Objective: To assess the effectiveness of intravenous immunoglobulin (IVIg) therapy in patients diagnosed with Crimean-Congo hemorrhagic fever (CCHF) disease. Methods: A single-center retrospective cohort study was conducted on hospitalized patients with confirmed severe CCHF at a tertiary care hospital in Turkey between 2010 and 2022. Cases were categorized into two groups based on whether they received IVIg therapy, with the treatment plan determined by the primary healthcare provider. The clinical, epidemiological, and laboratory parameters of these patients were evaluated. Demographic, laboratory findings, platelet counts on the day of IVIg indication and the third day, bleeding status during follow-up beyond 24 hours after IVIg administration, and prognosis recorded in patient information forms were retrieved. Results: 72 patients were included in the analysis, with IVIg administered to 42 cases (58.3%) and not given to 30 cases (41.7%). Among the patients, 37 (51.4%) were female. Fever (65.3%) was the most common clinical presentation. The overall mortality rate was 19.4%, and IVIg administration did not significantly impact overall survival outcomes ( P =0.48). On Day 3 following IVIg administration or indication, the platelet count was higher in the IVIg-treated group compared to the non-treated group ( P =0.02). Furthermore, during follow-up beyond 24 hours after IVIg administration, bleeding was observed in 19.0% of the IVIg-treated group, compared to 46.6% in the non-treated group ( P =0.01). Conclusions: This study underscores the potential advantages of IVIg therapy in managing severe CCHF. Although IVIg administration did not significantly affect overall survival, it was associated with earlier improvement in platelet counts and a notable reduction in bleeding complications. These findings indicate that IVIg may serve as an adjunctive treatment in CCHF, particularly for addressing hemorrhagic manifestations.

Objective: To analyse the prevalence of serotypes, antibiotic resistance, and virulence genes of Group B Streptococcus (GBS) strains isolated from pregnant women at 35-37 weeks of gestation in Ho Chi Minh City, Vietnam, from January 2022 to January 2023. Methods: GBS strains were isolated through selective culture methods and confirmed by PCR. Serotyping, virulence gene detection, and antibiotic susceptibility testing were performed using PCR, gel electrophoresis techniques and Kirby-Bauer test. Results: Totally, 61 GBS isolated from 300 participants have been identified including seven GBS serotypes (Ia, I b, II, III, IV, V, and VI). Serotypes VII, VIII, and IX were not detected in the study population. Antibiotic resistance patterns varied: 13.1% of isolates were fully susceptible, while the majority showed multi-drug resistance, with 34.4% resistant to three antibiotics. Serotype I a demonstrated high susceptibility (35.7%), while serotype III showed extensive resistance, with 87.5% being resistant to at least three antibiotics. All strains are susceptible to vancomycin and β-lactams susceptibility also remained high, but resistance to clindamycin, erythromycin, and tetracycline was high (>65%). The virulence genes scpB, cylB, fbsB , and cfb were highly prevalent (90%-100%), indicating their potential for vaccine and diagnostic development. Conclusions: Our findings provide valuable insights into GBS serotypes, resistance, and virulence factors, contributing to community monitoring, preventive measures, diagnostics, and vaccine development. However, the limited sample size necessitates further research.

Objective: Artemether is a semi-synthetic derivative of artemisinin and is widely used in the treatment of Plasmodium ( P. ) falciparum malaria. This study aimed to characterize the safety profile of artemether based on 15-year data retrived from FDA adverse event reporting system (FAERS). Methods: This is a retrospective analysis on 15-year data of artemether-related adverse effects (AEs) retrieved from the FAERS. AEs were classified according to System Organ Class (SOC) and Preferred Terms (PT). Signal detection was performed using Reporting Odds Ratios (ROR), Proportional Reporting Ratios (PRR), and Empirical Bayes Geometric Mean (EBGM). Stratified analyses examined the impact of demographic factors such as sex, age, and time-to-onset. Temporal patterns and associated risk factors were also investigated. Results: Haemolytic anaemia and haemolysis emerged as the most frequently reported AEs, exhibiting significantly elevated RORs (males: ROR 381.36, 95% CI 247.06-588.60; females: ROR 455.11, 95% CI 286.43-723.12). Sex-specific differences were evident, with females showing a higher incidence of reproductive-related AEs, including spontaneous abortion and premature labour. Temporal trend analysis revealed that the majority of AEs occurred within the first 30 days after the initiation of artemether administration, indicating a rapid onset. The most affected SOCs were blood and lymphatic system disorders and hepatobiliary disorders. Conclusions: Artemether is associated with a notable frequency of early-onset AEs, particularly hematological and hepatobiliary disorders. The observed sex-specific vulnerability to reproductive AEs highlights the need for sex-conscious clinical approaches. Enhanced post-treatment monitoring and further investigations into the drug’s pharmacokinetics and mechanistic pathways are recommended.

Objective: To evaluate the effectiveness of direct-acting antivirals (DAAs) in patients with chronic hepatitis C, assess changes in liver function and hepatic fibrosis following treatment, and identify independent predictors of treatment failure. Methods: This retrospective cohort study included patients who received DAA therapy at Hospital Kuala Lumpur between January 2020 and December 2023. Sustained virologic response (SVR) was assessed at least 12 weeks post-treatment by reverse transcription-polymerase chain reaction for hepatitis C virus (HCV) RNA. Demographic, clinical, and laboratory data were collected and analyzed. Multiple logistic regression analysis was performed to identify independent predictors of treatment failure. Results: A total of 335 patients in the study. The overall SVR rate was 89%. After achieving SVR, significant improvements were observed in liver enzyme levels and non-invasive liver fibrosis scores, whereas the overall Model for End-Stage Liver Disease (MELD) scores remained unchanged. Significant independent predictors of treatment failure included non-compliance with DAA therapy [adjusted odds ratio (aOR) 68.3; 95% confidence interval (95% CI ) 16.3-285.0; P <0.001], treatment with sofosbuvir/velpatasvir (aOR 6.1; 95% CI 1.4-26.5; P =0.015), MELD score of 10-15 (a OR 4.6; 95% CI 1.1-18.2; P =0.031), HCV genotype 3 infection (a OR 4.5; 95% CI 1.1-17.6; P =0.031), and elevated serum total bilirubin level (a OR 1.1; 95% CI 1.0-1.1; P =0.003). Conclusions: DAA therapy yielded a high SVR rate, and treatment failure was strongly associated with non-adherence to therapy and advanced liver disease. These findings underscore the necessity of adherence support, early diagnosis, and individualized clinical management to optimize treatment outcomes in patients with chronic hepatitis C.

Objective: To evaluate the cost-effectiveness of annual trivalent inactivated influenza vaccine (IIV3) under the context of Zhejiang province. Methods: A state transition simulation model was constructed to estimate the health and economic outcomes of IIV3 vaccination program compared to no vaccination for hypothetical cohorts of Zhejiang province stratified by age and risk status. Model input parameters were chosen based on published literatures and expert advices. The analysis used societal perspectives and a one-year time horizon, and permanent outcomes were also included. The primary outcome was the incremental cost-effectiveness ratio (ICER), with expression of US dollars per quality adjusted life years (QALYs) gained. Results: In subgroups not at high risk for influenza-related complications (non-high risk subgroup), ICER ranged from $6 268/QALY (for adults aged 50-64 years) to $11 260/QALY (for children aged from 6 months to 4 years). In subgroups at high risk for influenza-related complications (high risk subgroup), ICER ranged from cost-saving (adults aged ≥65 years) to $5 260/QALY (for children aged from 6 months to 4 years). ICER were most sensitive to changes in probability of influenza illness, cost of hospitalization, and probability of death for adults aged 18-49 years with non-high risk status. Conclusions: ICERs of annual influenza vaccination varied by age and risk status but were less than the Gross Domestic Product (GDP) per capita of Zhejiang province ($17 745 in 2023), which remained cost-effective for all-age and different risk status groups from a societal perspective.

Rationale: Myiasis is more commonly found in ulcerated tissues and tropical climates, although it can also occur in non-tropical climates and in healthy individuals. Patient concerns: The patient was a 4-year-old girl who presented to the emergency department with three nodular lesions on the skull, associated with edema, tenderness, pain, and purulent drainage. Diagnosis: Furuncular myiasis caused by Wohlfahrtia magnifica . Interventions: Antibiotic therapy was initiated, and the patient was taken to the operating room for larval removal. Mupirocin ointment and petroleum jelly were applied daily. Three days later, a second operation was performed to remove the remaining live larvae from the tissue. Outcomes: After 14 days of treatment, the patient was cured and discharged. Lessons: Although furuncular myiasis is more commonly observed in ulcerated and necrotic tissues, it can also occur in healthy individuals, particularly in the absence of proper hygiene, even in non-tropical regions.