Case Fatality Rate Research Articles

Large-scale HEV genotype 3 outbreak on New Caledonia Island.

Several symptomatic cases of HEV infections were reported to the New Caledonia Island Public Health Service between August and December 2023. This prompted epidemiological and virological investigations to identify the source of infection. HEV RNA was assessed in symptomatic patients, various food items, and pig farms on the Island. HEV strains were characterized by sequencing. A seroprevalence study was also conducted on asymptomatic blood donors before and after the outbreak. One hundred twenty-seven symptomatic cases were reported. Hospitalization was required for 29/127 patients (22.8%). Hospitalized patients presented more frequently with comorbidities, including liver and cardiovascular diseases (80.7% vs. 27%, p < 0.01), and 3 persons died (2.3%). Among the 100 HEV RNA-positive samples received at the French National Reference Centre for HEV, viral sequencing was possible for 76 samples. All strains were identified as HEV genotype 3, and 74/76 strains were grouped together (nucleotide identity: 98%-100%). Full-length sequencing indicated a new HEV-3 subtype within HEV-3 subclade abk. Only genotype 3f strains were detected on the Island's pig farms. No food items tested positive for HEV RNA. The seroprevalence of HEV IgG and IgM in blood donors was 9.2% (9/98) and 0%, respectively, in 2020, rising to 17.3% (17/98) and 2% (2/98) in 2024. Although all previous large-scale epidemics in Asia and Africa were associated with HEV-1 or 2, the New Caledonia outbreak was linked to HEV-3. A high number of symptomatic cases were admitted to the hospital, with a case-fatality rate of 2.3%.

Using NHS Data to Monitor Trends in the Occurrence of Severe, Food-Induced Allergic Reactions Work Package 1

People with food allergies may experience food allergic reactions due to accidental exposure. These reactions are commonly categorised as non-severe, fatal food anaphylaxis and near-fatal food anaphylaxis. Non-severe allergic reactions to food are more common with an incidence of up to 1,000 times greater than fatal food-related anaphylaxis. However, obtaining accurate data relating to the circumstances under which these reactions occurred is challenging under the current diagnosis coding system used in the National Health Service (NHS). This project addressed two key questions: 1. What are the trends in the occurrence of food hypersensitivity (FHS) reactions and their consequences in terms of healthcare encounters (both to hospital and primary care)? 2. What are the circumstances surrounding severe, life-threatening reactions to food? Approach The researchers used existing NHS datasets (relating to Hospital Admissions, Accident &amp; Emergency visits, Critical Care admissions and Primary care visits) to evaluate healthcare encounters due to food hypersensitivity over the study period. Patient pathways through the healthcare system were also assessed by linking these different datasets. Key Results • Food-induced anaphylaxis represented 29.4% of reported anaphylaxis. admissions, and increased significantly from 1.23 to 4.02 admissions per 100,000 population per annum over the study period. • However, despite an annual increase of 5.7% in hospitalisation for food-induced anaphylaxis between 1998 and 2018, the case fatality rate (proportion of hospital admissions associated with a fatal outcome) more than halved, from 0.7% in 1998 to less than 0.3% in 2018. • 152 deaths were identified during the study period where the cause was very likely to have been food-induced anaphylaxis. • At least 86 (46%) fatalities were triggered by peanut or tree nuts. • Cows’ milk was reported to be the most common cause of fatal anaphylaxis in children aged under 16 years. • Using data from England for the period 2008-2018, the prevalence of food allergy ranged from 4% in preschool-aged children (under 5 years), 1-2% in school-aged children and young people (5 to 20 years) and 0.9% in adults. Although the same methods were used throughout the study period, the statistics presented may be prone to limitations such as miscoding and incomplete datasets. • Prescription of adrenaline auto-injector devices (AAI) are an important risk management intervention in people at risk of food-induced anaphylaxis. However, there is significant under-prescribing of AAI. Data showed that 40% of individuals with prior food-induced anaphylaxis were not prescribed AAI and at least 59% did not have AAI on repeat prescription. • Most healthcare visits for food allergy occurred in general practice. Less than 3% of individuals with a diagnosis of food allergy attended Accident and Emergency during the study period, 2008-2018. Therefore, using hospital data in isolation to analyse patterns of health service utilisation with respect to FHS may not provide a comprehensive overview.

Acute leptospirosis in horses: A retrospective study of 11 cases (2015-2023).

Reports of leptospirosis in horses are limited. To describe the clinical and diagnostic findings of acute systemic leptospirosis in horses. Eleven client-owned horses presented to an equine hospital because of acute onset of disease between 2015 and 2023. Retrospective case series. Horses diagnosed with leptospirosis by 1 or more of urine PCR, serologic microscopic agglutination test (MAT), and histopathology. Common clinical signs included lethargy (10), anorexia (10), fever (9), tachypnea (9), abnormal lung sounds (9), and epistaxis (6). Acute kidney injury was present in all cases. Evidence of pulmonary hemorrhage and liver disease was found in 8 (73%) and 6 (55%) horses, respectively. In 6 (55%) horses, kidneys, lungs, and liver were affected. Urine quantitative polymerase chain reaction for detection of pathogenic Leptospira spp. was positive in 6 (55%) cases. On serology Leptospira interrogans serovar Australis, Autumnalis, and Bratislava accounted for 86% of all titers ≥1 : 800. Overall case fatality rate was 4/11 (36%). Main findings on necropsy were tubular necrosis, interstitial nephritis, hemorrhage in the alveoli, pulmonary edema, periportal hepatitis and necrosis, cholestasis, and cholangitis. Leptospirosis should be considered as a differential diagnosis in horses with evidence of acute systemic inflammation and acute renal injury, epistaxis, or hepatic disease. For increased likelihood of identifying positive cases, both MAT serology and urine PCR should be performed.

Advances in Dendritic-Cell-Based Vaccines against Respiratory Fungal Infections.

Ever since the discovery of dendritic cells by Ralph Steinman and Zanvil Cohn in 1973, it is increasingly evident that dendritic cells are integral for adaptive immune responses, and there is an undeniable focus on them for vaccines development. Fungal infections, often thought to be innocuous, are becoming significant threats due to an increased immunocompromised or immune-suppressed population and climate change. Further, the recent COVID-19 pandemic unraveled the wrath of fungal infections and devastating outcomes. Invasive fungal infections cause significant case fatality rates ranging from 20% to 90%. Regrettably, no licensed fungal vaccines exist, and there is an urgent need for preventive and therapeutic purposes. In this review, we discuss the ontogeny, subsets, tissue distribution, and functions of lung dendritic cells. In the latter part, we summarize and discuss the studies on the DC-based vaccines against pulmonary fungal infections. Finally, we highlight some emerging potential avenues that can be incorporated for DC-based vaccines against fungal infections.

Epidemiological Pattern and Case Fatality Rate among COVID-19 Patients during First and Second Wave of Pandemic in Madhesh Province, Nepal

Background &amp; Objectives: Evaluating multi-wave patterns of COVID-19 infection, hospitalization, and mortality across spatial scales can inform public health strategies for future pandemics. However, there is limited understanding of these patterns in developing countries, including Nepal. This study aimed to analyze epidemiological patterns, fatality rates, and factors associated with severe outcomes during the first and second waves of COVID-19 in Madhesh Province, Nepal. Materials and Methods: This retrospective cross-sectional study used provincial health records from Madhesh Province, covering April 9, 2020, to December 15, 2021, to analyze 37,551 positive COVID-19 cases and 1,037 deaths across two waves. The study examined changes in COVID-19-related deaths, with data on demographics, residence, isolation sites, treatment hospitals, care levels, and testing laboratories. The frequency and percentage of the variables were presented. The case fatality rate (CFR) for different categories were calculated. Additionally, the case fatality rate ratio (CFRR) for the first wave against second wave was obtained. Finally, case fatality risk ratios with 95% confidence intervals were presented. A p-value of &lt;0.05 was set as statistically significant. Results: The case fatality rate (CFR) for COVID-19 was significantly higher in the second wave, especially among the elderly (≥47 years), and in institutional isolation (7.82%). Tertiary level care and private hospitals consistently showed higher CFRs. Furthermore, the multivariable analysis of risk ratios (RR) for COVID-19 case fatality in revealed that the 25–34 year age group had the highest RR (2.39). Similarly, males had a higher RR (1.42) than females, and institutional isolation had a substantially higher RR (93.33) compared to home isolation. Primary level care RR (28.11) and government hospitals RR (4.32) showed a higher risk. Place of residence also impacted the RR, with Sarlahi (7.68) having higher. Conclusion: A significant increase in COVID-19 case fatality rates during the second wave, particularly among the elderly and those in institutional isolation. Higher mortality was observed in tertiary hospitals and among those who were tested in private laboratories, with substantial variations in risk ratios based on age, isolation type, and place of residence.

Locally Prepared Therapeutic Food for Treatment of Severely Underweight Children in Rural India: An Interventional Prospective Controlled Community-Based Study with Long Follow-Up:-'SAMMAN' Trial.

Severely underweight (SUW) children contribute significantly to under-five mortality and morbidity. There are WHO guidelines for the management of severe acute malnutrition but no specific guidelines for SUW management. The objectives were to achieve a recovery rate of 30% at 90 days of treatment for severe underweight (SUW) children aged 6-60 months, compare changes in weight-for-age Z (WAZ) scores, growth patterns, and case fatality rates between intervention and reference arms (RA), and reduce the prevalence of SUW in the intervention arm (IA). The target of a 30% recovery rate was achievable and significant based on our past research conducted in similar settings. Design: A prospective controlled community-based, longitudinal, two arms (IA, RA), intervention study with long follow-up was conducted between January 2011 and October 2023. Primary care for participants from 14 villages in rural Melghat, India. The study participants included SUW children aged 6-60 months and age-matched (±2 weeks) normal controls. The SAMMAN (Acronym for SAM-Management) intervention was comprised of local therapeutic food-micronutrient (LTF-MN) therapy for 90 days, intensive behavior change communication, infection treatment, and quarterly anthropometric records. SUW recovery, growth patterns, case fatality rate, prevalence at 90 days of therapy and at 60 months of age, and survival until early adolescence were assessed. ANCOVA analysis was used to obtain changes in Z-scores. In the IA, the recovery rate was 36.8% at 90 days and 78.2% at 60 months of age. The mean difference in change in WAZ scores between the intervention arm and the reference arm was statistically significant (p < 0.0001). Growth patterns were similar between the two arms up to early adolescence. The SUW case fatality rate was significantly lower in the IA (0.9%) as compared to 4.62% in the RA at 60 months (p = 0.022). The reduction in SUW prevalence in intervention villages was higher than in the control villages (p < 0.001). The cost of management per SUW child was 3888 INR (47 USD) less than RUTF. The SAMMAN intervention is safe and cost-effective for significantly improving WAZ scores, sustainable, and hence replicable in resource-limited areas.

Frequency and risk factors for Miliaria Tuberculosa in Bangui

Introduction: We conducted this study to describe the epidemiological and clinical profiles of patients with tuberculosis miliaria and to identify risk factors for the disease. Methodology: This was a case-control study of patients with tuberculosis miliaria (cases) and non-tuberculosis (controls), who were followed between 1 April 2010 and 31 December 2017 at the Friendship Hospital in Bangui. Results: A total of 192 patients were included, including 96 cases of miliaria tuberculosa and 96 controls. The mean age was 40.9±14.1 years [20; 87] for cases compared to 36.6+4.4 years [20; 45] for controls. The sex ratio was 1.2 in cases compared to 1 in controls. The in-hospital frequency of miliary tuberculosis was 15.5% out of a total of 621 tuberculosis cases. The frequency of TB/HIV co-infection was 69.7% (108/155). The median CD4 T cell count was 100/mm3 [1; 646] in cases versus 100/mm² [1; 1079] in controls. The case fatality rate was 35.4% compared to 33.3% for controls. HIV infection was the risk factor for miliary tuberculosis (p = 0.04; OR=2.1[1.1-4.5]). Ko Conclusion: In the Central African Republic, the hospital incidence of tuberculosis miliaria in Bangui is high, and HIV is associated with its occurrence. Effective preventive measures could reduce the incidence of this disease. Keywords: Miliary tuberculosis, epidemiology, Bangui.

Twenty-five years of Nipah outbreaks in Southeast Asia: A persistent threat to global health

ObjectivesNipah virus (NiV), a bat-borne zoonotic pathogen, poses persistent threats to global public health due to severe clinical manifestation and high case fatality rate (CFR). A critical examination of NiV outbreaks is essential for refining strategies and mitigating the impact of future infections. In this study, we provide a concise update on global NiV outbreaks that occurred during the past 25 years. MethodsIn this geospatial study, we conducted an in-depth examination of the epidemiological characteristics of human NiV cases and deaths from 1998 to 2024 through multiple analyses of public data and official reports. ResultsNiV emerged in 1998 in Malaysia during an outbreak among pig farmers. Since then, NiV outbreaks have been documented in five countries of South and Southeast Asia (Bangladesh, India, Malaysia, Philippines, and Singapore). As of May 2024, there have been 754 confirmed human NiV cases with 435 deaths (CFR: 58%) reported in these five countries. Bangladesh records the highest incidence (341 cases and 241 deaths; CFR: 71%) followed by Malaysia (283 cases and 109 deaths; CFR: 39%), India (102 cases and 74 deaths; CFR: 73%), the Philippines (17 cases and nine deaths; CFR: 53%), and Singapore (11 cases and one death; CFR: 9%). ConclusionsThe clinical outcomes of NiV have been underscoring constant global public health threats as no effective therapies and vaccines are available. Strong global understandings, with an eye on developing vaccines and therapeutics, are required to minimize clinical outcomes and future threats of NiV.

Patterns and outcomes of Emergency Pediatric Unit admissions in Usmanu Danfodiyo University Teaching Hospital in Sokoto State, Nigeria: a five-year review

Children are susceptible to illnesses that often require urgent medical attention, with attendant high mortality rates, especially in resource-constrained settings. Periodic audits in tertiary care facilities can guide preventive and therapeutic policies. The aim was to determine the admissions pattern and outcome over five years in the Emergency Paediatric Unit (EPU) of Usmanu Danfodiyo University Teaching Hospital (UDUTH), Sokoto, a major tertiary facility in North Western Nigeria. This was a retrospective study between January 2017 and December 2021. The admission records of children aged &gt;1 month to 15 years were retrieved, relevant information extracted, and entered into a study proforma. Data was analyzed using SPSS version 23. There were 6088 admissions. Under-fives constituted 4448 (73.1%), and males were 3558 (58.4%). The median age was 24.0 months (Interquartile Range, IQR, 12, 60). Top admissions were severe malaria (1100; 18.1%), acute diarrhoeal disease (631; 10.4%), Sickle Cell Disease (SCD) (624; 10.2%), pneumonia (547;9.0%), Severe Acute Malnutrition (SAM) (438;7.2%), febrile convulsions (421;6.9%), pharyngotonsillitis (402;6.6%) and sepsis (398;6.5%). Total discharges were 2483 (40.8%), 2635 (43.3%) were transferred, and mortalities were 679 (11.2%). Case fatality rates of the top admissions were sepsis (19.6%), SAM (19.4%), severe malaria (13.7%), pneumonia (10.6%), febrile convulsions (5.0%), acute diarrhoeal disease (4.9%), pharyngotonsillitis (2.5%) and SCD (2.1%). SCD was the most common non-infectious morbidity and responsible for most re-admissions. Malaria was the top cause of mortality in all age groups except infancy, where sepsis and pneumonia predominated. In conclusion, malaria and other infectious diseases accounted for most admissions. Non-communicable diseases, like SCD, also constitute significant morbidity. Hence, policymakers need to scale up targeted preventive measures.

Emergence and expansion of carbapenem resistant enterobacterales in the Western Cape Province, South Africa.

Carbapenem resistant Enterobacterales (CRE) have become established as leading pathogens in South African healthcare facilities. The aim of this study is to describe the epidemiology of CRE carriage and clinical infection episodes at healthcare facilities in the Western Cape Province of South Africa (2016-2020), and identify factors associated with mortality in CRE infected patients. We used routine data from the Provincial Health Data Centre to track the emergence of CRE in healthcare facilities in the Western Cape Province of South Africa. We included all CRE episodes (clinical and carriage) at Western Cape hospitals (including day and inpatients) from 2016 to 2020 to determine the distribution of CRE, patient demographics and antibiotic resistance phenotypes. Logistic regression was performed to identify factors associated with mortality from clinical CRE episodes. 2242 CRE episodes (1580 [70.5%] clinical and 662 [29.5%] carriage) were identified. From these, 2281 CRE isolates were identified, with Klebsiella species predominating (1644, 72.1%). Affected patients had a median age of 31 (IQR 0-52) years, and 1167 (52.0%) were male. Most CRE episodes were recorded in central hospitals (70.0%, p < 0.001). Where outcome data was available, crude in-hospital mortality rates were 26.9% (371/1379) for CRE clinical episodes versus 6.4% (41/640) for CRE carriage episodes (p < 0.001). Factors that showed a statistically significant association with in-hospital mortality were female sex [adjusted odd ratio (aOR) 1.40 (95% confidence interval (CI) 1.09-1.560)], adult patients [aOR 1.76 (95% CI 1.20-2.57)], CRE isolation from a sterile specimen [aOR 0.41 (95% CI 0.32-0.53)], and >3 days between hospital admission and specimen collection [aOR 1.56 (95% CI 1.11-2.18)]. CRE episodes at Western Cape healthcare facilities are concentrated at tertiary hospitals, with high case fatality rates in patients with clinical CRE episodes. Infection control interventions must be strengthened to reduce transmission of CRE, and to reduce infection risks.

Investigation of an outbreak of acute diarrheal disease in Dibrugarh district, Assam, India, 2023

BackgroundOn January 30, 2023, 26 acute diarrheal disease (ADD) cases and a death were reported from a village in Dibrugarh, Assam, India. We investigated and described the outbreak by time, place and person, identified the potential exposures, and formulated recommendations. MethodsWe defined a case of ADD as the occurrence of loose stools (≥3 episodes) between January 27, 2023 and February 11, 2023. We conducted a door-to-door case search, calculated attack rates by age and gender, drew an epidemic curve, and plotted cases by residence. We performed a case-control study to identify possible exposure variables, calculated odds ratio (OR) with 95 % confidence interval (CI), and collected stool and water specimens from households and schools for laboratory testing. ResultsWe identified a total of 55 cases, with an overall attack rate of 5.6 % and one death (case fatality rate of 1.8 %). School-going children exhibited a higher attack rate of 39 %. Shigella flexneri was isolated from one of the stool specimens. Furthermore, the water obtained from households' tube wells exceeded the permissible limits of E. coli for consumption. Consuming prasadam (Sacred food) at a school religious event (OR = 6.2, 95 % CI = 2.6–15.2) and not washing hands after defecation (OR = 8.2, 95 % CI = 1.7–38) were associated with ADD. ConclusionThe results indicated that the food served during the school religious event could potentially be the source of the ADD outbreak. The food served during the event likely acted as a medium for community transmission, possibly due to unhygienic practices and contaminated drinking water.

State assault weapons bans are associated with fewer fatalities: analysis of US county mass shooting incidents (2014–2022)

BackgroundThe need for evidence to inform interventions to prevent mass shootings (MS) in the USA has never been greater.MethodsData were abstracted from the Gun Violence Archive, an independent online database...

Genomic Characterization of a Dog-Mediated Rabies Outbreak in El Pedregal, Arequipa, Peru.

Rabies, a re-emerging zoonosis with the highest known human case fatality rate, has been largely absent from Peru, except for endemic circulation in the Puno region on the Bolivian border and re-emergence in Arequipa City in 2015, where it has persisted. In 2021, an outbreak occurred in the rapidly expanding city of El Pedregal near Arequipa, followed by more cases in 2022 after nearly a year of epidemiological silence. While currently under control, questions persist regarding the origin of the El Pedregal outbreak and implications for maintaining rabies control in Peru. We sequenced 25 dog rabies virus (RABV) genomes from the El Pedregal outbreak (n=11) and Arequipa City (n=14) from 2021-2023 using Nanopore sequencing in Peru. Historical genomes from Puno (n=4, 2010-2012) and Arequipa (n=5, 2015-2019), were sequenced using an Illumina approach in the UK. In total, 34 RABV genomes were analyzed, including archived and newly obtained samples. The genomes were analyzed phylogenetically to understand the outbreak's context and origins. Phylogenomic analysis identified two genetic clusters in El Pedregal: 2021 cases stemmed from a single introduction unrelated to Arequipa cases, while the 2022 sequence suggested a new introduction from Arequipa rather than persistence. In relation to canine RABV diversity in Latin America, all new sequences belonged to a new minor clade, Cosmopolitan Am5, sharing relatives from Bolivia, Argentina, and Brazil. Genomic insights into the El Pedregal outbreak revealed multiple introductions over a 2-year window. Eco-epidemiological conditions, including migratory worker patterns, suggest human-mediated movement drove introductions. Despite outbreak containment, El Pedregal remains at risk of dog-mediated rabies due to ongoing circulation in Arequipa, Puno, and Bolivia. Human-mediated movement of dogs presents a major risk for rabies re-emergence in Peru, jeopardizing regional dog-mediated rabies control. Additional sequence data is needed for comprehensive phylogenetic analyses.

Hospital case fatality and mortality related to Chagas disease in Brazil over two decades

ObjectiveTo analyse hospital case fatality and mortality related to Chagas disease (CD) in Brazil, 2000–2019.MethodThis is a mixed ecological study with spatial and temporal trends, based on national population data from the Brazilian Ministry of Health - hospital admissions (HA) and death certificates (DC). Records with CD as a primary or secondary cause of death in HA and/or as an underlying or associated cause of death in DC were evaluated. Temporal trends were analysed by Joinpoint regression and the spatial distribution of age- and gender-adjusted rates, spatial moving averages, and standardized morbidity ratios.ResultsThere were a total of 4,376 HA due to CD resulting in death in Brazil, with a hospital case fatality rate of 0.11/100,000 inhabitants. The Southeast region had the highest rate (63.9%, n = 2,796; 0.17/100,000 inhabitants). The general trend for this indicator in Brazil is upwards (average annual percentage change [AAPC] 7.5; 95% confidence interval [CI] 5.3 to 9.9), with increases in the North, Northeast and Southeast regions. During the same period 122,275 deaths from CD were registered in DC, with a mortality rate of 3.14/100,000 inhabitants. The highest risk of CD-related death was found among men (relative risk [RR] 1.27) and Afro-Brazilians (RR 1.63). There was a downward trend in CD mortality in the country (AAPC − 0.7%, 95%CI -0.9 to -0.5), with an increase in the Northeast region (AAPC 1.1%, 95%CI 0.6 to 1.6). Municipalities with a very high Brazilian Deprivation Index tended to show an increase in mortality (AAPC 2.1%, 95%CI 1.6 to 2.7), while the others showed a decrease.ConclusionHospital case fatality and mortality due to CD are a relevant public health problem in Brazil. Differences related to gender, ethnicity, and social vulnerability reinforce the need for comprehensive care, and to ensure equity in access to health in the country. Municipalities, states, and regions with indicators that reveal higher morbidity and mortality need to be prioritized.

Universal health coverage saves more lives among severely ill COVID-19 patients: A difference-in-differences analysis of individual patient data in South Korea

BackgroundUniversal health coverage (UHC) ensures affordability of a variety of essential health services for the general population. Although UHC could mitigate the harmful effects of coronavirus disease 2019 (COVID-19) on patients and their socioeconomic position, the debate on UHC’s scope and ability to improve health outcomes is ongoing. This study aimed to identify the impact of UHC policy withdrawal on the health outcomes of South Korea’s severely ill COVID-19 patients.MethodsWe used a propensity score matching (PSM) and difference-in-differences combined model. This study’s subjects were 44,552 hospitalized COVID-19 patients contributing towards health insurance claims data, COVID-19 notifications and vaccination data extracted from the National Health Information Database and the Korea Disease Control and Prevention Agency from 1 December 2020 to 30 April 2022. After PSM, 2460 patients were included. This study’s exposures were severity of illness and UHC policy change. The primary outcome was the case fatality rate (CFR) for COVID-19, which was defined as death within 30 days of a COVID-19 diagnosis. There were four secondary outcomes, including time interval between diagnosis and hospitalization (days), length of stay (days), total medical expenses (USD) and the time interval between diagnosis and death (days).ResultsAfter the UHC policy’s withdrawal, the severely ill patients’ CFR increased to 284 per 1000 patients [95% confidence interval (CI) 229.1–338.4], hospitalization days decreased to 9.61 days (95% CI −11.20 to −8.03) and total medical expenses decreased to 5702.73 USD (95% CI −7128.41 to −4202.01) compared with those who were not severely ill.ConclusionsDuring the pandemic, UHC may have saved the lives of severely ill COVID-19 patients; therefore, expanding services and financial coverage could be a crucial strategy during public health crises.

Assessment of early neonatal practices to prevent hypothermia ; A comparative study

Background Globally, neonatal deaths are significantly attributed to hypothermia. This is mostly because of its co-morbidity with asphyxia, premature birth and severe neonatal infections. Worldwide, neonatal hypothermia case fatality rates (CFRs) range from 8.5% to 52%. This study aimed to assess how well a video-based training intervention on mothers’ knowledge and practices in preventing neonatal hypothermia worked. Methods The knowledge and practices of two groups of primi-para mothers—one control group and one intervention group—were compared in order to achieve this. A total of 124 primipara mothers took part in the research. Using a video based tool, the intervention group was educated about preventing hypothermia in newborns. Both control and intervention group mothers were interviewed to compare the knowledge and practices. Results Sixty-one of the sixty-two mothers in the control group were unsure of which body area to cover in order to preserve the baby’s body heat. Following the intervention, 61 out of 62 mothers in the group recognised which body part to cover to protect the baby’s body heat. In the post-intervention group, 98.4% of moms wore a cap over their baby’s head, compared to just 35.5% in the control group. Conclusion The results of this study demonstrate the significant improvement in mothers’ knowledge and actions about the prevention of neonatal hypothermia resulting from the use of a video-based training tool.

Combination of Callyspongia sp. and Stem Cells for Wound Repair and Skin Regeneration: in Vivo and in Silico Evidences.

Delayed healing of chronic wounds results in amputation and mortality rates in serious cases. The present study examines the merged wound-restorative efficacy of injectable bone marrow-derived mesenchymal stem cells (BMMSCs) and topical Callyspongia sp. extract in immunocompromised rats. HR-LC-MS analysis of Callyspongia sp. extract tentatively identified twenty-nine compounds (1-29) and highlighted its richness in fatty acids and terpenoids, known for their wound regenerating efficacies. The wound closure was greatly prominent in the BMMSCs/Callyspongia sp. group in contrast to the control group (p<0.001). The RT-PCR gene expression emphasized these results by attenuating the oxidative, inflammatory, and immunity markers, further confirmed by histopathological findings. Additionally, in silico modeling was particularly targeting matrix metalloproteinase-9 (MMP9), a key player in wound healing processes. Computational analysis revealed that compounds 18 and 19 potentially modulate MMP9 activity. The combination of BMMSCs and topical Callyspongia sp. extract holds a promise for regenerative therapy constituting a drastic advance in the wound cure of immunocompromised patients, eventually further safety assessments and clinical trials are required.

Trends in invasive Haemophilus influenzae serotype b (Hib) disease in England: 2012/13 to 2022/23

Haemophilus influenzae serotype b (Hib) conjugate vaccines have been highly successful in reducing the Hib disease worldwide. Recently, several European countries have reported an increase in invasive Hib disease. We aimed to describe the epidemiology, clinical characteristics, genomic trends, and outcomes of invasive Hib disease over the past 11 years in England. The UK Health Security Agency (UKHSA) conducts national surveillance of invasive H influenzae disease and hosts a national reference laboratory for confirmation and serotyping. General practitioners are contacted to complete a surveillance questionnaire for confirmed Hib cases. Invasive Hib isolates routinely undergo whole genome sequencing. During 2012/13-2022/23, there were 6,881 invasive H. influenzae infections, of which 5,852 (85%) were serotyped; most isolates (4,881, 83%) were non-typeable H. influenzae, followed by Hif (591, 10%), Hie (189, 3%), Hib (118, 2%) and Hia (54, 1.0%). The median age for invasive Hib disease was 51 years and most cases (84%, 99/118) were in adults. Children accounted for 19 cases (16%), including 13 (11%) in <1 year-olds and 6 (5%) in 1-5-year-olds. Bacteraemic pneumonia was the most common diagnosis (66/118, 56%). Hib case-fatality rate was 5.9% (7/118), with the last fatality reported in 2016. Among 64 sequenced strains during 2016/17-2022/2023, most (56/64, 88%) belonged to the CC6 lineage (representing ST6 and single locus variants of ST6). In England, invasive Hib disease remains rare with no evidence of any increase in incidence and is rarely fatal, affecting mainly adults with underlying conditions, who typically develop pneumonia.

Disease modifiers and novel markers in HBV-related HCC.

Chronic hepatitis B (CHB) infection is responsible for 40% of the global burden of hepatocellular carcinoma (HCC) with a high case fatality rate. The risk of HCC differs among CHB subjects owing to differences in host and viral factors. Modifiable risk factors include viral load, use of antiviral therapy, co-infection with other hepatotropic viruses, concomitant metabolic dysfunction-associated steatotic liver disease or diabetes mellitus, environmental exposure, and medication use. Detecting HCC at early stage improves survival, and current practice recommends HCC surveillance among individuals with cirrhosis, family history of HCC, or above an age cut-off. Ultrasonography with or without serum alpha feto-protein every 6 months is widely accepted strategy for HCC surveillance. Novel tumor-specific markers, when combined with AFP, improve diagnostic accuracy than AFP alone to detect HCC at an early stage. To predict the risk of HCC, a number of clinical risk scores have been developed but none of them are clinically implemented nor endorsed by clinical practice guidelines. Biomarkers that reflect viral transcriptional activity and degree of liver fibrosis can potentially stratify the risk of HCC, especially among subjects who are already on antiviral therapy. Ongoing exploration of these novel biomarkers is required to confirm their performance characteristics, replicability and practicability.

Vaccine Platform Comparison: Protective Efficacy against Lethal Marburg Virus Challenge in the Hamster Model.

Marburg virus (MARV), a filovirus, was first identified in 1967 in Marburg, Germany, and Belgrade, former Yugoslavia. Since then, MARV has caused sporadic outbreaks of human disease with high case fatality rates in parts of Africa, with the largest outbreak occurring in 2004/05 in Angola. From 2021 to 2023, MARV outbreaks occurred in Guinea, Ghana, New Guinea, and Tanzania, emphasizing the expansion of its endemic area into new geographical regions. There are currently no approved vaccines or therapeutics targeting MARV, but several vaccine candidates have shown promise in preclinical studies. We compared three vaccine platforms simultaneously by vaccinating hamsters with either a single dose of an adenovirus-based (ChAdOx-1 MARV) vaccine, an alphavirus replicon-based RNA (LION-MARV) vaccine, or a recombinant vesicular stomatitis virus-based (VSV-MARV) vaccine, all expressing the MARV glycoprotein as the antigen. Lethal challenge with hamster-adapted MARV 4 weeks after vaccination resulted in uniform protection of the VSV-MARV and LION-MARV groups and 83% of the ChAdOx-1 MARV group. Assessment of the antigen-specific humoral response and its functionality revealed vaccine-platform-dependent differences, particularly in the Fc effector functions.