Complete Prophylaxis Research Articles

Isoniazid Prophylaxis Based on Tuberculosis Risk Factors in Living Kidney Transplantation Recipients: A Retrospective Cohort Study.

Tuberculosis (TB) is a major and severe opportunistic infection among solid organ transplant recipients. Chemoprophylaxis is advised for those with latent tuberculosis infection (LTBI). However, the effectiveness of an isoniazid (INH) prophylactic approach based on TB risk factors remains uncertain. This study included all living-donor kidney transplant recipients (KTRs) between January 2016 and December 2022. The recipients were categorized into three groups: the risk group with isoniazid (R-INH), the risk group without isoniazid (R-NINH), and the non-risk group (NR), based on the presence of TB risk factors and INH usage. The R-INH group received a 6-month INH prophylactic regimen to prevent post-transplant TB infection. The incidence of active TB among the groups was assessed. A total of 1348 patients were divided into R-INH (n=108), R-NINH (n=371), and NR (n=869). Forty-seven patients (3.49%) developed TB with an incidence rate of 16.0 per 1000 person-years. Compared to NR, the TB incidence in R-INH was not statistically different (HR, 0.55, 95% CI, 0.07-4.21, P = 0.564), whereas it was significantly higher in R-NINH (HR, 5.04, 95% CI, 2.64-9.62, P < 0.001). The median time from transplantation to TB was 19 months (IQR: 6-39), and 18 patients (38.3%) were diagnosed within one year of transplantation. Ninety-four patients (87.0%) completed INH prophylaxis, with adverse events including two cases of hepatotoxicity (1.85%) and one case of peripheral neuritis (0.93%). A 6-month INH regimen based on TB risk factors is effective and well tolerated for preventing post-transplant TB in KTRs.

Molecular characterisation of human rabies in Tanzania and Kenya: a case series report and phylogenetic investigation

BackgroundRabies remains a major public health problem in low- and middle-income countries. However, human rabies deaths are rarely laboratory-confirmed or sequenced, especially in Africa. Five human rabies deaths from Tanzania and Kenya were investigated and the causative rabies viruses sequenced, with the aim of identifying implications for rabies control at individual, healthcare and societal levels.Case presentationThe epidemiological context and care of these cases was contrasting. Four had a clear history of being bitten by dogs, while one had an unclear biting history. Two individuals sought medical attention within a day of being bitten, whereas three sought care only after developing rabies symptoms. Despite seeking medical care, none of the cases received complete post-exposure prophylaxis: one patient received only tetanus vaccination, one did not complete the post-exposure vaccination regimen, one followed an off-label vaccination schedule, and two did not receive any post-exposure vaccinations before the onset of symptoms. These cases highlight serious gaps in health-seeking behaviour, and in health systems providing appropriate care following risky exposures, including in the accessibility and effectiveness of post-exposure prophylaxis as it is administered in the region.ConclusionsThe viral genomic and epidemiological data confirms dog-mediated rabies as the cause of each of these deaths. The phylogenetic investigation highlights the transboundary circulation of rabies within domestic dog populations, revealing distinct rabies virus clades with evidence of regional spread. These findings underscore the importance of coordinated cross-border control efforts between the two countries. Urgent action is needed to improve awareness around the need for emergency post-exposure vaccines that should be accessible in local communities and administered appropriately, as well as investment in coordinated dog vaccination to control dog-mediated rabies, the underlying cause of these deaths.Graphical

Human dog-mediated rabies in the Circle of Kati, Mali: An epidemiological situation analysis and the stakeholder’s knowledge regarding rabies and the One Health approach

Background and Aim: Human dog-transmitted rabies remains a serious public health issue in Mali despite efforts to mitigate it. Indeed, several stakeholders have implemented multiple initiatives for years. However, there is still a lack of cooperation among stakeholders. This study was conducted to capture situational data on rabies and One Health practices among key actors involved in the fight against rabies in Mali. Materials and Methods: Data from veterinary and medical services were collected for analysis. Data collection was based on a review of technical documents (epidemiology of rabies in animals and humans and activities conducted to tackle the disease) and stakeholder interviews (awareness of rabies and the One Health approach). Results: With regard to the epidemiological situation, the findings revealed unsatisfactory vaccination coverage in dogs and low suspected sample collection for laboratory diagnosis. In addition, only half of the exposed individuals received complete post-exposure prophylaxis. A survey carried out by experts in the fields of animal health, human health, and the environment indicated that only 22.47% were well aware of rabies and had never heard of the One Health approach. Overall, there was no significant association between knowledge and participant sector of origin (p &gt; 0.05), highlighting the need for operationalization of the One Health approach in Mali. Conclusion: Therefore, an integrated national action plan for rabies control should be developed with a particular focus on capacity building, particularly in the area of the One Health core competencies. Keywords: epidemiology, multisectoral engagement, One Health, Public Health priority zoonoses, Stakeholders.

Haemolytic Disease of Newborn in a baby Delivered by Mother with Complete Anti-D Prophylaxis: An Unusual Case Report

Haemolytic Disease of the Newborn (HDN), also known as erythroblastosis foetalis, is an immune-mediated disorder among neonates with a wide range of clinical presentations. The occurrence of HDN due to ABO-Rh incompatibility between the mother and baby is becoming rare due to increased knowledge of the disease and adherence to Good Clinical Practices (GCP) during pregnancy. This case report highlights a rare case of HDN in which, despite following GCP, standard care, an uneventful antenatal period, and timely administration of Anti-D immunoprophylaxis, the mother delivered a baby with HDN. The baby was successfully managed by a group of skilled and caring clinicians. Therefore, it is crucial to screen all at-risk mothers for HDN to identify it earlier and treat it successfully. This case report is rare in terms of the baby’s survival with HDN born to a mother who had already received timely Anti-D immunoprophylaxis. Additionally, there is a need to emphasise on recent advances in diagnosis, such as foetal Doppler studies, and treatment options.

Preliminary clinical study of mucoadhesive propolis gel to gingival disorders control in patients with fixed orthodontic appliances.

Aims: Gingival hyperplasia (GH) etiology is diverse and ranges from acute or chronic inflammatory processes and is commonly observed in patients with fixed orthodontic appliances. Propolis has been globally studied and has anti -inflammatory and antimicrobial properties, however, there are few clinical studies involving orthodontics. Study design: This clinical study aims to obtain preliminary evidence of an oral gel containing 5% Brazilian propolis (BPG) in GH and gingivitis control on patients with fixed orthodontic appliances. Place and Duration study: Clinic Orthodontics, Faculty of Dentistry/UFMG, Belo Horizonte, Brazil, from March to October 2013. Methodology: Thirty patients were selected, but only 10 participated and reached the end of the study. The patients were submitted to questionnaire and a complete prophylaxis of dental structures before initiating the gel use(T0) and they were instructed to use the gel two times daily after brushing (morning and evening) during 30 days (T30). Patients were evaluated considering plaque and gingival index and photographs collection of first premolars - measuring gingiva of the clinical crown area. The SPSS version 18.0 statistical program, Shapiro Wilk normality test, presenting a normal or parametric distribution and all analyzes were performed using Student's t Test for paired samples. Results: BPG show statistically significant reduction of GBI and GSI (GB1 p =0.207; GB2 p = 0.122), respectively. Conclusion: Considering this study model, 5% propolis gel had effective in reducing GH and gingivitis. However, a double blind and randomized clinical studies with higher number of patients should be made to give greater credibility for gel use.

Sex aspects of guideline-directed therapy in young ST- elevation myocardial infarction patients

Abstract Background Young women are at specific risk for a poor outcome after ST- elevation myocardial infarction (STEMI). We aimed to investigate sex- and age-specific differences in adherence to a guideline-directed drug therapy for secondary prophylaxis and to assess its effect on overall survival. Methods Administrative health insurance data (≈26 million members) was screened for patients 18- &amp;lt; 60 years with STEMI from 01/2008 to 12/2018. Patient demographics, details on in-hospital treatment, long-term adherence to guideline-directed drug therapy and the effect on mortality was assessed. Results 59,401 patients &amp;lt;60 years (19.3 % women, median age 53 (IQR 48 - 56) were treated in-hospital with STEMI. Overall, adherence to a guideline-directed heart failure therapy decreased over time. 180 days post STEMI, 80.3 % of women and 82.9 % of men &amp;lt;60 were on complete secondary prophylaxis with ACE/AT1 blockers, beta blockers, statins and a platelet activation inhibitor. Five years after the event, however, only 36.6 % of women and 40.9 % of men were under complete therapy. Similarly with a lower drug adherence, women showed a poorer outcome after STEMI with a 90-day mortality of 7.9 % compared to 6.4 % in men as well as a poorer overall survival (p&amp;lt;0.001). After adjustment for patients’ risk factors, there was a clear association between guideline directed therapy and overall survival. The positive association increased with the number of drugs taken. Moreover, sex-specific differences were specifically evident, if all four drugs were prescribed. The effect on overall survival of one heart failure drug was marginal and not sex-specific with a HR of 0.88 (95% CI 0.76-1.02) in women versus HR 0.91 (95% CI 0.84 - 0.99) in men (pint =0.707). Under complete guideline directed therapy, however, HR for overall survival was 0.22 (95% CI 0.19-0.26) in women versus HR 0.31 (95% CI 0.28 - 0.33) in men (pint &amp;lt;0.001). Conclusion Long-term adherence to an optimal guideline-directed drug therapy after STEMI is generally low with specifically women &amp;lt;60 years lacking a consistent therapy. The lack of consistent therapy is one aspect explaining the poor outcome after STEMI in younger women. Our data show, that women specifically benefit from a consistent secondary prophylaxis. As the underutilization of heart failure drugs is contributory to the unfavorable outcome in young female and male patients, systematic approaches and education of healthcare providers are needed to ensure the long-term use of heart failure drugs specifically in this patient cohort at risk.Kaplan-Meier estimatesCox regression analysis

Patterns of CMV infection after letermovir withdrawal in recipients of posttransplant cyclophosphamide–based transplant

AbstractReactivation of latent cytomegalovirus (CMV) is increased in recipients of allogeneic hematopoietic cell transplantation (allo-HCT) with seropositive CMV using posttransplant cyclophosphamide (PT-Cy)–based graft-versus-host disease (GVHD) prophylaxis. Letermovir, a novel DNA terminase complex inhibitor, reduces the incidence of clinically significant CMV infection (csCMVi) in this population; however, parameters that predict csCMVi after letermovir withdrawal are not well described. Here, we examined clinical and immunological parameters in 294 recipients of PT-Cy–based allo-HCT, including 157 patients with CMV, of whom 80 completed letermovir prophylaxis without csCMVi and subsequently stopped letermovir. In this population, the median duration of letermovir exposure was 203 days (interquartile range [IQR], 160-250 days). After letermovir withdrawal, the 90-day cumulative incidence of csCMVi was 23.0% (95% confidence interval, 14.3-32.8). There were no episodes of CMV end-organ disease. Hypogammaglobulinemia before letermovir discontinuation was predictive of csCMVi (hazard ratio, 0.33; 95% confidence interval, 0.12-0.93; P = .03), whereas T-cell and B-cell reconstitution before letermovir withdrawal were not predictive of csCMVi. Higher numbers of natural killer cells were found before letermovir withdrawal in patients who experienced csCMVi (median, 202 vs 160; P = .03). In recipients with seropositive CMV, CD3+CD4–CD8+ T-cell reconstitution was faster in patients with CMV regardless of letermovir exposure. Taken together, these data suggest that csCMVi after letermovir withdrawal was frequent in patients treated with PT-Cy, despite prolonged exposure. Strategies to boost CMV-specific adaptive immunity in patients with persistent hypogammaglobulinemia is a logical pathway to reduce csCMVi after letermovir withdrawal.

A rare craniofacial anomaly associated with balanced reciprocal translocation between chromosome 1 and 7: a case report

The occurrence of balanced reciprocal translocation of chromosome 1 and 7 is one of the rare anomalies. The present case report focuses on a case of 07-year-old male patient with craniofacial anomaly due to balanced reciprocal translocation of chromosome 1 and 7 manifesting as microcephaly, microstomia, oligodontia and scrotal hypospadias with bilateral retractile testis. The patient had severe retrognathic and hyperdivergent mandible along with multiple carious and unerupted permanent teeth. After complete oral prophylaxis of the patient, the restorations of all carious teeth were carried out. Extraction of root stumps under conscious sedation has been planned in later phase. The patient will further be followed up for orthodontic correction of maxillary and mandibular arches in all three planes keeping in view of the growth status of the patient. The present case report intends to provide an overview of the clinical and radiographical features of this rare anomaly who need a prolonged interdisciplinary management and long term follow up. Further, this will add value to the existing prevalence in the available literature.

Management of fever and acute painful crises in children with sickle cell disease in emergency departments: a tertiary hospital experience.

Sickle Cell Disease (SCD) is highly prevalent in Saudi Arabia with variable demographics and access to health care facilities including emergency departments. Literature reviews for locally published articles are deficient in the in-depth evaluation of current emergency practices in managing patients with SCD. The study aims to assess the current emergency practice in managing SCD patients in tertiary hospitals. We reviewed data of 212 visits by patients with SCD over three years and assessed the current emergency department practices in managing common SCD crises, such as vaso-occlusive (VOC) and febrile episodes. Our findings revealed that 47.2%, 37.7%, and 15% of the patients presented with pain, fever, or both, respectively. The patients were triaged level III according to the Canadian triage and acuity scale system in 89% of the visits. The Median time for patients to see healthcare providers was 22 min. In the first 2 h, 86% of the patients received at least one fluid bolus and 79% of them received appropriate analgesia for pain crises. Approximately 41.5% of the patients with fever were admitted and received ceftriaxone as single intravenous antimicrobial agent. However, none of the patients had bacteremia. Only 2.4% of the patients had either urinary tract infection or osteomyelitis based on imaging. ED management is a key factor in the successful management of patients with SCD in a timely manner by providing fluids, analgesia, and antibiotics. Adopting evidence-based guidelines and avoiding unnecessary admissions are suggested in clinically well patients with fever in the era of completed vaccination, antibiotic prophylaxis, and good access to care for patients with a clear viral infection focus.

Compliance rate of anti-rabies vaccination in patients presenting with an animal bite

Introduction: To prevent rabies in animal bite victims, complete postexposure prophylaxis (PEP) with an anti-rabies vaccination (ARV) is essential. This study was done to determine the compliance rate of ARV in patients with animal bites who presented to the emergency department (ED) during the COVID-19 pandemic. Materials and Methods: This was a prospective observational study done on patients presenting to the ED with a history of animal bites over 1 year (May 2020–June 2021). Categorical variables were presented as percentages, and quantitative variables were summarized using mean and standard deviation (SD). Results: A total of 122 animal bite (World Health Organization [WHO] Category II and III) victims presented to the ED during the study. The mean age of the cohort was 38.12 (SD: 16.4) years with a male (n = 67: 54.9%) preponderance. Based on the physiological stability, a majority were triaged as priority III (n = 119; 97.5%). Most patients presented with dog bites (n = 88; 72.1%), followed by cat (n = 14; 11.5%) and rat bites (n = 13; 10.7%). Two-thirds were unprovoked (n = 82; 67.2%) and were caused by stray animals (n = 62; 50.8%). More than half (n = 65; 53.3%) of the bites were WHO Category III bites. All Category II and III patients had received the first dose of ARV at our center and category III patients received immunoglobulin local injection as well. Noncompliance to ARV was seen in almost a quarter (n = 32; 26.2%) of patients of which forgotten dates (n = 11; 34.4%) were the most common cause. There was no significant statistical variable to determine the cause of noncompliance. Conclusion: Unprovoked bites by stray dogs were the cause of a majority of the animal bites. Compliance with PEP remains low at two-thirds of the total. The most common cause of noncompliance to ARV was due to forgotten dates. The following core competencies are addressed in this article: Medical knowledge, Systems-based practice, Practice-based learning and improvement.

Partial vs. complete course of antenatal corticosteroid prophylaxis: An Italian single center retrospective study.

IntroductionThis study aimed to compare the outcomes of preterm infants given 12 vs. 24mg of betamethasone prophylaxis to understand whether a partial course of antenatal corticosteroids (CCS) could prevent or mitigate the major preterm birth complications.MethodsThis is a retrospective single-center cohort study including neonates born between 24 and 34 weeks of gestation from 2001 to 2019 at the University Hospital of Udine. The study population was divided into two groups: one group received 12mg, and another received a 24mg dose of betamethasone before the delivery. A separate analysis was performed for single and multiple pregnancies. The two groups were evaluated for various neonatal outcomes.ResultsThe study population included a total of 1,258 pregnancies and 1,543 neonates delivered between 24 and 34 weeks of gestation, of which 1,022 (803 single and 219 multiple pregnancies) were exposed to the complete CCS prophylaxis, whereas 236 (192 single and 44 multiple pregnancies) received the incomplete CCS prophylaxis. In single pregnancies, as for maternal characteristics, the most significant differences observed between the two groups are the following: a higher prevalence of spontaneous vaginal deliveries in the incomplete CCS prophylaxis (36.46 vs. 23.91%) and, by contrast, a higher prevalence of cesarean deliveries in the complete CCS prophylaxis group (75.72 vs. 63.02%). As for neonatal outcomes, the low Apgar score in the first and fifth min was significantly more prevalent in the incomplete CCS prophylaxis group compared with the complete CCS prophylaxis group. The group of incomplete CCS prophylaxis reported a higher occurrence of the following outcomes: IVH grade 3-4 (7.81 vs. 3.74%, p < 0.05), PVL (7.29 vs. 1.99% p < 0.05), ROP (23.96 vs. 18.06% p = 0.062), and RDS (84.38 vs. 78.83% p = 0.085). After adjusting for covariates, the complete CCS prophylaxis group in single pregnancies was significantly protective for IVH grade 3-4, PVL, and low Apgar's scores. Similar results were found in multiple pregnancies except for RDS.DiscussionThis retrospective single-center cohort study found that, compared with preterm infants treated with 24mg betamethasone in utero, those given half course of betamethasone had a significantly higher prevalence of IVH grade 3-4, PVL, RDS, and lower Apgar scores at 1 and 5 min. In conclusion, the evidence from this single-center retrospective study supports the preference for the complete CCS prophylaxis in women at risk of preterm birth because of its beneficial effect on the main adverse outcomes.

Imported malaria in children: A 13 years retrospective study

Malaria is not endemic in Italy, however every year about 600-700 imported cases are detected in people born or living in Italy who return from a stay in their country of origin (visiting friends and relatives – VFR). Children account for 20% of this population and they have an higher risk of severe disease. Socio-economic problems and deficiencies in the doctor-patient relationship often lead to a lack of awareness of the importance of prophylaxis, making the category of VFRs at increased risk of disease. The aim of this study is to analyze the characteristics of pediatric imported malaria, with a specific focus on prevention and risk factors for severe malaria.All malaria cases diagnosed from 2007 to 2019 in Ospedale Infantile Regina Margherita in Turin were retrospectively observed. Epidemiological and clinical data were described.A total of 72 patients were reported: 98.6% had African origins and 73.6% traveled as VFRs. Plasmodium falciparum was the species most commonly isolated (94.4%). Twenty-four patients (33.3%) underwent chemoprophylaxis and never appropriately. Patients not undergoing prophylaxis and those undergoing incomplete prophylaxis showed not statistically significant difference in term of disease severity (p = 0.26). Nineteen cases were considered severe, including 3 with cerebral malaria. High levels of parasitemia were statistically significantly correlated with severe anemia (p = 0.049) and severe thrombocytopenia (p = 0.036). In 25% of cases the first diagnosis was incorrect. The therapeutic use of artemisinin derivatives has resulted in a significant shortening of the parasitemia clearance time compared to the use of other drugs (p < 0.001).Families have to be educated about the serious implications of a malaria infection and the importance of a correct and complete prophylaxis. Clinicians should always consider malaria in the differential diagnoses in patients with fever and a history of a recent travel to an endemic area. Prompt diagnosis and use of appropriate drugs, according to the latest guidelines, could guarantee a better outcome for patients.

Development and Dynamics of Cytomegalovirus UL97 Ganciclovir Resistance Mutations in Transplant Recipients Detected by Next-Generation Sequencing.

Background(Val)ganciclovir resistance mutations in CMV UL97 (UL97-GCV-R) complicate anti-CMV therapy in recipients of solid organ and hematopoietic stem cell transplants, but comprehensive data on prevalence, emergence, and outcome are scarce.MethodsUsing next-generation sequencing (NGS; Illumina MiSeq platform), we analyzed UL97-GCV-R in patients with available plasma samples and refractory CMV replication/DNAemia (n = 87) containing viral loads ≥910 IU/mL. Twenty-one patients with CMV DNAemia resolving under antiviral therapy were analyzed as controls. Detected mutations were considered induced and of potential clinical significance if they increased by ≥10% compared with the first detected frequency or if they had a maximum frequency ≥25%.ResultsNineteen of 87 (21.8%) with refractory CMV replication had ≥1 UL97-GCV-R detected by NGS, in comparison to 0/21 of the controls (P = .02). One-third of the recipients had 2 or more induced UL97-GCV-R mutations. The most frequently induced mutations affected codons 595 (42% [8/19]), 594 (32% [6/19]), and 603 (32% [6/19]). C592G was present in all episodes of both cases and controls at frequencies <15%, but never induced. UL97-GCV-R tended to be more frequent in donor/recipient CMV immunoglobulin G mismatch or following failure to complete primary prophylaxis, and many developed invasive CMV disease.ConclusionsUL97-GCV-R is common among transplant patients with refractory CMV replication. Early testing by NGS allows for identification of major mutations at codons 595, 594, and 603 and excludes a major role of C592G in ganciclovir resistance. Large prospective studies on UL97-GCV-R are warranted.

Proportion of Unsensitized Rh(D)-Negative Pregnant Women Delivered at Siriraj Hospital Who Received a Complete Course of Anti-D Immunoglobulin: An Awareness problem?

Background: Rh(D) alloimmunization prophylaxis should be administered to unsensitized Rh(D)-negative pregnant women. A routine antenatal dose and a postpartum dose for women that delivered an Rh(D)-positive neonate are recommended. Due to a very low prevalence of Rh(D)-negative blood type in Thai population, awareness of this specific management may be lacking. Objective: To determine the proportion of unsensitized Rh(D)-negative pregnant women that delivered at Siriraj Hospital who received a complete course of anti-D immunoglobulin and to determine the factors associated with the failure to achieve a complete administration as well as pregnancy and neonatal outcomes. Materials and Methods: Medical records of 133 unsensitized Rh(D)-negative pregnant women were reviewed to determine the proportion of cases receiving a complete anti-D prophylaxis. Possible reasons for missing anti-D administration were postulated. Comparison between cases receiving and not receiving antenatal anti-D prophylaxis was performed in terms of associated factors. Pregnancy and neonatal outcomes were compared between women who received complete prophylaxis and those who did not. Results: A complete anti-D prophylaxis was obtained in 71.4% of the women with antenatal dose given to 78.2%. Late antenatal care (OR 2.6, 95% CI 1.4 to 4.9) and late or no antenatal care at Siriraj Hospital (OR 7.1, 95% CI 2.8 to 17.9) were associated with missing antenatal anti-D administration. Desire for tubal sterilization and positive maternal Rh(D)-antibody in the third trimester appeared to be the causes of postpartum dose omission. Pregnancy and neonatal outcomes were comparable between women receiving and not receiving a complete anti-D prophylaxis. Conclusion: The proportion of unsensitized Rh(D)-negative pregnant women delivering at Siriraj Hospital who received a complete anti-D prophylaxis was 71.4%. Late antenatal care, late or no antenatal care at Siriraj Hospital, desire for tubal sterilization, and positive maternal Rh(D)-antibody in the third trimester were associated with the incomplete Rh(D) alloimmunization prophylaxis. Keywords: Rh(D)-negative, Alloimmunization, Anti-D immunoglobulin, Anti-D prophylaxis, Rh immunoglobulin

Effect of locally delivered 0.2% Thymoquinone gel in subjects with Grade C Periodontitis: Clinical, Immunological and Microbiological Assessment

To evaluate the clinical, immunological and microbiological efficacy of local application of Thymoquinone (TQ) gel in subjects with grade C periodontitis. Materials and Methods: Twenty-six individuals of both sexes aged between24 and 37 years, diagnosed as grade C periodontitis with pocket depth ≥5 mm were selected for this study. The patients received a complete prophylaxis including scaling and root planning (SRP) followed by local intrapocket administration of placebo gel in the control group and 0.2% TQ gel in the study group sites. Probing pocket depth (PPD), relative attachment level (RAL), matrix metallo-proteniease-8 (MMP8) concentration ingingival crevicular fluid (GCF) and Aggregatibacter actinomycetecomitans (A.a) count in subgingival plaque were measured and recorded at baseline and 8 weeks postoperatively. Results: At 8 weeks evaluation period, TQ group showed a significant reduction in PPD, RAL, MMP-8 levels in GCF and A.a count in subgingival plaque samples when compared to the placebo group. Conclusion: The results showed more favorable clinical, immunological and microbiological outcomes with topically administered 0.2 % TQ gel when used as an adjunct to nonsurgical periodontal therapy in subjects with grade C periodontitis.

Clinical aspects of human rabies in the state of Ceará, Brazil: an overview of 63 cases.

INTRODUCTION Rabies is considered one of the most relevant public health problems owing to its high fatality rate and the high number of deaths worldwide. METHODS We included patients with human rabies who attended a reference hospital in the state of Ceará during 1976-2019. RESULTS Data were available for 63 out of 171 (36.8%) patients. Of these patients, 48 (76.2%) were attacked by dogs. In recent years, wild animals have been the most common aggressor species (marmosets and bats). Only 39 (70%) patients were initially correctly suspected with rabies. Bites were the most frequent exposure (56; 96%), most commonly on the hands (21; 42%) and the head (9; 18.4%). Only 14 (22%) patients had sought medical assistance before the onset of symptoms, and only one completed post-exposure prophylaxis. The most prevalent signs and symptoms included aggressiveness/irritability (50; 79.4%), fever (42; 66.7%), sore throat/dysphagia (40; 63.5%), and myalgia (28; 44.4%). Hydrophobia was present in 17 patients (22.0%). CONCLUSIONS Most cases of human rabies in Ceará occurred due to the failure to seek medical assistance and/or the failure of the health system in initiating early post-exposure prophylaxis. There is a need for specific information and education campaigns focusing on the cycle of sylvatic rabies as well as prevention measures. Health professionals should undergo refresher training courses on the signs and symptoms of rabies and on the specific epidemiological features of the disease in Brazil.

Chronic macrocheilia in an adolescent—diagnostic work-up and management

An 18-year-old female was referred to the Department of Oral Medicine and Radiology at the Tamil Nadu Government Dental College & Hospital (Chennai, Tamil Nadu, India) for the evaluation of upper lip swelling of over 2 months’ duration. The patient presented with swollen bleeding gums that had persisted for the past 3 months and had not resolved despite complete and thorough oral prophylaxis. Gingival biopsy was performed, but the histopathologic result was inconclusive. An asymptomatic upper lip swelling developed within a month after onset of the gingival swelling.

Epidémiologie de la rage et connaissance, attitudes et pratiques des communautés au Burkina Faso

La rage est une zoonose endémique dans les pays en développement et compte parmi les pathologies virales les plus virulentes et mortelles. Elle constitue une menace pour la sante publique et animale au Burkina Faso. La présente étude transversale a été conduite pour décrire l’épidémiologie de la rage et les connaissances, attitudes et pratiques (CAP) des populations à Ouagadougou. Elle a consisté en une collecte de données auprès des ménages et des structures techniques impliquées dans la prévention, le contrôle et la surveillance de la rage humaine et animale. L’enquête CAP a été réalisée auprès de 616 ménages. Elle a montré que la majorité des participants avaient entendu parler de la rage humaine (80,7 %) et animale (94,6 %), savaient qu’elle se transmettait essentiellement à la suite de morsure par un chien infecte (94,2 %) et étaient capables de citer correctement au moins deux voies de transmission de la maladie (65,7 %). En revanche, seuls 9,7 % des propriétaires de chiens affirmaient être capables de financer la vaccination antirabique canine annuelle. Les principaux canaux d’information et de communication sur la rage utilises par les participants étaient l’entourage (41,8 %), l’école (33,4 %) et les médias (24,8 %). Quant à l’étude épidémiologique rétrospective, qui s’est appuyée sur les documents disponibles au sein des structures nationales, elle a mis en évidence qu’en moyenne 4172 cas de morsures étaient enregistrées chaque année, que seules 31,7 % des personnes mordues avaient bénéficié d’une prophylaxie postexposition complète et que 68 % des animaux testes étaient positifs au virus rabique. Ces études confirment la présence du risque rabique dans le pays et montrent la nécessite de renforcer l’éducation et l’engagement communautaire ainsi qu’une étroite collaboration entre les secteurs de la santé animale et de la santé humaine pour une gestion intégrée des cas de morsures.

Re-exposure animal bite management among incident animal bite cases in a secondary care Hospital in Delhi, India

Complete postexposure prophylaxis with 4 doses of anti-rabies vaccine (ARV) in a previously vaccinated (nonnaïve) individual results in administration of two extra ARV doses resulting in wastages of precious resources comprising vaccine logistics, human resources, physician, and patient time. This cross-sectional study conducted in a secondary care hospital in Delhi among 175 incident animal bite cases observed 39 (22.3%) had an animal-bite history within the previous 5 years. A total of 19 (10.8%) cases reported a history of complete ARV vaccination during a previous animal-bite exposure. However, in the absence of supportive patient medical documentation, all the animal bite cases without exception were prescribed a full course of ARV irrespective of their previous exposure status. Rabies immunoglobulins (anti rabies serum) were also re-administered in 13 (81.2%) cases. National guidelines for rabies prophylaxis should, therefore, consider the inclusion of an explicit decision-making algorithmic mechanism when the health-care provider is confronted with this situation carrying the potential for hidden vaccine wastage.

Protective effect of Nelumbo nucifera (Gaertn.) against H2O2-induced oxidative stress on H9c2 cardiomyocytes.

Ischemic heart disease (IHD), a severe condition of myocardium facing impediment in the supply of basic needs for cellular metabolism is caused by atherosclerosis. Though statin drugs could control the use of surgery on IHD patients, the complete rehabilitation or prophylaxis can be achieved through herbal-based medicines viz. either in the form of crude extract or pure phytocompounds. In the present study, pretreatment with leaf extract of Nelumbo nucifera Gaertn. was investigated for cardioprotective activity-in vitro by mitigating H2O2-induced oxidative stress. Analysis such as estimation of antioxidants, lipid peroxidation, and DNA fragmentation assay revealed significant protective effect of plant extract on cardiomyocytes. Reactive oxygen species detection was done by using 2',7'-dichlorofluorescein diacetate, apoptosis detection with Acridine Orange/Ethidium Bromide and nuclear damage detection by diamidino-2-phenylindole which confirmed the protective effect of N. nucifera extract. In addition, gene expression studies of apoptotic regulatory genes (Bcl2 and Cas-9) resulted in significant protection of nucifera extract pretreated and maintained cells. To conclude, in vitro cardioprotective activity of N. nucifera against H2O2 induced oxidative stress was achieved at the concentration of 50µg/ml. Therefore, major phytocompounds present in extract could be beneficial in managing cardiac complications in the future.