Case Fatality Research Articles

Experience and Perspectives on Antibacterial Therapy for Listeriosis in a Tertiary Teaching Hospital in China: A Retrospective Study and Health Care Provider Survey.

Listeriosis is a rare, life-threatening bacterial infection. Prompt, appropriate antibiotic treatment is essential to save lives. We aimed to investigate antibiotic selection and listeriosis knowledge among health care providers. We first performed a retrospective study on patients with listeriosis who were treated in a hospital in China from January 2013 to March 2023. Patient characteristics and antibiotic selections were recorded. Antibiotics were classified as effective or ineffective based on the efficacy classifications listed in The Sanford Guide to Antimicrobial Therapy (50th edition). We then conducted a questionnaire survey of health care providers to investigate their listeriosis knowledge and practices between April 2023 to May 2023. Fifteen listeriosis patients were identified, with a case fatality rate of 26.7% (4/15). Empirical treatments assessed as effective antibiotics or ineffective antibiotics were given to 33.3% (5/15) and 66.7% (10/15) of the patients, respectively. After Listeria monocytogenes was identified, 40% (6/15) of the patients received an adjustment to their antibiotics, although 50% (3/6) patients still received ineffective antibiotics. The questionnaire survey of 77 participating health care providers showed that 32.9% (24/73) of the clinicians were unaware of the appropriate antibiotics for listeriosis. Most participants (83.1%, 64/77) would read the drug sensitivity report before selecting the antibiotics. The selection of effective antibiotics differed between the infectious diseases department and other departments (p < 0.001), but did not differ between junior title and other titles (p = 0.088). Most patients with listeriosis did not receive appropriate antibiotics, which might have accounted for the high fatality rate, and may have resulted from inadequate listeriosis knowledge. More education and correct reporting of drug sensitivity results are urgently needed.

Detection and identification of Naegleria species along with Naegleria fowleri in the tap water samples

Naegleria fowleri, the causative agent of Primary Amoebic Meningoencephalitis (PAM), is commonly found in warm freshwater environments and can enter the brain through nasal passages during activities like swimming or ablution. PAM has a high fatality rate, raising concerns about its global health impact. In Pakistan, particularly in Karachi, a significant number of cases have been reported, often with no history of recreational water exposure, but with regular ablution using tap water. This study analyzed the physicochemical parameters, abundance of total and fecal coliforms, and detected N. fowleri and other Naegleria species in tap water samples from Karachi using PCR with ITS- and Naegl-primers. Almost all samples exhibited high temperatures, low chlorine levels, and a high presence of coliforms. N. fowleri and other Naegleria species were detected in 11 out of 39 samples. Sequence analysis identified N. fowleri in tap water from the Golimar and Lyari areas of Karachi, while the other nine samples revealed different Naegleria species. This study suggests that the combination of high temperatures, insufficient chlorination, and the presence of coliforms may create favorable conditions for N. fowleri growth. However, these factors are not exclusive to the Golimar and Lyari areas, indicating that other environmental or infrastructural factors, not detailed in this study, may have contributed to the presence of N. fowleri in that specific location.

Neurological immune-related toxicity to ipilimumab/nivolumab therapy in malignant melanoma: A challenging case report

Introduction: Malignant melanoma poses a significant threat due to its aggressiveness and high fatality rates. Recent advances in immunotherapy and targeted molecular therapies have transformed the treatment landscape for advanced melanoma, improving overall survival. However, the rising use of immune checkpoint inhibitors (ICIs) introduces complexities, particularly in neurological immune-related adverse events (irAEs), necessitating careful consideration and multidisciplinary management. Case Report: We report the case of a 77-year-old woman with stage IV cutaneous melanoma, which was hospitalized with polyneuropathy following immunotherapy treatment with ipilimumab and nivolumab combination. The complex presentation involved considerations of COVID-19 vaccination, detection of Epstein–Barr virus (EBV) in cerebrospinal fluid, and the challenge of distinguishing infectious from immune-related causes. The multidisciplinary team navigated multiple diagnostic uncertainties. The patient’s clinical evolution, including complications and treatment responses, provided insights into managing severe neurological irAEs associated with immunotherapy. Conclusion: Neurologic immune-related (IR) toxicity is well established, and it may led to severe adverse events, which are complex to diagnose and manage. This case report highlights the challenges and difficulties found, with relevant confounding factors, which arise the relevance of the need of a multidisciplinary team to deal with neurologic immune-related toxicities.

IMPACT MONITORING OF LOW AND HIGH DEXAMETHASONE DOSES ON COVID-19 OUTCOMES IN HODEIDAH, YEMEN: A PHARMACOEPIDEMIOLOGICAL STUDY

Objectives: The study aimed to describe the pharmacoepidemiological properties of high and low dexamethasone doses on patients from COVID-19 in Hodeidah, Yemen. Methodology: A randomized clinical trial included 192/323 patients with COVID-19 (28/49 cases in the first wave 2020 and 164/274 cases in the second wave 2021), aged from 3 to 80 years old, confirmed by real time-polymerase chain reaction. All patients were admitted in the isolation department, Center of Tropical Medicine and Infectious Diseases, AL Thawara Public Hospital Authority, Hodeidah, Yemen. 28 patients received high dose of dexamethasone (20–10 mg daily for 10 days) with standard care in the first wave and 164 patients received low dose of dexamethasone (6–8 mg daily for 10 days) in the second wave with standard care. Results: The results showed non-significant differences between the impact of dexamethasone in both waves with different doses of dexamethasone (X2: 1.70; p=0.91). On the other mean, the case fatality rate (CFR) in the first wave with high dose was 10.71% and CFR of the second wave with low dose was 22.29%. While the results showed significant differences between high dose and low dose group with mechanical ventilator “mechanical ventilation (MV)” (X2: 7.10; p=0.0076), the CFR of patients with MV and high dose was 37% and CFR of the second wave with low dose was 77% In addition, all admitted cases had acute respiratory distress syndrome and the onset date of symptom was 2 weeks before hospitalization. Old age, chronic diseases, and co-infection may be contributing factors to effect on dexamethasone efficacy and excess mortality among COVID-19 patients. Conclusion: The study assessed the effectiveness of dexamethasone in high and low dose in treating patients hospitalized with COVID-19 in Hodeidah, Yemen and found difference between mortality and recovery outcomes with high and low dose where the high doses of dexamethasone had good outcome for critical cases with MV.

Epidemiological characterization of COVID-19 in children under 18 years old in Mexico: an analysis of the pandemic.

The study aimed to describe the characteristics and risk factors associated with disease severity across six waves of COVID-19 in the pediatric population in Mexico. A cohort study was conducted using data from the Mexican Ministry of Health, covering the period from March 2020 to March 2023. The dataset included patients under 18 years of age with confirmed SARS-CoV-2 infection. Univariate, bivariate, and logistic regression analyses were performed to determine demographic and clinical characteristics, mortality across waves, and age group distributions. Of the total cohort, 9.5% were children, with 497,428 confirmed cases. Among these, 50% were male, 4.4% required hospitalization, and there were 1,447 (0.03%) deaths. The highest prevalence was observed in the 12-17-year age group (52%), followed by the 5-11-year age group (32%), with incidence rates peaking towards the end of 2021 and the early 2022. Although the 0-2-year age group represented 9.6% of cases, it had higher hospitalization (40%), ICU admission (58%), and case fatality rate (CFR) (44%). Cardiovascular disease, hypertension, diabetes and immunosuppression were identified as risk factors for severe outcomes. The initial wave displayed the highest CFR (OR 5.28) especially in children aged 0-2 years. Children were less affected during the pandemic compared to adults; however, children under two years-old experienced more severe outcomes. Currently, with 95% of the population estimated to be immune due to vaccination and/or prior infection, children under 2 years of age are now at higher risk of severe disease and should be evaluated for vaccination as a public health policy.

Burden of disease of respiratory syncytial virus in older adults and adults considered at high risk of severe infection.

Availability of new vaccines for adults has increased interest in understanding Canada's respiratory syncytial virus (RSV) burden in older adults and adults considered at high risk of severe infection. To characterize the burden of RSV disease in Canada by joint analysis of the published literature and hospitalization data from a healthcare administrative database. Electronic databases of published literature were searched to identify studies and systematic reviews reporting data on outpatient visits, hospitalizations, intensive care unit (ICU) admissions and deaths associated with RSV infection in adults. For the hospitalization data analysis, hospital discharge records were extracted from the Canadian Institute of Health Information Discharge Abstract Database for all patients admitted to an acute care facility for RSV infection defined by ICD-10 codes from 2010 to 2020 and 2021 to 2023. Overall, 26 studies, including seven systematic reviews, were identified and summarized. Evidence suggests that medically attended RSV respiratory tract infections (RTI) are frequently causing 4.7%-7.8% of symptomatic RTI in adults 60 years of age and older. Incidence of RSV RTI increases with age and presence of underlying medical conditions. This trend was consistently observed across all RSV clinical outcomes of interest. Patients who reside in long-term care or other chronic care facilities have a higher likelihood of severe clinical outcomes compared to patients with other living situations upon hospital admission. Approximately 10% of older adults hospitalized with RSV infection require ICU admission. Although data are limited, the case fatality ratio (CFR) among those admitted to hospital varies between 5% and 10%. Some evidence suggests that RSV burden may be close to the influenza burden in older adults. In general, the results from the Canadian hospitalization data support the rapid review findings. Rates of hospitalization, ICU admission and death associated with RSV all increased with age, with 16% of hospitalizations resulting in ICU admission and with an in-hospital CFR of 9%. In adults, the burden of severe RSV outcomes in general increases with age and presence of comorbidities.

Time trends of catheter-directed treatment in acute pulmonary embolism in Germany.

Catheter-directed treatment (CDT) is an innovative treatment for patients with elevated risk pulmonary embolism (PE) to resolve embolus and restore pulmonary perfusion. We aimed to analyse the use and the benefit of CDT in PE patients in Germany. The German nationwide inpatient sample was used to include all hospitalizations of patients with PE from 2005 to 2020 in Germany. PE patients were stratified for CDT usage. Temporal trends and the impact of CDT on case fatality and other outcomes were investigated. Overall, 1,373,084 hospitalizations of patients with PE (55.9% aged ≥70 years; 53.0% females) were included in this study from 2005 to 2020, and among these, 427,238 (31.1%) patients were categorized as having elevated-risk PE and 3330 (0.2%) were treated with CDT with annual increase from 0.17% (2005) to 0.51% (2020). PE patients of younger age, male sex, with previous surgery, and elevated-risk PE were more often treated with CDT. In patients with elevated risk-PE, CDT attributed to a lower observed rate of major adverse cardiac and cerebrovascular events (major adverse cardiac and cerebrovascular events [MACCE]; 28.2% vs 34.2%; P< .001) and in-hospital case fatality (24.9% vs 31.0%; P< .001). CDT was associated with reduced MACCE (OR, 0.91; 95% CI, 0.83-0.99) and with a trend toward lower case fatality (OR, 0.92; 95% CI, 0.84-1.01). The benefit of CDT regarding case fatality was age-dependent. Although the annual rate of CDT increased in Germany between 2005 and 2020, only 0.2% of the PE patients were treated with CDT. Selection criteria for CDT treatment were younger age, male sex, previous surgery, and elevated risk-PE. CDT treatment was associated with reduced MACCE and case-fatality rate in PE patients with elevated-risk PE.

Exploring the Cardioprotective Mechanisms of Ligusticum wallichii in Myocardial Infarction Through Network Pharmacology and Experimental Validation.

Myocardial infarction represents a coronary artery ailment with the highest incidence and fatality rates among cardiovascular conditions. However, effective pharmacological interventions remain elusive. This study seeks to elucidate the molecular mechanisms underlying the effects of Ligusticum wallichii on myocardial infarction through network pharmacology and experimental validation. Initially, potential targets of Ligusticum wallichii's active ingredients and myocardial infarction-related targets were retrieved from databases. Subsequently, core targets of Ligusticum wallichii on myocardial infarction were identified via the PPI network analysis and subjected to GO and KEGG pathway enrichment analyses. Molecular docking was employed to validate the binding affinities between the core targets and the bioactive components. The findings from network pharmacology analysis were corroborated through in vitro and in vivo experiments. Seven active ingredients from Ligusticum wallichii were identified, corresponding to 122 targets. Molecular docking revealed robust binding affinities of Myricanone, Senkyunone, and Sitosterol to key target proteins (EGFR, STAT3, and SRC). In vitro, experiments demonstrated that pretreatment with the active components of Ligusticum wallichii protected myocardial cells from OGD exposure and modulated the expression of their key target genes. In vivo, experiments showed that the active components of Ligusticum wallichii significantly improved myocardial infarction via alleviating myocardial fibrosis and oxidative stress and did not elicit toxic effects in mice. The collective findings suggest that Ligusticum wallichii shows promising potential for myocardial infarction treatment by regulating key target proteins (EGFR, STAT3, and SRC), which play roles in oxidative stress and myocardial fibrosis.

Outbreak of ruminal acidosis in cattle caused by the ingestion of hedge lucerne (Desmanthus virgatus L. Willd.) in Northeastern Brazil

This study describes the epidemiological, clinical, and pathological aspects of an outbreak of ruminal acidosis and ruminitis caused by the ingestion of hedge lucerne (Desmanthus virgatus L.) in 70 cattle in the state of Paraiba, Northeastern Brazil. The herd had been transported from the state of Piauí to Paraiba. The deaths of the cattle occurred 15 days after the animals were introduced to a native pasture containing D. virgatus. All animals exhibited ruminal atony, which ranged from mild to severe. A total of 35 cattle died, with five undergoing necropsy. Initial clinical signs included apathy, followed by a marked increase in left abdominal volume, consistent with ruminal distension, absence of rumination (ruminal atony), lateral recumbency, and ultimately death. All affected animals were treated with oral administration of rumen fluid, enteral fluid therapy, and oral antacids. During this period, twenty animals succumbed to the condition, and an additional 15 died after being relocated, resulting in a 50% fatality rate. Significant gross pathological findings were observed primarily in the digestive system. The forestomachs were markedly distended, containing large amounts of reddish, pasty, and serous ingesta. A demarcation line was evident in the esophagus, separating the pale and bloodless distal esophagus from the congested proximal esophagus at the thoracic inlet, corresponding to the "bloat line." Frothy material was present in the tracheal lumen, indicating pulmonary edema. Additionally, rectal prolapse was noted. Histopathological examination revealed marked edema and severe hydropic (ballooning) degeneration of the basal layer in the forestomachs, along with intercellular edema. Separation of the epithelium from the lamina propria, forming multiple clefts, was observed, accompanied by areas of lymphoplasmacytic inflammatory infiltrate in the submucosa. This study demonstrates that this plant can cause severe gastrointestinal disturbances in cattle unaccustomed to its consumption and ingesting large quantities of the plant's shoots.

Atypical Patients With Severe Fever With Thrombocytopenia Syndrome.

Severe fever with thrombocytopenia syndrome (SFTS) is an emerging tick-borne disease with a high fatality rate. The clinical diagnosis criteria mainly rely on white blood cell (WBC) and platelet (PLT), which, however, are of limited usage in identifying atypical SFTS. A multicenter study was performed in two hospitals from 2011 to 2023. SFTS patients were categorized as atypical or typical based on the clinical diagnosis criteria. Clinical progress and outcomes were compared between the two groups. A total of 2876 laboratory-confirmed SFTS patients were included in this study, 90.54% (2604/2876) of whom exhibited both thrombocytopenia and leukopenia and were defined as typical SFTS patients, while 9.46% (272/2876) were defined as atypical SFTS patients. Patients with typical SFTS were more likely to develop complications (adjusted odds ratio [OR] = 2.09, 95% confidence interval [CI]:1.48-2.92, p < 0.001) and fatal outcomes (adjusted OR = 2.24, 95% CI: 1.37-3.89, p = 0.002) compared to patients with atypical SFTS. Among atypical patients, those with decreased PLT and normal WBC levels (PLT↓ and WBC→) experienced increased complication rates (adjusted OR = 2.76, 95% CI: 1.30-6.05, p < 0.001) compared to those with decreased WBC and normal PLT (WBC↓ and PLT→). In the typical group, 238 patients developed thrombocytopenia earlier than leukocytopenia (defined as the TL group), while 311 subjects developed leukocytopenia earlier than thrombocytopenia (defined as the LT group). Compared to the LT group, patients in the TL group were more likely to develop fatal outcomes (HR = 1.91, 95% CI: 1.04-3.50). These findings highlight the presence of atypical SFTS cases that did not meet the clinical diagnosis criteria. Clinical profiles and outcomes differed between typical and atypical SFTS patients. A less stringent diagnostic criterion than combined thrombocytopenia and leukopenia is suggested for making clinical diagnoses within 7 days of disease onset.

Epidemiological analysis and potential factors affecting the 2022-23 Crimean-Congo hemorrhagic fever outbreak in Iraq.

Crimean-Congo hemorrhagic fever (CCHF) is an acute tick-borne disease with a case fatality rate of up to 40% in humans, posing a significant health threat. This study investigates the 2022-23 CCHF outbreaks in Iraq, the highest recorded to date, and analyzes potential factors at the human-animal-environmental interface. Data from the Iraqi government, the World Health Organization, and the World Bank were used to analyze CCHF trends and affecting factors. This included epidemiological reports, clinical data, tick infestation and seroprevalence studies, and climate data. Descriptive and statistical analyses examined case trends, geographic and demographic characteristics, clinical manifestations, risk factors, seasonal patterns, and influencing factors. A sudden rise in CCHF cases began in southern Iraq in April 2022 and expanded across all governorates, with a shift toward urban areas. Higher incidence was observed among males, aged 25-44, and those involved in slaughtering. The most common clinical manifestation was fever (97%), followed by hemorrhagic symptoms (54%). Bleeding from the gums or mouth and subcutaneous bleeding were more frequent in patients with fatal outcomes. Seasonal patterns showed peaks during spring and fall, correlating with tick activity and potentially exacerbated by climate change. Tick infestation and seroprevalence studies indicated a high prevalence of Hyalomma ticks and CCHF seropositivity among domestic animals in southern Iraq (60%), consistent with the distribution of CCHF human cases. Iraq's ongoing CCHF outbreak demands multidisciplinary One Health strategies. The Iraqi government has adopted such a control strategy, contributing to regional and global efforts to enhance pandemic preparedness.

Epidemiological pattern of dengue fever in Afghanistan in the period 2021-22.

Dengue fever is considered as an emerging disease in Afghanistan. Since the first outbreak was reported in 2019, other outbreaks have been reported in the following years. The current study aims to describe the epidemiological features and clinical manifestations of suspected and confirmed cases of dengue fever detected by the National Disease Surveillance and Response (NDSR) Department of the Ministry of Public Health (MoPH) during 2021 and 2022 to prevent further spread and minimize its impact on the country's health system and on the limited number of health workers. Through a retrospective analysis of historical data related to suspected dengue fever cases in Afghanistan detected by the National Disease Surveillance and Response Department during 2021 and 2022, several variables were identified, including demographic characteristics, clinical features, clinical management, the outcome of infection, laboratory data, and epidemiological factors. All statistical analyses were developed using Microsoft 365 (Excel). The mean age of the 1977 reported suspected dengue fever cases was 30.4 ± 14.9 years, with males 70.7%. The epidemic curve showed a steep rise in cases in 2022, starting from week 39, with a peak reached in week 45, which was higher than that observed in 2021. The majority of cases (97.9%) were reported from Nangarhar Province, east of the country. Regarding symptoms, fever, headache, and muscle pain were expressed in nearly all cases. The reverse transcription polymerase chain reaction was positive in 379 cases out of 497 cases (76.3%). For the management of cases, 97.6% received antipyretics. Less than 5% of cases were admitted to health care units, with death reported in only two cases (case fatality rate of 0.1%). The number of suspected cases of dengue fever reported in Afghanistan was increasing. The trends for 2021 and 2022 followed almost the same pattern, with a higher peak in 2022. Understanding the epidemiological and clinical characteristics of dengue fever cases is fundamental for preparedness for upcoming seasons.

Enhancing Skin Cancer Diagnosis using Cubic Pythagorean Fuzzy Hypersoft Set with Salp Swarm Algorithm

Due to the rapid increase in population density, medical sciences now face a major challenge in the automated detection of diseases. Intelligent system assists health personnel in earlier disease diagnosis and provides reliable treatment to reduce the fatality rates. Skin cancer is one of the most severe and deadliest kinds of cancer. A health professional uses dermoscopic images to manually diagnose skin tumors. This technique can be time-consuming and labor-intensive and needs a considerable level of expertise. The automatic recognition method is essential for the earlier diagnosis of skin tumors. In recent times, N-soft Set model has become widespread, which is a generalization of fuzzy set where all the elements have a membership value in the complement (0 to 1) and in the set (0 or 1). This study presents a Skin Cancer Diagnosis using Cubic Pythagorean Fuzzy Hypersoft Set (SCD-CPFHSS) technique. The presented SCD-CPFHSS technique performs identification of skin cancer using the application of NSs and metaheuristic algorithms. In the SCD-CPFHSS technique, neural architectural search network (NASNet) model derives feature extractors from the dermoscopic image. In addition, the efficacy of the NASNet model can be boosted by the design of salp swarm algorithm (SSA). For skin cancer recognition, the SCD-CPFHSS technique applies CPFHSS model. The experimental outcome of the SCD-CPFHSS methodology was validated using medical dataset. The extensive results pointed out that the SCD-CPFHSS technique reaches better results on skin cancer diagnosis

Risk Factors for Co-Infections in Patients With Severe Fever With Thrombocytopenia Syndrome.

Severe fever with thrombocytopenia syndrome (SFTS) is an emerging viral hemorrhagic fever with a high fatality rate and notable public health impact, caused by a novel phlebovirus, primarily transmitted through infected tick bites. This study aimed to assess the prevalence of co-infections among hospitalized patients with SFTS, characterize isolated pathogens, and evaluate demographics, clinical features, and laboratory variations to identify potential risk factors for co-infections. In a cohort of 78 SFTS patients categorized into co-infection and non-co-infection groups, 44.9% (35/78) experienced co-infections, with a 25.7% mortality rate in that subgroup. Pulmonary and bloodstream infections, particularly fungal infections, were most common, and earlier onset of co-infections correlated with higher fatality. Univariable logistic regression identified significant risk factors, followed by multivariable analysis to determine independent predictors. Changes in mental status, hemorrhage, deep venous or arterial catheterization, mechanical ventilation, activated partial thromboplastin time (APTT) > 55 s, albumin < 37.5 g/L, interleukin-6 > 18.700 pg/mL, and interleukin-10 > 21.300 pg/mL emerged as significant risk factors, with hemorrhagic symptoms and low albumin remaining independent predictors. Internal validation through bootstrap resampling yielded a mean area under the receiver operating characteristic curve of 0.795 (95% CI: 0.706-0.868). These findings suggest that early recognition of these predictors may improve co-infection management in SFTS patients, leading to better clinical outcomes and more informed clinical decisions.

Risk factors and preventive role of vaccination in adult tetanus fatality: a systematic review of reported cases (1990-2024) and meta-analysis.

This study identifies key risk factors for fatality among adult tetanus patients and assesses the impact of vaccination status and antibody levels on disease severity and outcomes in tetanus cases. Despite widespread vaccination, fatality rates remain high due to diagnostic and management challenges. A meta-analysis of 182 tetanus cases from 36 countries, published since 1990, was conducted. The analysis focused on risk factors such as autonomic dysfunction, opisthotonus, incubation time, diabetes, cardiovascular diseases, and skin infections. Key risk factors for fatality included autonomic dysfunction, opisthotonus, shorter incubation periods, diabetes, cardiovascular diseases, and cutaneous infections. Interestingly, fatalities occurred in patients with antibody levels above the proposed protective threshold, showing that serological evidence of immunity is not absolute. Importantly, patients with a complete vaccination history experienced less severe disease, and no fatalities were observed among those who had received a full course of childhood vaccinations. The findings highlight the importance of maintaining up-to-date vaccination schedules to reduce the severity of disease and improve outcomes in tetanus cases. The results suggest that while immunity may not always prevent infection, prior vaccination significantly mitigates disease severity. Given that immunity may not be entirely protective and up-to-date vaccinations seem to improve the outcomes, prompt diagnosis and effective booster vaccinations are crucial to further reduce mortality in tetanus patients.

Achievement of one health multi-sectoral collaboration in containment of Rift Valley Fever outbreak, Sudan, Red Sea State 2019.

Rift Valley Fever is endemic in Sudan, with a notable outbreak declared in 2019, affecting multiple states. In this study, we examine the Red Sea State, Sudan's experience in applying the One Health approach, to contain Red-Sea RVF outbreak. A retrospective analysis of national and sub-national data and a review of literature were conducted to assess the application of One Health response and to derive lessons learned. The analysis revealed a total of 576 human cases and two deaths, with a case fatality rate of 0.35%, from 25 September 2019 to 25 January 2020. Most cases (99%) were from the Red Sea and River Nile States, and only six sporadic cases were from other five states. The Red Sea State reported 322 human and 74 animal cases, including 74 abortions and 12 animal deaths. Triggers and risk factors include floods, uncontrolled movement of animal, close contact with animals, poor disposal, and unsafe burial practices for animals. One Health approach was utilized all through the defeat of outbreak. A multi-sectoral response plan was implemented, leading to the declaration of the end of the outbreak in 2020 which was reviewed and lessons were derived. One Health approach provided a coordinated action between health, veterinary, and environmental authorities at national and subnational levels. Synergistic efforts have minimized risk of RVF spreading among human and animal. The experience was leveraged to strengthen response approaches for zoonotic diseases. Structural and capacity gaps and financial constraints were identified as implementation challenges.

Omics approaches: Role in acute myeloid leukemia biomarker discovery and therapy.

Acute myeloid leukemia (AML) is the most common acute leukemia in adults and has the highest fatality rate. Patients aged 65 and above exhibit the poorest prognosis, with a mere 30 % survival rate within one year. One important issue in optimizing outcomes for AML patients is their limited ability to predict responses to specific therapies, response duration, and likelihood of relapse. Despite rigorous therapeutic interventions, a significant proportion of patients experience relapse. Consequently, there is a pressing need to introduce new targets for therapy. Sequencing and biotechnology have come a long way in the last ten years. This has made it easier for many omics technologies, like genomics, transcriptomics, proteomics, and metabolomics, to study molecular mechanisms of AML. An integrative approach is necessary to understand a complex biological process fully and offers an important opportunity to understand the information underlying diseases. In this review, we studied papers published between 2010 and 2024 employing omics approaches encompassing diagnosis, prognosis, and risk stratification of AML. Finally, we discuss prospects and challenges in applying -omics technologies to the discovery of novel biomarkers and therapy targets. Our review may be helpful for omics researchers who want to study AML from different molecular aspects.

Automated quantitative pupillometry as a predictor for transtentorial brain herniation in patients with malignant acute ischemic stroke.

Brain herniation can be a life-threatening condition, resulting in poor prognosis and higher fatality rates. We examined whether quantitative characteristics of sequential pupillary light reflex (PLR) could serve as biomarkers for identifying brain herniation in fatal acute stroke cases with anterior circulation involvement admitted to neurological intensive care unit (Neuro-ICU). Automatic pupillometer assessed PLR automatically every 4-6 hours, measuring eight specific features: NPi (Neurological pupil index) score, initial resting and constriction pupil size, constriction change, constriction velocity, constriction latency, and dilation velocity. Generalized estimating equations were used to analyze the main effects of assessment time (3-to-0 hours, just before brain herniation, and 27-to-21 hours, considerably before) and clinical groups. The study involved 59 patients (mean age 68.8 ± 1.6 years, 23 females) divided into herniation (n = 10) and non-herniation (n = 49) groups. The herniation group exhibited significantly lower ipsilateral NPi scores at 3-to-0 hours (1.80 ± 0.44, p < 0.0001) compared to 27-to-21 hours (4.26 ± 2.21). Additionally, the herniation group had a larger ipsilateral pupil size at constriction at 3-to-0 hours (4.01 ± 0.40 mm) compared to 27-to-21 hours (2.11 ± 0.17 mm). Specifically, at 3-to-0 hours, the herniation group had lower NPi scores (1.80 ± 0.44 vs. 3.97 ± 0.13, p < 0.0001) and larger pupil size at constriction (4.01 ± 0.04 mm vs. 2.90 ± 0.10 mm, p = 0.007) compared to the non-herniation group. These findings suggest that evaluating PLR characteristics can aid in the early identification of brain herniation, facilitating timely triage and appropriate surgical management.

COVID-19 mortality among solid organ transplant recipients and candidates before specific vaccine availability in Colombia.

Coronavirus disease 2019 (COVID-19) is a life-threatening disease that was declared a pandemic in March 2020. Organ transplant recipients are vulnerable to infection and complications from COVID-19. The objective of this study was to investigate the rates of infection, mortality, and case-fatality ratios (CFR) in solid organ transplant recipients and patients on the waiting list for organ allocation in the period prior to the availability of specific vaccines. This was an observational study of official sources that are used to report information on COVID-19. Quantitative variables were described with arithmetic means and categorical variables with proportions. Percentages of positivity to infection, number of deaths, CFR, and all-cause mortality were calculated for each group and subgroup. There were 2,551 eligible subjects; 602 (26.2%) were positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). There were 265 (10.4%) deaths from all causes during the follow-up period; 119 (44.9%) of them were associated with COVID-19, which indicated a COVID-19-related mortality rate of 4.7 %. CFRs were 21.4% and 17.1% in transplant recipients and waitlisted patients, respectively. CFR was significantly higher in transplant recipients (23.8%) than in patients waitlisted for kidney (16.5%; p = 0.044) Among SARS-CoV-2-positive patients, the probability of dying from COVID-19 was higher in the first group (87.3% and 73%, respectively; p = 0.034). COVID-19 had a significant impact on the deaths of transplant patients and patients on the solid organ waiting list during the first year of the pandemic in Colombia, before the availability of vaccines.

Virological Aspects of COVID-19 in Patients with Hematological Malignancies: Duration of Viral Shedding and Genetic Analysis.

Coronavirus disease 2019 (COVID-19) has been associated with a significant fatality rate and persistent evolution in immunocompromised patients. In this prospective study, we aimed to determine the duration of excretion of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in 37 Tunisian patients with hematological malignancies (40.5% with lymphoma and 37.8% with leukemia). In order to investigate the accumulation of viral mutations, we carried out genetic investigation on longitudinal nasopharyngeal samples using RT-PCR and whole-genome sequencing. Patients' samples were collected until the RT-PCR results became negative. SARS-CoV-2 infection was symptomatic in 48.6% of cases with fever, and cough was symptomatic in 61% of cases; the mortality rate was estimated to be 13.5%. The duration of viral RNA shedding ranged from 7 to 92 days after onset; it exceeded 18 days in 79.4% of cases. An intermittent PCR positivity was observed in two symptomatic patients. Persistent PCR positivity, defined as the presence of viral RNA for more than 30 days, was found in 51.4% of cases. No significant differences were observed for age, sex, type of hematological malignancy, or COVID-19 evolution between this group and a second one characterized by non-persistent PCR positivity. Lymphopenia was an independent predictor of prolonged SARS-CoV-2 RNA detection (p = 0.04). Three types of variants were detected; the most frequent was the Omicron. Globally, the mean intra-host variability in the SARS-CoV-2 genome was 1.31 × 10-3 mutations per site per year; it was 1.44 × 10-3 in the persistent group and 1.3 × 10-3 in the non-persistent group. Three types of mutations were detected; the most frequent were nucleotide substitutions in the spike (S) gene. No statistically significant difference was observed between the two groups as to the type and mean number of observed mutations in the whole genome and the S region (p = 0.650). Sequence analysis revealed the inclusion of one to eight amino acid-changing events in seventeen cases; it was characterized by genetic stability from the third to the twentieth day of evolution in six cases. For the two patients with intermittent PCR positivity, sequences obtained from samples before and after negative PCR were identical in the whole genome, confirming an intra-host evolution of the same viral strain. This study confirms the risk of persistent viral shedding in patients with hematological malignancies. However, persistence of PCR positivity seems to be correlated only with a continuous elimination of viral RNA debris. Additional studies based on cell culture analysis are needed to confirm these findings.