Kumbh Mela, the world's largest religious gathering held in Prayagraj, India. Anchored in Hindu mythology, the Maha Kumbh attracts millions of pilgrims, ascetics, and tourists, creating significant socioeconomic opportunities. The research examines how religious events function as economic catalysts by stimulating key sectors such as accommodation, transportation, and food services. It also assesses the impact of such mega religious events on different segments of societies i.e. marginalized(informal) and formal sectors. Regression analysis is used to quantify the relation between religion and economy and statistical analyses are employed to quantify the financial impact of the event. The findings indicate that Maha Kumbh contributes to substantial economic growth, fostering infrastructural development, revenue generation, and employment while also highlighting economic disparities and challenges in equitable benefit distribution.

The Kumbh Mela at Prayagraj, India, is the largest mass gathering of humanity on Earth, combining religious fervour, historical depth, and complex logistical execution. Held every twelve years, it represents Hindu spirituality's essence and the search for liberation through ritual bathing. This narrative review synthesises information regarding its historical origins, organisational challenges, public health management strategies, environmental concerns, socioeconomic benefits, and the role of modern technological interventions, particularly during the 2025 event. By analysing government reports, academic research, and international guidelines, this review highlights key lessons and identifies future directions to ensure sustainability, public health resilience, and preservation of the event's cultural significance.

COVID-19, a pandemic, is an expanding global threat that has nearly affected all the countries in the world. As the pandemic advances without any medical intervention in place, a global lockdown has been issued along with quarantine orders and social distancing restrictions to prevent further transmission. We discussed the transmission and control effort of COVID-19 based on available information since the disease outbreak. COVID-19 can be symptomatic or asymptomatic, spreading from person-to-person either by respiratory droplets or touching contaminated surfaces. People with underlying medical conditions such as hypertension, diabetes mellitus, and respiratory illnesses are more prone to having a critical disease. Federal, state and local governments have taken effective measures in preventing further transmission by imposing social distancing and isolation, to stop the spread via travel-related cases, which can also influence local spread. To date, there is no vaccine licensed for use and the only therapeutic strategy is supportive care. Chloroquine and hydroxychloroquine, two antimalarial agents, are currently being tested and used as therapeutic agents in the management of COVID-19. This study described the transmission and control effort of COVID-19 hoping that this study will inform the global community of the virus transmission and different public health measurements implemented to prevent further spread.

PURPOSE: This study is aimed at making analysis of haemorrhagic syndrome in leptospirosis. METHODS: Clinical symptoms and laboratory parameters of 84 cases with leptospirosis, which have been treated in the Clinic of Infectious Diseases at University Hospital, Pleven (1982 - 2005), are studied retrospectively. RESULTS: Haemorrhagic syndrome appears within five to nine days after clinical onset and occurs in 30,95% of cases. It is presented by petechial rash (30,95%) and bleeding from viscera (haematuria in 28,57%, melaena in 14,28%, haematemesis in 10,71%, epistaxis in 5,95%). Haemorrhages have been observed in 75% of fatal cases and are risk factors for death. Laboratory investigations demonstrate anaemia (73,81%), thrombocytopenia (42,86%), increased fibrinogen (73,81%), prolonged prothrombin time (11,90%). Treatment includes antibiotics, corticoids, vessels stabilising drugs, diuretics, substitution with thrombocyte or erythrocyte concentrate, hemodiaperfusion. CONCLUSIONS: Hemor...

Общие итоги новейших исследований Северного пещерного монастыря Мангупского городища в ущелье Табана-дере. Работы проводились в 2019-2022 гг. и носили характер комплексных архитектурно-археологических исследований. Установлена новая дата функционирования монастыря - конец XI - начало XIII вв.

The Prayagraj Kumbh Mela, the world's biggest religious congregation, has grown beyond its spiritual pilgrimage status to become a significant socioeconomic and cultural institution. This article investigates the Kumbh Mela's varied impact on India's spiritual tourist scene, including its historical evolution, religious significance, infrastructure demands, public health issues, and socioeconomic implications. It emphasises the event's impact on urban planning, economic growth, and cultural preservation, as well as the issues of environmental sustainability and crowd management. Drawing on scholarly research and policy studies, this paper provides a complete knowledge of how the Kumbh Mela serves as a case study for managing large-scale religious events around the world, as well as its potential to create sustainable spiritual tourism in India.

The trematodes Fasciola hepatica and F. gigantica are transmitted by lymnaeid snails and cause fascioliasis in livestock and humans. Human infection is emerging in southern and southeastern Asia. In India, the number of case reports has increased since 1993. This multidisciplinary study analyzes the epidemiological scenario of human infection. The study reviews the total of 55 fascioliasis patients, their characteristics, and geographical distribution. Causes underlying this emergence are assessed by analyzing (i) the climate change suffered by India based on 40-year-data from meteorological stations, and (ii) the geographical fascioliasis hotspots according to archeological-historical records about thousands of years of pack animal movements. The review suggests frequent misdiagnosis of the wide lowland-distributed F. gigantica with F. hepatica and emphasizes the need to obtain anamnesic information about the locality of residence and the infection source. Prevalence appears to be higher in females and in the 30-40-year age group. The time elapsed between symptom onset and diagnosis varied from 10 days to 5 years (mean 9.2 months). Infection was diagnosed by egg finding (in 12 cases), adult finding (28), serology (3), and clinics and image techniques (12). Climate diagrams and the Wb-bs forecast index show higher temperatures favoring the warm condition-preferring main snail vector Radix luteola and a precipitation increase due to fewer rainy days but more days of extreme rainfall, leading to increasing surface water availability and favoring fascioliasis transmission. Climate trends indicate a risk of future increasing fascioliasis emergence, including a seasonal infection risk from June-July to October-November. Geographical zones of high human infection risk defined by archeological-historical analyses concern: (i) the Indo-Gangetic Plains and corridors used by the old Grand Trunk Road and Daksinapatha Road, (ii) northern mountainous areas by connections with the Silk Road and Tea-Horse Road, and (iii) the hinterlands of western and eastern seaport cities involved in the past Maritime Silk Road. Routes and nodes are illustrated, all transhumant-nomadic-pastoralist groups are detailed, and livestock prevalences per state are given. A baseline defining areas and seasons of high infection risk is established for the first time in India. This is henceforth expected to be helpful for physicians, prevention measures, control initiatives, and recommendations for health administration officers.

The research reported in this dissertation, except where otherwise indicated is my original work. ii. This dissertation has not been submitted for any degree or examination at any other university. iii. This dissertation does not contain other person's data, pictures, graphs or other information, unless specifically acknowledged as being sourced from other persons. iv. This dissertation does not contain other persons writing, unless specifically acknowledged as being sourced from other researchers. Where other sources have been quoted, then: a. Their words have been rewritten but the general information attributed by them has been referenced. b. Where their exact words have been used their writing has been placed inside quotation marks and referenced. v. Where I have reproduced a publication of which I am the author, co-author, I have indicated in detail which part of the publication was actually written by myself alone and have fully referenced such publications. vi. This dissertation does not contain text, graphics, or tables copied and pasted from the internet, unless specifically acknowledged and the source being detailed in the dissertation and the reference sections.

Abstract
Leprosy, caused by Mycobacterium leprae, is a chronic infectious disease that impacts the skin and peripheral nerves, causing long-term disability. The invasion of M. leprae into the body triggers immunologic responses and single single-nucleotide polymorphisms in cytokine-encoding genes may influence predisposition and susceptibility, possibly predicting the incidence of leprosy reactions. This study aimed to assess the gene polymorphism of interleukin-10 promoter IL-10 −819C/T in leprosy patients, leprosy patients with erythema nodosum leprosum (ENL) reaction, and household contacts. A total of 54 individuals were included, with 18 in each group. Skin smear and histopathologic examinations were used to confirm the diagnosis of leprosy and ENL. The polymerase chain reaction and restriction fragment length polymorphism (PCR-RFLP) technique was used to determine the polymorphism. The results confirmed the presence of polymorphism of which all TT, CT, and CC genotypes presented. The TT genotype was most prevalent in household contacts (94.4%) followed by ENL (50%), and leprosy patients (44.4%). The CT genotype was most frequently detected in leprosy patients (50%), followed by ENL cases (44.4%), and household contacts (5.56%). In contrast, CC was mostly presented in ENL cases (5.56%), only 1% in leprosy patients, and absent among household contacts. Although the most prevalent allele in all three groups was the T allele, the C allele presented in 27% and 30% of ENL and leprosy patients, respectively and only 5% in household contact individuals. This study suggests that the polymorphism variations of IL-10 −819C/T are higher in leprosy and ENL patients compared to household contacts. Since this data is preliminary, larger studies are needed.

The Kumbh Mela is a large religious mass gathering event organised in India. During April 01 to April 30, 2021, Kumbh Mela was organized in Haridwar, Uttarakhand, India in the amid of COVID-19 pandemic. To detect and respond to unusual health events, a special surveillance model was established during Kumbh Mela-2021, Haridwar. The Kumbh module of Integrated Health Information Platform (IHIP) is utilized for real time data capturing. An Emergency Operations Centre (EOC) established to monitor COVID-19 and other disease situations through IHIP. Capacity building of Rapid Response Teams (RRT) was conducted. The special surveillance monitored 24 diseases/ syndromes. Kumbh mela area was divided into 4 zones with total 75 health facilities. A total of 31021 cases were reported on IHIP, including 86% communicable diseases (CDs), 8% non-communicable diseases (NCDs) and 6% unusual syndrome. Among total CDs, 27% acute febrile illness (AFI), 25.3% acute respiratory illness (ARI), 19% water borne diseases (WBDs), 15% COVID-19 and 14% others encountered. Out of total NCDs, 67% trauma, 25% dog bite, 8% others. A total of 36 early warning signals generated and responded, of which 22% WBDs, 22% ARI, 17% COVID-19, 14% AFI, 11% unusual syndrome and 14% others. The special disease surveillance helped monitoring health event alerts and health condition alerts. EOC monitored early warning signals and facilitated early detection and quick response to public health threats. Acute febrile illnesses emerged as a leading cause of morbidity. Future Mass Gathering events like Kumbh Mela should include disease surveillance as part of planning and augment capacity to diagnose and management of acute febrile illness.

Candida species are a group of fungi that can cause infections in humans. These fungi are commonly found in nature and on human skin, but can cause infections in immunocompromised individuals. Candida can affect various areas such as the mouth, throat, vagina, and blood, leading to different clinical manifestations. Candida species include C. albicans, C. glabrata, and C. tropicalis, and many more. In the recent decade, several studies bring into light the Identification of Candida-specific drug targets which enables targeted therapies with minimal impact on the host, Effective drug targets can disrupt essential fungal processes, leading to efficient elimination of the infection, Specific protein targets in Candida to reduce the chances of off-target effects often associated with broad-spectrum antifungal agents. Common targets in Candida include fungal cell wall, ergosterol biosynthesis to disrupt fungal membrane integrity and protein synthesis pathways. Current challenges in antifungal therapy include resistance to antifungal drug candidates, host immune reactions and drug- induced toxic effects. Mechanism for antifungal drug resistance comprises drug efflux pump, target modification and drug catabolism, biofilm formation. To overcome these challenges, drug discovery approaches concentrate on quorum sensing and quorum quenching based anti-virulence and host-fungal interaction kinetics to improve treatment strategies. Future goals of anticandidal therapy would nano-based pharmacophores, immunotherapies, natural product-based antifungals and personalized medicine to minimize host reactions against drugs. Hence, in this paper, we will explore the importance of drug targets and the challenges in antifungal therapy.

Hepatitis B virus (HBV) infection, a viral disease, is of great concern to health community due to its adverse effects on the liver of infected individuals. Haemoparasites are blood-dwelling parasites whose effects span from mild to severe infections. This study focused on Plasmodium falciparum Trypanosoma brucei gambiense and microfilaria which causes malaria, sleeping sickness and microfilaramia in humans respectively. This is a retrospective study that was designed to determine the prevalence of hepatitis B infection and haemoparasistes among apparently healthy individuals in the College of Health Sciences, Ladoke Akintola University of technology, Ogbomoso. Paucity of data regarding prevalence of HBV and haemoparasites among apparently healthy individuals in Ogbomoso necessitated this study. A total number of one hundred and fifty five (155) blood samples were collected within 3months for this study. Out of the one hundred and fifty five (155) blood samples collected, ten (10) tested positive to HBsAg giving a prevalence rate of 6.5%. The samples were also examined for haemoparasites on thin and thick blood smears stained with Giemsa dye using oil immersion (100X) objective of the light microscope. Only one type of haemoparasite was detected: malaria parasite with a prevalence of 87.1%. Prevalence rate for HBV and malaria parasite with respect to age group was found to be higher in age group of 25-30 and in term of sex, males have higher prevalence rate than females. The prevalence of 7.4% for co-infection of HBV and malaria parasite within the study population confirmed the high endemicity of both infections in the studied area being an urban area. It could be recommended that the Nigerian government HBV vaccination program should be extended to the adult population and not just limited to the national childhood immunization program. This is important because none of the subjects that participated in the study were vaccinated.

This study reports the clinical profile, pattern of organ involvement and the case fatality of 112 cases of Leptospirosis admitted during an outbreak in the post flood period from August to September 2006 in Surat city. The study reveals the necessity for early detection of cases in an epidemic situation, chemoprophylaxis of those exposed and prompt referral and management with excellent ICU support for decreasing the mortality associated with the disease.

Context: Leptospirosis is a zoonotic disease with worldwide distribution caused by pathogenic leptospira. Leptospirosis is more prevalent in South Gujarat due to heavy rain fall and clay soil structure. The current study was conducted to analyse the profile of patients with Leptospirosis admitted in Surat Municipal Institute of Medical Education and Research (SMIMER), Surat.

Methods and Material: This prospective study, involves patients visiting SMIMER hospital during the time period of 1st August to 31st October 2011 who were suspected for Leptospirosis. Their presenting complaints, examination findings, lab findings, treatment and outcome were recorded and analyzed based on the modified Faine’s criteria.

Results: Among the 24 suspected cases of Leptospirosis, 14 (59%) were males and age of patients ranged from 10 to 65 years with mean age of 34 years. Fever, myalgia, and headache were predominant complaints and all had history of contact with animals or contaminated environment. Liver functions and renal functions were deranged in 96% and 63% cases respectively. Fifteen patients were found positive for Leptospirosis. Fifteen (63%) patients had Weil’s syndrome and 8 had ARDS. There were 4 deaths, all were males, had ARF and presented with systolic hypotension.

Conclusions: The disease prevalence usually increases during rainy season. Most cases were from rural origin and all had history of contact with animals. Myalgia (calf tenderness), jaundice and conjunctival suffusion were characteristic physical examination findings. Jaundice and renal failure are associated with severity of the disease and are considered bad prognostic signs with high mortality rate (16%).

Objective: To analyze the temporal trend and spatial patterns of schistosomiasis-related morbidity in Northeast Brazil, 2001–2017. Methods: Ecological study, of time series and spatial analysis, based on case notifications and hospital admission data, as provided by the Ministry of Health. Results: Of a total of 15,574,392 parasitological stool examinations, 941,961 (6.0%) were positive, mainly on the coastline of Pernambuco, Alagoas and Sergipe states. There was a reduction from 7.4% (2002) to 3.9% (2017) of positive samples and in the temporal trend of the detection rate (APC—11.6*; Confidence Interval 95%—13.9 to −9.1). There was a total of 5879 hospital admissions, with 40.4% in Pernambuco state. The hospitalization rate reduced from 0.82 (2001) to 0.02 (2017) per 100,000 inhabitants. Conclusion: Despite the reduction in case detection and hospitalizations, the persistence of focal areas of the disease in coastal areas is recognized. This reduction may indicate a possible positi...

Analysis of the role played by different job occupations in relation to bacterial contamination of currency notes in circulation was conducted at the University of Maiduguri main campus from March 2014 to April 2014. The study was aimed at identifying the extent of contamination of the notes in circulation, and to determine if job occupation has an influence in the bacterial contamination of currency notes, which serve as a medium of exchange. A total of 108 samples of the Nigerian currency note (Naira: N) of the following denominations; N5, N10, N20, N50, N100 and N200, were randomly collected from six (6) occupational groups namely: Fish/Meat sellers, Restaurant operators, Traders, Taxi drivers, Students and Banks. Samples were processed for bacterial isolation. 29 out of 108 samples yielded bacterial growth which gives a total recovery rate of 27%. Currency note with the highest contamination was N50 (24.1%), followed by N10 (17.2%), N100 (17.2%), N200 (17.2%), N20 (14%) and N5 (10.3%). Organisms isolated from the currency notes in descending order of prevalence include Staphylococcus spp (24.1%), Streptococcus spp (24.1%), Escherichia coli (17.2%), Klebsiella spp (13.8%), Enterobacter spp (10.3%), Pseudomonas spp (3.45%), Coliform bacteria (3.45%), and Candida spp (3.45%). Occupational group with the highest currency note contamination rate was Restaurant operators (31%), followed by Traders (24%), Fish/Meat sellers (21%), Taxi drivers (14%), Bank (7%) and Students (3%). N50 note collected from restaurant operators recorded the highest contamination rate of 14%. A significant relationship has been observed between occupation and level of contamination. We advocate that proper standards of hygiene should be observed to avoid contamination, and onward transmission of these pathogens.

Background: An appraisal of the pattern of orofacial neoplasms managed in the University of Uyo Teaching Hospital (UUTH) became imperative due to the observed increase in the number of presentations. Location and histologic types of these lesions can be valuable in clinical diagnosis and patient's management. Aim: The aim of this study was to document the pattern of presentation and histologic types of orofacial tumors seen in our center in the past 2 years and to compare the findings with previous studies in the literature. Methods: A retrospective analysis of biopsy results of all patients who presented to the maxillofacial unit of University of Uyo Teaching Hospital (UUTH) over a period of 2 years was done. Information on socio-demographics and histopathologic diagnosis were obtained and analyzed. Statistical significance was set at P<0.05. Results: A total of 186 orofacial lesions were recorded within the 2 year period of study. Benign lesion accounted for 112 (60.21%) while malignant lesions were 74(39.79%). Squamous cell carcinoma (32.43%) was the most prevalent malignant variant while ameloblastoma was found to be the most prevalent of the benign group. More females (62%) were affected with male:female ratio of 1:1.5. Conclusion: The pattern and types of orofacial neoplasms observed in the study differ from reports of other studies. It appears that the benign oral and jaw lesions are more prevalent in the study area.

Zika virus is an RNA virus belonging to the Flavivirus family that is chiefly transmitted by the female Aedes mosquito. The Zika virus first infected humans in Uganda and Tanzania in 1952. Since, it has spread to several parts of the world causing outbreaks of variable extent. In India, these outbreaks have been reported from Gujarat, Tamil Nadu, Madhya Pradesh, Rajasthan, Kerala, and Maharashtra. The most recent outbreak is from the most populous state of India, Uttar Pradesh, where the climate is conducive to the breeding and transmission of other arboviral infections such as Dengue, Chikungunya, and Malaria. These infections also happen to share similar incubation periods and overlapping clinical manifestations with Zika virus (ZIKV) infection, leading to misdiagnoses or delayed diagnosis. We aim to provide an account of the outbreak, its repercussions, errors made in attempting to contain the spread of the disease, and, measures to be taken in the future.

Iron is an essential element for life. Its uptake and utility requires a careful balancing with its toxic capacity, with mammals evolving a safe and bio-viable means of its transport and storage. This transport and storage is also utilized as part of the iron-sequestration arsenal employed by the mammalian hosts' 'nutritional immunity' against parasites. Interestingly, a key element of iron transport, i.e., serum transferrin (Tf), is an essential growth factor for parasitic haemo-protozoans of the genus Trypanosoma. These are major mammalian parasites causing the diseases human African trypanosomosis (HAT) and animal trypanosomosis (AT). Using components of their well-characterized immune evasion system, bloodstream Trypanosoma brucei parasites adapt and scavenge for the mammalian host serum transferrin within their broad host range. The expression site associated genes (ESAG6 and 7) are utilized to construct a heterodimeric serum Tf binding complex which, within its niche in the flagellar pocket, and coupled to the trypanosomes' fast endocytic rate, allows receptor-mediated acquisition of essential iron from their environment. This review summarizes current knowledge of the trypanosomal transferrin receptor (TfR), with emphasis on the structure and function of the receptor, both in physiological conditions as well as in conditions where the iron supply to parasites is being limited. Potential applications using current knowledge of the parasite receptor are also briefly discussed, primarily focused on potential therapeutic interventions.

Acinetobacter baumannii is a major pathogen of health care associated infections (HCAI) throughout the world. Acinetobacter is located in front row with persistence in the hospital environment, with its high mortality and morbidity development potential, and transfer of resistance genes between bacteria and other species [1]. Carbapenemase activity is the most important cause of carbapenem resistance; therefore, all efforts to develop carbapenemase inhibitory agents derive from the aim of carbapenem resistance prevention for A. baumannii and other Gram-negative enteric bacteria [2]. According to Antimicrobial Surveillance Program (SENTRY) reports, carbapenem resistance rates among A. baumannii isolated from two Turkish Health Centers were reported between 20-60% [3]. Although carbapenem resistance in A. baumannii strains in Turkey was seen sporadically until 2005, isolation rates have increased since August 2005 [4]. Many outbreaks related to multidrug-resistant A. baumannii have been reported in Turkish hospitals as a result of molecular epidemiologic studies in recent years [5,6]. Major outbreaks were caused by OXA-Carbapenemases. The first outbreak appeared with OXA-23 and OXA-48 carbapenemases-producing A. baumannii between 2005 and 2006 [7]. The outbreaks continued in the following years and MDR Acinetobacter has been established as an endemic strain in hospitals. All these have led to a further increase of resistance as well as more carbapenem use. The widespread use of carbapenem in the empirical treatment of A. baumannii infections has also begun to restrict the use of the carbapenem for the treatment of other Gram-negative enteric bacterial infections.

Background: Many acute respiratory syndrome coronavirus 2 (SARS-CoV-2) related deaths were reported in Yemen. The question is about what risk factors contribute to this excess death. Hodeidah governorate in the Western part of Yemen is exposed to the COVID-19 pandemic like other governorates in Yemen, adding to the current chronic problems. No study till now documented the SARS-CoV-2 pandemic process in Hodeidah, Yemen, especially deaths. Objective: The aim of this short report is to explore more data about the first ten SARS-CoV-2-related deaths in Hodeidah. Yemen.  Methods: An outbreak investigation was carried out directly with patients before death and their families based on world health organization (WHO) guideline and Center for Disease Control and Prevention -US (CDC-US) guideline. On the other hand, the medical reports of patients were investigated  in the triage area of the Center of Tropical Medicine and Infectious Diseases (CTMID), AL-Thawrah Public Hospital Authority, H...

Purpose: Chronic kidney disease of uncertain etiology (CKDu) is an environmental nephropathy in which the etiological factors are yet uncertain. Leptospirosis, a spirochetal infection that is common among agricultural communities, has been identified as a potential etiology for CKDu beyond environmental nephropathy. Although CKDu is a chronic kidney disease, in endemic regions, an increasing number of cases are reported with features suggestive of acute interstitial nephritis without any known reason (AINu), with or without background CKD. The study hypothesizes that exposure to pathogenic leptospires is one of the causative factors for the occurrence of AINu. Method: This study was carried out using 59 clinically diagnosed AINu patients, 72 healthy controls from CKDu endemic region (endemic controls [ECs]), and 71 healthy controls from CKDu non-endemic region (non-endemic controls [NECs]). Results: The seroprevalence of 18.6, 6.9, and 7.0% was observed in the AIN (or AINu), EC, and...

Leptospirosis is a common zoonotic disease of the tropics, caused by pathogenic spirochetes of the genus Leptospira. Though infection tends to be mild and self limiting in most cases, it is known to cause life threatening complications such as acute kidney injury, pulmonary haemorrhages and acute respiratory distress syndrome, myocarditis and rhabdomyolysis. Severe myocarditis leading to cardiogenic shock with circulatory collapse in leptospirosis is a rare clinical entity. Here we describe a young healthy male, who presented with extensive myocardial injury with cardiogenic shock, and made an uneventful recovery with timely intervention and care.

For over 200 years, the name molluscum contagiosum-a dermatological disease-has unfairly associated molluscs (the second largest group of animals on the planet) with this highly contagious infectious disease. Herein, arguments are presented demonstrating the serious problem of continuing to use this name, including animal welfare concerns. Thus, to minimize any unnecessary impacts on the biodiversity and conservation of molluscs, we follow WHO best practices in naming diseases to suggest the use of the new term 'wpox' or 'water warts' as a synonym for molluscum contagiosum.

Objective Few prospective studies have been undertaken of maternal mortality in sub-Saharan Africa. National statistics are inadequate, and data from hospitals are often the only source of information available. Reported maternal mortality ratios may therefore show large variations within the same country, as in Mali. This study was designed to produce an estimate of the maternal mortality ratio for the population of Bamako. Design Prospective cohort study. Setting Bankoni (population 59,000), a district of Bamako (population 700,000). Population Methods After enrolment, two follow up visits, at six weeks and one year after delivery, were performed to collect information on the pregnancy, its outcome, the method of delivery, the puerperium and the first year after birth. Detailed inquiries on deaths were undertaken in the community, the maternity units and the reference hospital. J 5782 pregnant women identified during quarterly household visits. Main outcome measures Maternal mortality ratio, late maternal mortality, likely cause of death. Results Complete data at follow up were available on 4717 women (82%) (4653 single and 64 twin pregnancies). Most of the women had antenatal care were and delivered in a district maternity hospital. There were 4580 live births (96%). Fifteen maternal deaths were recorded, yielding an overall maternal mortality ratio of 327 per 100,000 live births. Hypertensive disorders and haemorrhage were the main causes of death. Five more deaths occurred within 42 days or one year after delivery. This study gave an estimate of the maternal mortality ratio for the population of Bamako, and stressed the need of better emergency obstetric care and the importance of late maternal mortality. Conclusions

BACKGROUND: Breast cancer is a common neoplasm in women worldwide. Its varying patterns of incidence and clinical prognosis in Brazil make it an important and complex public health problem that needs to be solved. OBJECTIVES: To analyze the temporal dynamics of hospital admissions and deaths due to female breast cancer in the state of Alagoas, Brazil, from 2009 to 2019. DESIGN AND SETTING: Cross-sectional study including secondary data from hospital admissions and deaths due to female breast cancer in Alagoas. METHODS: A joinpoint regression model was constructed for temporal analysis of hospital admissions and deaths due to female breast cancer in Alagoas, over this period. The hospital information system of the Department of Informatics of the National Health System was used. RESULTS: There were 5,801 hospitalizations and 633 hospital deaths due to neoplasm in Alagoas over the period. The age group from 50 to 59 years old stood out, corresponding to 28.1% of hospitalizations and 31.1% of registered deaths. An increasing trend in the rate of hospital admissions was observed (average annual percentage change, AAPC = 14.0; P-value < 0.001), from 14.9/100,000 inhabitants in 2009 to 53.6 in 2019. There was a growth trend in the in-hospital mortality rate (AAPC = 19.8; P-value < 0.001), from 6.3% in 2009 to 11.0% in 2019. CONCLUSION: The results indicated an increasing trend of hospital admissions and mortality rates in the state of Alagoas, with a higher percentage of hospitalizations and deaths in the 50-59 age group.

Background: Perinatal infection heightens the risk of childhood malaria in endemic areas. In Nigeria, exhaustive case studies are necessary to document obviously unrecorded cases of infantile malaria to aid control efforts. Aim: The study aimed to determine the prevalence of congenital malaria among neonates delivered in the hospital. Methods: A retrospective analysis of a five-year medical record, 2009 to 2013 was conducted in General Hospital, Calabar. The study examined laboratory data of 9,398 pregnant women on antenatal admission and 5,730 children aged 0-7 days; delivered in the hospital within the five-year period. Records of confirmed blood tests by microscopy for Plasmodium species were extracted for analysis. Data were analysed using descriptive and nonparametric statistics. Results: The study identified congenital malaria prevalence of 1.08% and maternal malaria prevalence of 9.17% within the period. The relationship between maternal malaria and congenital malaria was statistically significant (X 2 = 13.62; P = 0.05). The five-year prevalence profile indicated a rising trend of congenital malaria towards the current year; from 21% in 2009, 29% in 2010, 14.5% in both 2011 and 2012, to 21% in 2013. Conclusion: Findings suggest possible weakness in the mechanism of maternal malaria management in the city. There is a need to strengthen the existing malaria control capabilities, with ardent attention on vector control, intermittent preventive treatment for pregnant women and capacity for early diagnosis and case management.

Introduction VVC is defined as a condition with signs and symptoms of inflammation in the presence of Candida species and in absence of other etiology. 1 Women having VVC present with spectrum of manifestations ranging from asymptomatic colonization to severe acute symptomatic infection. VVC accounts for 17-39% of all cases of vaginitis among symptomatic women. Recent studies suggest that there is an increasing incidence of isolation of non albicans species from cases of VVC besides C.albicans. 2 The transition of candida sp. from commensal to potential pathogen is determined by various host predisposing factors and virulence

Background: Endemic countries like India are burdened with the bludgeoning effects of tuberculosis. While pulmonary tuberculosis is more prevalent and communicable, diagnosis of extra pulmonary tuberculosis (EPTB) is more challenging. Methods: This was a retrospective study done for three consecutive years 2013 to 2015. The extra-pulmonary smear samples from patients suspected of tuberculosis were stained with Zeihl Neelsen stain and examined. Results: Based on ZN stain, EPTB was diagnosed in 13.4%, 9.5%, 10.6% suspected cases between 2013 to 2015 respectively. Highest positivity was seen among pus aspirates from lymph nodes in 13-25 years age group. Conclusion: New technological advances are being made all across the globe for faster and specific tuberculosis diagnosis. However in resource limited settings, reliance is often on the smear microscopy findings. Diligently observed smears increase chances of diagnosis and is often rewarding.

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Background: The Expanded Program on Immunization (EPI) aims at delivering primary immunization services to at least 90% of infants. This study seeks to evaluate routine vaccination coverage using estimated and survey generated populations and also investigates the reasons for inadequate levels of routine vaccination coverage. Method: A cross-sectional survey was conducted in all 11,101 households spread across 111 communities in the 12 administrative wards of Orhionmwon LGA of Edo state in October 2016. Results: A total of 1209 children under the 0-11 month’s age bracket had been fully immunized. From this figure, 72.9% of the children had been fully immunized based on the actual population (1657) of children as discovered from this survey while 12.5% of the children in the same aforementioned age bracket had been fully immunized based on the projected target population (9625). Obstacles (40%), ‘lack of information (33%)’ and ‘lack of motivation (27%)’were the major reason why surve...

COVID-19, a pandemic, is an expanding global threat that has nearly affected all the countries in the world. As the pandemic advances without any medical intervention in place, a global lockdown has been issued along with quarantine orders and social distancing restrictions to prevent further transmission. We discussed the transmission and control effort of COVID-19 based on available information since the disease outbreak. COVID-19 can be symptomatic or asymptomatic, spreading from person-to-person either by respiratory droplets or touching contaminated surfaces. People with underlying medical conditions such as hypertension, diabetes mellitus, and respiratory illnesses are more prone to having a critical disease. Federal, state and local governments have taken effective measures in preventing further transmission by imposing social distancing and isolation, to stop the spread via travel-related cases, which can also influence local spread. To date, there is no vaccine licensed for use and the only therapeutic strategy is supportive care. Chloroquine and hydroxychloroquine, two antimalarial agents, are currently being tested and used as therapeutic agents in the management of COVID-19. This study described the transmission and control effort of COVID-19 hoping that this study will inform the global community of the virus transmission and different public health measurements implemented to prevent further spread.

Accessibility of rural dwellers, particularly in Northern Nigeria, to basic water services has been a significant challenge over the years, thereby contributing significantly to the high mortality rates associated with waterborne disease recorded in the region. Recent information is required about the state of water facilities in some of these marginalized communities to proffer sustainable solutions. This community-based survey explored the water services available to rural dwellers in Tinda village, Gombe State. Data was collected via participant and community observation. Grab water samples were also obtained and analyzed for physicochemical and bacteriological parameters using standard methods. The village lacked an improved drinking water source. The major source present was a dam, while other sources available were a river and an unsanitary well. The surface water samples were turbid and coloured, while the well water was slightly turbid and coloured. The lead, iron, and manga...

Restrictive episiotomy is recommended for the prevention of vertical transmission of HIV. The study compared the frequency of episiotomy use and the occurrence of perineal tears; and related factors in HIV positive and HIV negative women and to assess their effect on Mother-to-child transmission (MTCT) of HIV. A total of 110 HIV positive and 134 HIV negative parturients were enrolled in the study. The incidence of episiotomy was more in the HIV negative group (p=0.0000) while that of perineal tear was not affected by HIV status (p=0.17). The rate of episiotomy was significantly affected by primigravidity in HIV negative subjects (OR= 0.032, 95% CI 0.0072-0.13). The rate of perineal tear was significantly affected by primigravidity in HIV positive subjects (OR=8.55, 95% CI 1.91-38.7) and multigravidity in HIV negative subjects (OR= 0.030, 95% CI 0.133-0.71). Gestational age and mean birth weight had no effect on the rate of episiotomy (p value =0.57 and 0.30) and perineal tear (p val...

Background: The health implications surrounding a mass gathering pose significant challenges to public health officials. The use of syndromic surveillance provides an ideal method for achieving the public health goals and objectives at such events. In the absence of published reports of systematic documentation of public health preparedness in mass gatherings in the local context, we describe the public health preparedness and demonstrate the operational feasibility of a tablet-based participatory syndromic surveillance among pilgrims during the annual ritual circumambulation-Panchkroshi Yatra. Methods: A real-time surveillance system was established from 2017-2019 to capture all the health consultations done at the designated points (medical camps) in the Panchkroshi yatra area of the city Ujjain in Madhya Pradesh. We also surveyed a subset of pilgrims in 2017 to gauge satisfaction with the public health measures such as sanitation, water, safety, food, and cleanliness. Results: In 2019, injuries were reported in the highest proportion (16.7%; 794/4744); most numbers of fever cases (10.6%; 598/5600) were reported in 2018, while 2017 saw the highest number of patient presentations of abdominal pain (7.73%; 498/6435). Conclusion: Public health and safety measures were satisfactory except for the need for setting up urinals along the fixed route of the circumambulation. A systematic data collection of selected symptoms among yatris and their surveillance through tablet could be established during the panchkroshi yatra, which can complement the existing surveillance for detecting early warning signals. We recommend the implementation of such tablet-based surveillance during such mass gathering events.

Analysis of the role played by different job occupations in relation to bacterial contamination of currency notes in circulation was conducted at the University of Maiduguri main campus from March 2014 to April 2014. The study was aimed at identifying the extent of contamination of the notes in circulation, and to determine if job occupation has an influence in the bacterial contamination of currency notes, which serve as a medium of exchange. A total of 108 samples of the Nigerian currency note (Naira: N) of the following denominations; N5, N10, N20, N50, N100 and N200, were randomly collected from six (6) occupational groups namely: Fish/Meat sellers, Restaurant operators, Traders, Taxi drivers, Students and Banks. Samples were processed for bacterial isolation. 29 out of 108 samples yielded bacterial growth which gives a total recovery rate of 27%. Currency note with the highest contamination was N50 (24.1%), followed by N10 (17.2%), N100 (17.2%), N200 (17.2%), N20 (14%) and N5 (10.3%). Organisms isolated from the currency notes in descending order of prevalence include Staphylococcus spp (24.1%), Streptococcus spp (24.1%), Escherichia coli (17.2%), Klebsiella spp (13.8%), Enterobacter spp (10.3%), Pseudomonas spp (3.45%), Coliform bacteria (3.45%), and Candida spp (3.45%). Occupational group with the highest currency note contamination rate was Restaurant operators (31%), followed by Traders (24%), Fish/Meat sellers (21%), Taxi drivers (14%), Bank (7%) and Students (3%). N50 note collected from restaurant operators recorded the highest contamination rate of 14%. A significant relationship has been observed between occupation and level of contamination. We advocate that proper standards of hygiene should be observed to avoid contamination, and onward transmission of these pathogens.

By 22nd January 2021, the Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) virus had infected over 98 million and 10.6 million individuals globally and in India, with 1.7 million and 153, 067 deaths, respectively. Case Fatality rates (CFR) due to coronavirus disease 2019 (COVID 19) have varied significantly between countries. In order to understand the true impact of the pandemic, we should report coronavirus (COVID-19) mortality in the context of all-cause and non-COVID-19 mortality, and compare with previous years. The consequences of the pandemic have been, and will be, different in different settings within and across countries. To compare the all-cause mortality in the year 2020 with previous years in three selected states of India correlate it to the burden of COVID19 and compare all-cause mortality between three states of India to four high income countries. We provide quantitative data in three states across India (Himachal Pradesh, Kerala and Odisha) and compare...

The seroprevalence to hepatitis E virus (HEV; IgG and total antibodies) in Nigeria lies between 7.0-66.75% in different populations. This is due to the fact that only a limited number of studies have been performed on the seroprevalence of (HEV). In the present study, demographics, the associated risk and the behavioral characteristics of blood donors were identified based on direct and indirect questions. These were applied to those who gave their consent to participate in the study. Purposive sampling was employed following the principle of gradual selection and multinomial regression analysis was applied. The seroprevalence of HEV in different centers investigated in the present study indicated the high prevalence of HEV infection among blood donors in Southwest Nigeria. The findings of the present study therefore reveal the risks associated with the presence of HEV in blood donor samples, and the potential for this infection to be transmitted to others via blood transfusion.

Background: Coronavirus Diseases 2019 (COVID 19) is caused by Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2). Vitamin D deficiency shows 6 times more risk of being infected with severe degree of COVID 19 and 15 times more risk of dying. An increase in the neutrophil lymphocyte ratio (NLR) was significantly related to the severity of the disease. The aim of this study was to determine the relationship between serum vitamin D levels and neutrophil lymphocyte ratio with mortality of COVID 19 patients at H Adam Malik General Hospital Medan. Method: This was an observational study with cross-sectional design with retrospective data collection from medical record sources. This research was conducted from January 1 to November 31 2022 at H Adam Malik General Hospital in Medan. The sample for this study were all COVID 19 patients from January 1 until November 31 2022 at H Adam Malik General Hospital Medan who met the inclusion and exclusion criteria. Serum vitamin D levels, neutrophils, lymphocytes, neutrophil lymphocyte ratio, mortality and comorbidities were recorded and data analysis was carried out. Results: The number of samples that met the inclusion criteria in this study were 125 people, the group that died was 60 people while the group that alive was 65 people. There was a significant difference in vitamin D levels between living and deceased COVID 19 sufferers (p<0.001) and there was a significant difference in NLR between living and deceased COVID 19 sufferers (p=0.046). Conclusion: There is an association between serum vitamin D levels and neutrophil lymphocyte ratio with the mortality of COVID 19 patients at H Adam Malik General Hospital Medan.

Introduction Voluntary medical male circumcision (VMMC) is one of the key interventions for HIV prevention. However, its uptake among men in Malawi is low. Implementation science strategies for demand creation of VMMC increase uptake. We designed an implementation science demand-creation intervention to increase the uptake of VMMC among men with sexually transmitted infections (STIs). Methods and analysis We designed a pragmatic preinterventional and post-interventional quasi-experimental study combined with a prospective observational design to determine the uptake, acceptability, appropriateness and feasibility of a multifaceted intervention for scale up of uptake of VMMC among men with STIs at Bwaila STI clinic in Lilongwe, Malawi. The intervention includes transport reimbursement (R), intensified health education (I) and short messaging service (SMS)/telephonic tracing (Te) (RITe). The intervention will be implemented in phases: pre-implementation and implementation. Pre-implementation phase will be used for collecting baseline data, while the RITe intervention will be rolledout in the implementation phase. The RITe intervention will be implemented in a sequential and incremental manner called implementation blocks: block 1: intensified health education; block 2: intensified health education and SMS/telephonic tracing; and block 3: intensified health education, SMS/telephonic tracing and transport reimbursement. The target sample size is 80 uncircumcised men for each intervention block, including the pre-implementation sample, making a total of 320 men (280 total, 70 per block will be surveyed). The primary outcome is uptake of VMMC during the implementation period. Mixed methods assessments will be conducted to evaluate the acceptability, appropriateness and feasibility of the RITe intervention. Ethics and dissemination The study protocol was approved by the Malawi's National Health Sciences Research Ethics Committee (approval number: 19/10/2412), University of North Carolina at Chapel Hill's Institutional Review Board (approval number: 19-2559) and University of the Witwatersrand's Health Research Ethics Committee (approval number: M200328). Results will be disseminated via publication in a peer-reviewed journal and presentations at relevant scientific conferences and meetings. Trial registration number NCT04677374.

Background: Hands of healthcare personnel are known to be the main route of cross transmission of pathogens in healthcare facilities and it is known that hand hygiene is the most effective preventive measure against healthcareassociated infections (HAIs). WHO Hand Hygiene Improvement Strategy is being implemented in a University Teaching Hospital of Butare (CHUB) since November 2011 to improve patients and staffs safety. Methods: This quasi-experimental study was conducted in Butare University Teaching Hospital, a tertiary academic hospital, between November 2011 and November 2015. We implemented the WHO's Multimodal Hand Hygiene Improvement Strategy and assessed the compliance of hand hygiene before and after the interventions. The entire project included five steps: (1) facility preparedness, (2) baseline evaluation, (3) implementation, (4) follow-up evaluation, and (5) ongoing planning and review cycle. Baseline evaluation of multimodal hand hygiene self-assessment and hand hygiene compliance was performed, using the WHO Multimodal Hand Hygiene Self-Assessment Framework tool and the WHO's direct observation method. Data was analysed using Ms Excel. Results: The baseline hand hygiene compliance was measured at 6.25%. The Hand Hygiene Level of the hospital was 100 at the baseline, which means inadequate level. The intervention was conducted during 2012 and 2013 and it included provision of hand hygiene supplies, training of healthcare workers, and display of reminders in the workplace. The post intervention hand hygiene programme evaluation was conducted in 2015. Hand hygiene audit was conducted in 6 wards (Neonatology, Intensive Care Unit, Paediatrics, Surgical, Internal Medicine and Gynaeco-Obstetrics) and revealed an average score of 20.86%. There were 58 hand hygiene actions from 278 hand hygiene opportunities, with an average of 46 hand hygiene opportunity per ward. The compliance ranged from 1.9% (Internal Medicine) to 57.8% (ICU). An improvement of 14.61% of hand hygiene practice (6.25% in 2012 to 20.86% in 2015) was noted. Alcohol-based hand rub (ABHR) was the most used procedures and it was used in 89.66% (52/58) of performed indications. Hand hygiene practice among professional categories was 24.6% (33/134) actions for nurses' opportunities, 22.7% (25/110) actions for medical doctors and there was no action among allied health professionals (0/8) or caretakers (0/26). Hand hygiene self-assessment tool was completed and the score was 355 which mean intermediate level. 60.46% (159/263) of hand washing basins were in good conditions (means working and not damaged) and availability of water was 40.30% (106/263). Conclusion: It is feasible and possible to implement WHO Hand Hygiene Improvement Strategy even in healthcare facilities with limited resources. The findings from the study showed the improvement from the basic level to intermediate level of hand hygiene and improvement in hand hygiene compliance of 14.61% (from 6.25% to 20.68%) in three year period. There is a need to continue with the implementation of the WHO Multimodal Hand Hygiene Improvement Strategy by sustaining what have been achieved and putting more effort in areas of improvement such developing SMART plans for staff training and education, patient involvement and infrastructure improvement plan.