Central Public Health Laboratory Research Articles

Seroprevalence and Distribution of Toxoplasma gondii Infections among Patients in the West Bank, Palestine (2017-2021).

Toxoplasmosis is a zoonotic disease caused by the obligate intracellular protozoan Toxoplasma gondii. The current study assessed the seroepidemiological status and risk factors of T. gondii in the West Bank, Palestine. We conducted a retrospective study among 1,475 patients referred for serological examination for toxoplasmosis between 2017 and 2021 at the Central Public Health Laboratory. The overall prevalences of anti-T. gondii IgG and IgM antibodies were 1.0% [18.9-23.0%] and 1.0% [0.5-1.6%], respectively. Multifactorial analysis showed that age and sex were significantly associated with the presence of IgG antibodies. The prevalence of IgG antibodies was highest in 2018 and decreased significantly each year until 2021. Routine serological screening in women of childbearing age and pregnant women is recommended.

HEMATOLOGICAL CHANGES ASSOCIATED WITH COVID-19 INFECTION IN ADEN/ YEMEN

Chronic Hematological alterations in COVID-19 patients range from mild to severe, with common changes including lymphopenia, neutrophilia, and thrombocytopenia. The gold standard for diagnosis is the polymerase chain reaction (PCR) test, which is highly specific and sensitive for detecting SARS-CoV-2 genetic material. The study was a single isolation center retrospective analysis of 200 patients with COVID-19 confirmed cases. The hematological indicators were taken after sample blood collected from the staff of Central Public Health Laboratory to determine the changes, and compared between different grades of severity and prognosis with the hematological indicators. The data was analyzed using Statistical Package for the Social Sciences (SPSS) version 22.0. simple frequencies and percentage were used, while chi-square test used to determine the association between variables. Males consisted 73.5% in this study, while 63% of participants suffered from moderate severity. Related to the hematological changes; and comparisons made according to real-time PCR test results revealed that the Lymphocytopenia and leukocytosis presented among 47.5% and 46.5% respectively with significance association with illness severity and outcome of patients with p-value< 0.05. hematological changes in COVID-19 patients are a common and significant aspect of the disease. Lymphopenia, neutrophilia, thrombocytopenia, and increased levels of inflammatory markers are frequently observed. These hematological abnormalities are associated with disease severity, poor clinical outcomes. Blood parameters aid in COVID-19 diagnosis and prognosis, with abnormal hematological parameters providing early evidence. However, interpretation should consider limitations, sample size, and potential biases. Further research needed.

High viral suppression rates among PLHIV on dolutegravir who had an initial episode of viral non-suppression in Uganda September 2020-July 2021.

In 2019, WHO recommended dolutegravir (DTG) as a backbone for first- and second-line antiretroviral therapy (ART) regimens for people living with HIV (PLHIV). According to the 2018 Uganda's HIV treatment guidelines, patients with viral non-suppression (≥1,000 copies/mL) should receive intensive adherence counseling (IAC) with repeat viral load (VL) within 6 months. This analysis focused on the prevalence and factors associated with viral suppression following IAC among PLHIV on DTG-based regimens (DBRs) with an initial episode of viral non-suppression (VNS) in Uganda. We conducted a retrospective analysis for PLHIV on DBRs with an initial episode of VNS (≥1,000 copies/mL) in Uganda during October 2019-September 2020 who had a follow up VL test result during September 2020-July 2021. Data were abstracted from the Central Public Health Laboratory (CPHL) database, including patient demographics and VL results. Viral non-suppression (VNS) was defined as a VL test result of ≥1,000 copies/mL. We characterized PLHIV on DBRs and used logistic regression models to determine factors associated with VL suppression after an initial episode of VNS. A total of 564 PLHIV on DBRs with an initial episode of VNS were followed up and 43 were excluded due to missing data. Of the 521, 220 (42.2%) were children (<15 years) and 231 (44.3%) were female. Median age was 28 years (interquartile range [IQR]: 12-43 years), and median duration on DBRs was 12 months (IQR: 6-15 months). Overall, 80.8% (421/521) PLHIV had a suppressed viral load at first follow up testing (children = 74.5% [164/220]; adults = 85.4% [257/301]). Children with initial VL results ≥5,000 copies/mL were less likely to achieve viral suppression at follow up testing compared to those with <5,000 copies/mL (AOR: 0.38; 95% CI: 0.20-0.71; p = 0.002). In a programmatic setting, most adults and children suppressed following an initial episode of VNS on DBRs. High rates of suppression after VNS suggest adherence challenges, rather than drug resistance. Continuation of DBRs should be considered before regimen switch.

Canine visceral leishmaniasis: Seroprevalence and georeferencing in the state of Santa Catarina, Brazil

Canine visceral leishmaniasis (CVL) has long been considered an endemic disease in the northern and northeastern regions of Brazil, while the southern region remains non-endemic. However, in recent years, several cases of CVL have been reported in southern states. The objective of this work was to determine the seroprevalence of CVL in dogs in the state of Santa Catarina, Brazil, through immunochromatographic tests (DPP®) and ELISA (Enzyme-Linked Immunosorbent Assay) and its correlation with environmental characteristics through georeferencing. Blood samples from dogs (n = 1227) were collected in six mesoregions of the state and evaluated by the rapid test (DPP®). Positive samples were sent to Lacen (Central Public Health Laboratory) in Santa Catarina to be tested using ELISA. Information obtained from the epidemiological questionnaire was subjected to statistical analysis (Chi-square and Student's t-test; P < 0.05) to verify the correlation between serology and the analyzed variables. The locations (GPS) of the samples were used for georeferencing and creating heatmaps (Kernel Method). Four animals that died from CVL were necropsied and organ samples were collected for molecular analysis (PCR), immunohistochemistry, and histopathology (HE). Of the 1227 dogs analyzed, 22 (1.8%) were reactive in the DPP® and of these, 7 (0.6%) were also positive in the ELISA. A correlation (P < 0.01) was observed between positive serology and region, environment, access to the street, and clinical signs. The positive cases were concentrated in the eastern region of the state, in low-altitude areas with average rainfall and higher average temperatures, and in more populated areas close to forest fragments. PCR, HE, and immunohistochemistry, along with serology, have proven to be efficient for characterizing positive cases.

Biodiversity of carbapenem-resistant bacteria in clinical samples from the Southwest Amazon region (Rondônia/Brazil)

Brazil is recognized for its biodiversity and the genetic variability of its organisms. This genetic variability becomes even more valuable when it is properly documented and accessible. Understanding bacterial diversity through molecular characterization is necessary as it can improve patient treatment, reduce the length of hospital stays and the selection of resistant bacteria, and generate data for health and epidemiological surveillance. In this sense, in this study, we aimed to understand the biodiversity and molecular epidemiology of carbapenem-resistant bacteria in clinical samples recovered in the state of Rondônia, located in the Southwest Amazon region. Retrospective data from the Central Public Health Laboratories (LACEN/RO) between 2018 and 2021 were analysed using the Laboratory Environment Manager Platform (GAL). Seventy-two species with carbapenem resistance profiles were identified, of which 25 species carried at least one gene encoding carbapenemases of classes A (blaKPC-like), B (blaNDM-like, blaSPM-like or blaVIM-like) and D (blaOXA-23-like, blaOXA-24-like, blaOXA-48-like, blaOXA-58-like or blaOXA-143-like), among which we will highlight Klebsiella pneumoniae, Pseudomonas aeruginosa, Acinetobacter baumannii, Serratia marcescens, and Providencia spp. With these results, we hope to contribute to the field by providing epidemiological molecular data for state surveillance on bacterial resistance and assisting in public policy decision-making.

Evaluation of the GeneXpert MTB/RIF to diagnose tuberculosis in a public health laboratory.

To evaluate the performance of geneXpert MTB/Rif versus conventional methods (bacilloscopy and culture) in the diagnosis of tuberculosis in a Central Public Health Laboratory (LACEN, Tocantins), Northern Brazil. Retrospective study, with information from 1,973 suspected cases of tuberculosis from patients treated from January 2015 to December 2020. From the culture (reference standard), the sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of the geneXpert MTB/Rif were 100%, 97%, 74%, 100%, and 97%, respectively, against 85%, 98%, 80%, 98%, and 97% of bacilloscopy. The geneXpert MTB/Rif performed similarly to culture and better than bacilloscopy. Although positive cases with negative culture should be evaluated with caution, its routine use is important for the early detection of tuberculosis.

Exploring the Genomic Dynamics of the Monkeypox Epidemic in Paraguay.

In recent months, Paraguay has been grappled with a notable monkeypox outbreak, straining its healthcare infrastructure. The sudden spike in cases underlines the imperative need for a comprehensive understanding of the virus's dynamics, enabling the formulation of robust containment measures. To address this challenge, our team joined forces with the Central Public Health Laboratory of Asunción and the Pan-American Health Organization. Through this collaboration, we employed portable whole-genome sequencing combined with phylodynamic analysis to examine the MPXV strains circulating in Paraguay. Our genomic monitoring approach has produced the first 30 whole-genome sequences from Paraguay, all of which were identified under lineage IIb. Interestingly, our data suggest that the origin of the monkeypox virus in Paraguay at the beginning of 2022 can be traced back to Brazil. This introduction subsequently catalyzed further community spread that was further exacerbated by several independent introduction events as time progressed. These findings not only shed light on the transmission patterns of the virus but also highlight the pivotal role such insights play in sculpting effective response strategies and driving impactful public health measures. Furthermore, our findings strongly advocate intensified surveillance at international borders, ensuring swift detection and proactive countermeasures against potential outbreaks in the future.

Implementation and expansion of laboratory capacity for molecular diagnostics in response to COVID-19 and preparedness for other emerging infectious diseases in the Islamic Emirate of Afghanistan.

Afghanistan experienced various outbreaks before and during the Covid-19 pandemic, including dengue, Crimean Congo hemorrhagic fever (CCHF), measles, and acute watery diarrhea (AWD). Diagnostic and surveillance support was limited, with only the Central Public Health Laboratory equipped to handle outbreak responses. This article highlights initiatives taken to improve diagnostic capabilities for COVID-19 and other outbreaks of public health concern encountered during the pandemic. The World Health Organization (WHO) Afghanistan Country Office collaborated with the WHO Eastern Mediterranean Regional Office (EMRO), Central Public Health Laboratory (CPHL), and National Influenza Center (NIC) to enhance COVID-19 diagnostic capacity at national and subnational facilities. To alleviate pressure on CPHL, a state-of-the-art laboratory was established at the National Infectious Disease Hospital (NIDH) in Kabul in 2021-2022, while WHO EMRO facilitated the regionalization of testing to subnational facilities for dengue, CCHF, and AWD in 2022-2023. COVID-19 testing capacity expanded nationwide to 34 Biosafety Level II labs, improving diagnosis time. Daily testing rose from 1000 in 2020 to 9200 in 2023, with 848,799 cumulative tests. NIDH identified 229 CCHF cases and 45 cases nationally. Dengue and CCHF testing, decentralized to Nangarhar and Kandahar labs, identified 338 dengue and 18 CCHF cases. AWD testing shifted to NIDH and five subnational facilities (Kandahar, Paktia, Balkh, Herat, and Nangarhar labs), while measles testing also decentralized to nine subnational facilities. Afghanistan implemented a remarkable, multisectoral response to priority pathogens. The nation now possesses diagnostic expertise at national and subnational levels, supported by genomic surveillance. Future efforts should concentrate on expanding and sustaining this capacity to enhance public health responses.

Pulmonary mycobacteriosis: clinicalepidemiological profile of patients, treatment management, clinical outcome, and its species in the state of Mato Grosso, Brazil (2013-2020)

This study aimed to describe the clinical-epidemiological profile of patients in the State of Mato Grosso, who were affected by non-tuberculous mycobacteria (NTM), treatment management, clinical outcomes, and the species most commonly isolated from clinical samples. Between 2013 and 2020, the study analyzed 37 medical records from the Health Pulmonology sector of the Reference Center for Medium and High Complexity and it searched the Laboratory Environment Manager (GAL) system of the Central Public Health Laboratory of Mato Grosso. Patients with mycobacteriosis were predominantly diagnosed with MAC complex (avium-intracellulare complex) (n= 23.6%), with an average age of 62 years old; 51.4% were male, Caucasian (62%), and predominantly immunocompetent (HIV-negative). Most patients with comorbidities were older adults, they had sequelae of previous tuberculosis (56.8%), they were smokers (62.2%), and they had a low body mass index (29.7%) due to weight loss. Other patients had bronchiectasis (81.1%) and cavitary lesions (48.6%), with a lower incidence of chronic obstructive pulmonary disease (COPD). The municipalities with the highest rates of nontuberculous mycobacteria were Cuiabá (14 cases), Várzea Grande (five cases), Sinop (two cases), Nova Mutum (two cases), and Rondonópolis (two cases). This study presented data from the region, with a clinical, epidemiological profile, diversity of NTM species, and treatment management according to the patient’s response to the specific treatment of the identified Mycobacterium and various outcomes. KEY WORDS: Non-tuberculous mycobacteria; MAC complex Mycobacterium; comorbidities; tuberculosis; mycobacteriosis.

Unveiling the Impact of the Omicron Variant: Insights from Genomic Surveillance in Mato Grosso do Sul, Midwest Brazil.

Genomic surveillance has emerged as a crucial tool in monitoring and understanding the dynamics of viral variants during the COVID-19 pandemic. In the Midwest region of Brazil, Mato Grosso do Sul has faced a significant burden from the SARS-CoV-2 epidemic, with a total of 613,000 confirmed cases as of June 2023. In collaboration with the Central Public Health Laboratory in the capital city of Campo Grande, we conducted a portable whole-genome sequencing and phylodynamic analysis to investigate the circulation of the Omicron variant in the region. The study aimed to uncover the genomic landscape and provide valuable insights into the prevalence and transmission patterns of this highly transmissible variant. Our findings revealed an increase in the number of cases within the region during 2022, followed by a gradual decline as a result of the successful impact of the vaccination program together with the capacity of this unpredictable and very transmissible variant to quickly affect the proportion of susceptible population. Genomic data indicated multiple introduction events, suggesting that human mobility played a differential role in the variant's dispersion dynamics throughout the state. These findings emphasize the significance of implementing public health interventions to mitigate further spread and highlight the powerful role of genomic monitoring in promptly tracking and uncovering the circulation of viral strains. Together those results underscore the importance of proactive surveillance, rapid genomic sequencing, and data sharing to facilitate timely public health responses.

Uptake and effectiveness of a mobile application for real-time reporting and quality assurance of decentralized SARS-CoV-2 testing in Uganda.

Effective management of the COVID-19 pandemic required rapid expansion of diagnosis. The introduction of antigen tests presented an opportunity to decentralize testing, but raised challenges with ensuring accurate and timely reporting of testing data, which is essential to guide the response. Digital solutions can help address this challenge and provide more efficient means of monitoring and quality assurance. Uganda's existing laboratory investigation form was digitized in the form of an Android-based application, eLIF, which was developed by the Central Public Health Laboratory and implemented in 11 high-volume facilities between December 2021 and May 2022. The app enabled healthcare workers to report testing data via mobile phone or tablet. Uptake of the tool was monitored through a dashboard that enabled real-time visibility into data being transmitted from sites, as well as qualitative insights from site visits and online questionnaires. A total of 15,351 tests were conducted at the 11 health facilities during the study period. Of these, 65% were reported through eLIF, while 12% were reported through preexisting Excel-based tools. However, 23% of tests were only captured in paper registers and not transmitted to the national database, illustrating the need for increased uptake of digital tools to ensure real-time data reporting. While data captured through eLIF were transmitted to the national database within 0-3 days (min, max), data transmitted through Excel were transmitted in within 0-37 days (min, max), and data for paper-based reporting took up to 3 months. The majority of healthcare workers interviewed in an endpoint questionnaire responded that eLIF improved timeliness of patient management, and reduced reporting time. However, some functions of the app were not successfully implemented, such as providing random selections of samples for external quality assurance and enabling seamless linkage of these data. Challenges arose from broader operational complexities, such as staff workload, frequent task-shifting and unexpected changes to facility workflows, which limited adherence to the envisioned study procedures. Ongoing improvements are needed to adjust to these realities, to strengthen the technology and support to healthcare workers using it, to optimize the impact of this digital intervention.

Retrospective Spatio-Temporal Dynamics of Dengue Virus 1, 2 and 4 in Paraguay.

Dengue virus (DENV) has been a major public health concern in Paraguay, with frequent outbreaks occurring since early 1988. Although control measures have been implemented, dengue remains a significant health threat in the country, and continued efforts are required for prevention and control. In response to that, in collaboration with the Central Public Health Laboratory in Asunción, we conducted a portable whole-genome sequencing and phylodynamic analysis to investigate DENV viral strains circulating in Paraguay over the past epidemics. Our genomic surveillance activities revealed the co-circulation of multiple DENV serotypes: DENV-1 genotype V, the emerging DENV-2 genotype III, BR4-L2 clade, and DENV-4 genotype II. Results additionally highlight the possible role of Brazil as a source for the international dispersion of different viral strains to other countries in the Americas emphasizing the need for increased surveillance across the borders, for the early detection and response to outbreaks. This, in turn, emphasizes the critical role of genomic surveillance in monitoring and understanding arbovirus transmission and persistence locally and over long distances.

Structure, Process and Outcome Evaluation of Central Public Health Laboratory Performance About Neonatal Screening Program in Karbala in 2022

Background: Neonatal screening is a preventive medical act aims to early detecting neonates affected byspecific disorders that endanger their lives or cause long-term health problems and require prompt intervention. This canresult in significant reductions in morbidity, death, and related costs and disabilities. The panel of neonatal screened disordershas been gradually expanded. Expansion has been empowered with the introduction of tandem mass spectrometry, whichallowed for the screening of up to 40–50 diseases with a single blood spot. Part of the implementation of neonatal screeningprogram must include, just like any other program, monitoring and evaluation task in order to identify difficultiesor barriers to improve procedures and methodologies. This study aimed to evaluate the Central Public Health Laboratory/Karbala Directorate of Health performance in Neonatal Screening program. Method: The evaluation method has beencarried out in Holy Karbala Governorate for the period between the first of September 2021 and the end of June 2022using a check list of standards taken from the National Guideline for Newborn Screening for Care Providers inPrimary Health Care Centers in Iraq. This was to evaluateCentral Public Health Laboratory by meeting the manager employee and evaluate theCentral Public Health Laboratory room.

An assessment of the current epidemiological and laboratory capacities for influenza-like illnesses and severe acute respiratory infection surveillance, Yemen 2022.

We aim to re-activate influenza sentinel surveillance system in Yemen after disruption related to repurposing for COVID-19 pandemic. WHO Country Office (CO) in collaboration with Yemen's Ministry of Public Health and Population (MOPH&P) jointly conducted an assessment mission to assess the current situation of the influenza sentinel surveillance system and assess its capacity to detect influenza epidemics and monitor trends in circulating influenza and other respiratory viruses of epidemic and pandemic potential. This study presents the results of the assessment for three sentinel sites located in Aden, Taiz, and Hadramout/Mukalla. A mixed methods approach was used to guide the assessment process and to help achieve the objectives. Data were collected as follows: desk review of the sentinel sites records and data; interviews with stakeholders, including key informants and partners; and direct observation through field visits to the sentinel sites, MOPH&P and the Central Public Health Laboratory (CPHL). Two assessment checklists were used: assessment of sentinel sites for SARI surveillance, and checklist for assessment of availability of SARI sentinel surveillance. COVID-19 has affected health systems and services, and this was demonstrated in this assessment. The influenza sentinel surveillance system in Yemen is not effectively functional; however, there is plenty of room for improvement if investment in the system's restructuring, training, building technical and laboratory capacities, and conducting continuous and regular supervision visits.

First molecular characterization of Escherichia coli O157:H7 isolates from clinical samples in Paraguay using whole-genome sequencing

Escherichia coli O157:H7 is a foodborne pathogen implicated in numerous outbreaks worldwide that has the ability to cause extra-intestinal complications in humans. The Enteropathogens Division of the Central Public Health Laboratory (CPHL) in Paraguay is working to improve the genomic characterization of Shiga toxin-producing E. coli (STEC) to enhance laboratory-based surveillance and investigation of foodborne disease outbreaks. Whole genome sequencing (WGS) is proposed worldwide to be used in the routine laboratory as a high-resolution tool that allows to have all the results in a single workflow. This study aimed to carry out for the first time, the genomic characterization by WGS of nine STEC O157:H7 strains isolated from human samples in Paraguay. We were able to identify virulence and resistance mechanisms, MLST subtype, and even establish the phylogenetic relationships between isolates. Furthermore, we detected the presence of strains belonging to hypervirulent clade 8 in most of the isolates studied.

Norovirus and rotavirus in surface, malacoculture, and human consumption water in Santa Catarina State, Brazil.

This study evaluated the results recorded at the Central Public Health Laboratory of Santa Catarina state (Brazil) concerning the investigation of Rotavirus (RVA) and Norovirus (NoVs) - genogroups GI and GII. Samples were taken from seawater, river water, estuary water, lagoon water, and treated water samples, from 2018 to 2021. The aim was to correlate them with each other and evaluate their association with the type of water, presence of shellfish farming, population density, and sewage treatment. The most prevalent enteric virus was RVA, followed by NoV GI and NoV GII. There was a strong correlation between the presence/absence of RVA and the presence/absence of at least one NoV genogroup, mainly in samples collected in rivers. No correlation was observed between the presence of any virus and the presence of shellfish farming. When evaluating the binomial sewage treatment vs. population density, the correlation coefficients between population density and the presence of the virus in a sample were higher than the coefficients between the percentage of treated sewage and the presence of the virus. Sources of human-origin pollution impair the quality of treated and surface waters, and therefore the results of this work can help develop viral-monitoring programs in these places.

Phlebotominae Fauna (Diptera: Psychodidae) and the Spatial Distribution of Species in Sergipe, Brazil.

Some sand fly species are the vectors responsible for the transmission of Leishmania spp. (Kinetoplastida: Trypanosomatidae), the etiological agent of leishmaniasis, and in the state of Sergipe, the two main forms of the disease (visceral and cutaneous) are recorded. Few works show information about the species that form the Phlebotominae fauna in Sergipe. This study aimed to update and determine how they are distributed throughout the state. The study used data from surveys about phlebotomines in Sergipe, from the Program of Surveillance and Control of Visceral Leishmaniasis, carried out by the Central Public Health Laboratory of Sergipe, from 2008 to 2018, along with review and original data from 2022. The commentary on this information was developed with focus on the species that can be vectors for the disease. Sergipe has, up to now, 27 registered species of phlebotomines from 12 genera, 15 of them are of sanitary relevance. Twenty two of these species are in the mesoregion East, 19 in the Agreste, and 11 in the Sertão of Sergipe. The species with the greatest distribution was Evandromyia lenti (Mangabeira, 1938), present in 74.6% of the municipalities of Sergipe, followed by Lutzomyia longipalpis (Lutz & Neiva, 1912), the main vector of the etiological agent of visceral leishmaniasis in Brazil, present in 68% of the municipalities studied. This study expands the number and distribution of species recorded in the state. This information can contribute to disease containment plans and support health education actions aimed at the control of leishmaniasis in Sergipe.

DETECTION OF THE MOST IMPORTANT PATHOGENIC BACTERIA AFFECT EXTERNAL ORGANS OF CYPRINUS CARPIO IN WASIT PROVINCE

The present study was aimed to find the most common causative agents relates to skin ulceration in most common fish farming (ponds and cages) affects Cyprinus carpio in Wasit province harvested from three different regions. The laboratory isolation and detection of bacteria in this study was carried out in medical laboratory techniques in Middle Technical University and Central Public Health Laboratory in Baghdad from September to December 2020. For this study 240 infected common carp Cyprinus carpio L. were used, 120 samples from cages and 120 samples from ponds. Samples were taken from three regions, which represented the north, central, and south of the governorate. Samples from skin ulcers were taken from affected areas in the body of the fish, skin, gills and fins, then transporting to the laboratory to perform bacterial culture. The present study illustrates that the common causative agent of ulceration in fish skin, gills and fins was bacteria with most detected bacteria were Aeromonas hydrophila (56.7%) in cages and (37.5%) in ponds, followed by Pseudomonas aeruginosa (40.83%) in cages and (35.08%) in ponds, and Citrobacter freundii (41.66%) in cages and (25.8%) in ponds through the months including in this study. In conclusion, the most important pathogenic bacteria related to skin ulceration in both cages and ponds in all three locations in Wasit province were Aeromonas hydrophila, Pseudomonas aeruginosa and Citrobacter freundii. The infection rate was higher in cages compared to ponds because of increase pollution by sewage and organic compound and due to stress condition resulting from higher stoking density.

Correlation between Toxoplasmosis and Vitamin D Deficiency in women

Background: Recently it has been noticed that toxoplasmosis played an important role in distressing women’s pregnancy through certain outcomes such as congenital abnormalities and abortions. The lack in Vitamin D may play role fragility of bones like; osteoporosis, and bone deformities. Objective: To evaluate the association between the lake in vitamin D and toxoplasmosis seropositivity in the women’s sera in the age of childbearing by applying ELISA method. Materials and Methods: 56 women, from Central Public Health Laboratories in Baghdad Province were selected in this study, their age range between (17-45) years. The individuals were diagnosed with BOH (Bad Obstetric History). Among 56 women infected (44)or not infected (12)with toxoplasmosis blood samples were collected from patients who visited Central Public Health Laboratories in Baghdad Province . IgG and IgM Abs Antibodies against Toxoplasma gondii were detected using minividas kit ) BioMerieux /France). Also vitamin D was detected using by ELISA microwells method (Monobind Inc. USA). Results: The results were considered as statistically significant (P=0.386), it shows no important difference between toxoplasmosis and the concentration of vitamin D3 in women with history of abortion or not. Conclusion: The toxoplasmosis rate in women in childbearing age was elevated, and the association between vitamin D deficiency and toxoplasmosis was not considerable.

HIV viral load assays when used with whole blood perform well as a diagnostic assay for infants.

Over the past several years, only approximately 50% of HIV-exposed infants received an early infant diagnosis test within the first two months of life. While high attrition and mortality account for some of the shortcomings in identifying HIV-infected infants early and putting them on life-saving treatment, fragmented and challenging laboratory systems are an added barrier. We sought to determine the accuracy of using HIV viral load assays for infant diagnosis of HIV. We enrolled 866 Ugandan infants between March-April 2018 for this study after initial laboratory diagnosis. The median age was seven months, while 33% of infants were less than three months of age. Study testing was done using either the Roche or Abbott molecular technologies at the Central Public Health Laboratory. Dried blood spot samples were prepared according to manufacturer-recommended protocols for both the qualitative and quantitative assays. Viral load test samples for the Roche assay were processed using two different buffers: phosphate-buffered saline (PBS: free virus elution viral load protocol [FVE]) and Sample Pre-Extraction Reagent (SPEX: qualitative buffer). Dried blood spot samples were processed for both assays on the Abbott using the manufacturer's standard infant diagnosis protocol. All infants received a qualitative test for clinical management and additional paired quantitative tests. 858 infants were included in the analysis, of which 50% were female. Over 75% of mothers received antiretroviral therapy, while approximately 65% of infants received infant prophylaxis. The Roche SPEX and Abbott technologies had high sensitivity (>95%) and specificity (>98%). The Roche FVE had lower sensitivity (85%) and viral load values. To simplify and streamline laboratory practices, HIV viral load may be used to diagnose HIV infection in infants, particularly using the Roche SPEX and Abbott technologies.