Deadliest Communicable Diseases Research Articles

The Past, Present, and Future of the Healthcare Delivery System Through Digitalization

The prevalence of chronic diseases and the recent global spread of deadly communicable diseases such as Covid-19 has resulted in changing global health needs that require new and adaptable approaches toward delivering healthcare. Healthcare digitization has aided in dealing with old and new healthcare issues, and there is still enormous untapped power. This power can further transform healthcare delivery systems provided that safe and accurate aggregation of individual health data is achieved. We explore a typical patient's healthcare pathway for two major chronic conditions, namely 1) cardiovascular and 2) mental diseases. The aim is to reveal healthcare delivery approach changes as used in the past, present, and with a look to the future to manage these diseases. Furthermore, we provide a holistic overview of the technologies behind the digital healthcare transformation. The study also offers a roadmap that depicts the evolution in the healthcare delivery system enabled by these technological health advancements and concludes with a critical evaluation of such systems.

Ensuring Safety of Forensic Medical Examiners during Autopsy of Suspected or Detected Cases of Deadly Communicable Diseases

Background: Forensic medical examiners are known to be exposed to a combined effect of occupational risk factors potentially leading to adverse health outcomes. In the current epidemiologic situation largely influenced by the ongoing COVID-19 pandemic, postmortem examination of the bodies having signs of deadly communicable diseases, including the novel coronavirus disease, poses a high infection risk, thus making the development and implementation of appropriate preventive measures an urgent and important task. Objective: To summarize and systematize the results of scientific research and requirements of legal and regulatory documents in the field of ensuring workplace safety of forensic medical examiners. Materials and methods: We searched for literary sources published in Russian and English in 2000–2021 in the PubMed, eLibrary, and Cyberleninka databases using such keywords as “healthcare workers”, “safety”, “forensic medical examiner”, “prosector”, and “deadly infections”. We conducted an analytical review of legal documents regulating safety in the conduct of forensic medical examination. Based on the relevance of search results, we selected 30 articles and five legal and regulatory documents for this review and carried out their content analysis using descriptive and analytical methods. Results: As a solution to the problem of epidemiological surveillance, a series of modular buildings for postmortem examination of patients with suspected or confirmed deadly infectious diseases, including COVID-19, was developed and introduced. Conclusions: Our findings indicate that in the context of the current pandemic, it is critical to update the requirements for biological safety of forensic experts stipulated in sanitary rules and norms. Construction of modular special purpose buildings in the city of Kazan contributed to improvement of biological safety during autopsy of COVID-19 victims.

Economic development with deadly communicable diseases and public prevention

AbstractInfectious diseases have been a major determinant of human mortality in history and the key regulator of population size, including the first epoch of the Industrial Revolution (until the 1950s) in Western countries and still now in developing countries, especially in Sub‐Saharan Africa. In recent times, a new vein of economic research dealing with the interplay between communicable diseases and economic development has grown. However, pioneering previous research has analysed this issue in a framework where prevention decisions were the outcome of private individual rational choices. This assumption neither seems to hold for least‐developed countries, primarily due to a lack of resources, nor for developed countries, where prevention policies are mostly planned by the public authority through its (public) health system, as also well documented by the current COVID‐19 crisis. Our aim in this article is twofold. First, we pinpoint the properties of Chakraborty et al.'s (2010, 2016) basic epidemiological equation to fully enlighten its usability in economic‐epidemiology modelling. Second, we apply this framework to analyse prevention activities against a range of infectious diseases by endogenous public (rather than private) health expenditures. Our results identify the relationships governing the interplay between—on the one hand—typical epidemiological phenomena, namely invasion (i.e., the tendency of infection to establish in a population) versus endemicity (i.e., the tendency of infection to persist in the long term) and—on the other hand—economic variables, such as capital accumulation, GDP, and taxation. This is done by identifying threshold quantities, depending on both epidemiological and economic parameters, and by bifurcation analysis showing the effects that public intervention can have on previously uncontrolled infectious diseases. Both direct and indirect, that is, partial and general equilibrium, effects of control interventions are identified.

Utility of GeneXpert Mycobacterium tuberculosis/rifampicin assay in smear-negative pulmonary tuberculosis

Background: Tuberculosis (TB) remains one of the world's deadliest communicable diseases. An alarming rise in the incidence of Mycobacterium tuberculosis (MTB) has prompted the need for rapid diagnostic techniques. Despite low sensitivity in MTB detection, sputum microscopy remains the main diagnostic method, especially in resource-limited settings. Mycobacterial culture is the gold standard method for TB diagnosis; however, the use in clinical practice is limited due to longer time, biosafety requirements, and high cost. In December 2010, the World Health Organization (WHO) 1st endorsed the usage of Xpert MTB/rifampicin (RIF) assay. The WHO recommends that GeneXpert test could be used as a follow on test to microscopy, especially in smear-negative specimens. Objectives: To assess percentage of Tuberculosis cases and Multi Drug Resistant (MDR) case detection at diagnosis using Xpert MTB/RIF assay in smear-negative pulmonary cases. Materials and Methodology: Detailed relevant clinical history and examination were carried out for 105 pulmonary TB suspect patients. Sputum acid-fast bacilli smear two samples and human immunodeficiency virus status were checked under RNTCP; chest X-ray PA view was done. Smear-negative patients were subjected to bronchoscopy and bronchoalveolar lavage (BAL)/bronchial washing. BAL/Bronchial washing was tested for GeneXpert. Interpretation and Conclusion: MTB was detected in 21 (20%) samples out of 105 samples and RIF resistance was detected in 1 (1%) sample. Most common chest x-ray abnormalities were cavity (33.3%) and consolidation (33.3%). 8 cases (38.1%) among Gene xpert positives had past history of Tuberculosis. Comorbidities were found in 5 cases (23.8%) among Gene Xpert positives. The present study concludes that using standard clinical assessment for selection, five patients need to be tested to detect one case of smear-negative TB. Smear-negative patients could benefit from Xpert, particularly in areas where no culture is available.

Prevalence of Alcohol Use and Associated Factors Among Dilla University Students, Dilla Town, Southern Ethiopia: A Cross-Sectional Study

Introduction: Compared to other deadly communicable diseases, Psychoactive Substance use is among the leading cause of death. Repeated use linked to addiction, dependence and predisposition for criminal and antisocial behaviours. Even though drug use in Africa relatively is short; however the abuse of the drug in Africa is escalating rapidly. Substances use is also one of the most burning and growing public health problems in Ethiopia, as in many developing countries; alcohol is the most frequently used substance. Objective: This study aimed to assess the Prevalence of Alcohol use and associated factors among Dilla University undergraduate students in Southern Ethiopia, 2018. Methods: An institution-based cross-sectional study was conducted at Dilla University among undergraduate regular students from January-February. Systematic random sampling technique was used to get a total of 803 samples of students from each year and the department of the university. The collected data were coded, entered into EPI-INFO version7.1 and analyzed by using SPSS version 20. Crude and adjusted OR were analyzed using logistic regression and the level of significance of association was determined at P-value <0.05. Result: A total of 803 participants were interviewed with a response rate of 91.7%. Among the Participants, alcohol use was found to be (41.8%; n=336). Being 4th-year students (AOR =2.66, 95% CI: 1.64, 4.31), having friends who use the substance (AOR=1.53, 95% CI: 1.09, 2.1), being Khat user (AOR= 1.48, 95% CI: 1.05, 2.09) and being Cigarette smoker (AOR=1.76, 95% CI: 1.09, 2.84) were found to be significantly associated with alcohol use. Conclusion: In the current study, half of the participants found to have alcohol use. Therefore, early prevention, detection and alleviating of alcohol use should be implemented among students in the university. Funding Statement: Not applicable. Declaration of Interests: The author declares that he has no conflicts of interest. Ethics Approval Statement: Ethical clearance was obtained from the Institutional Review Board (IRB) of Dilla University. Written consent was obtained from each participant during data collection.

Studies on Antioxidant and Antimicrobial Potential of Biogenic Silver Nanoparticles Synthesized Using Nothapodytes foetida Leaf Extract (Wight) Sleumer

Introduction In recent years biogenic nanomaterials have emerged with an immense scope in biomedicine as these nanostructures are proved to combat against deadly communicable and non-communicable diseases. Intensifying application of antibiotics in therapeutics endorsed multidrug resistance (MDR)

COVID‐19: Lessons from SARS and MERS

COVID‐19: Lessons from SARS and MERS

Tuberculous granuloma of the gingiva – A forgotten entity

Tuberculosis (TB) claims to be one of the most deadly communicable diseases. Mycobacterium tuberculosis is identified as the causative micro-organism. Extrapulmonary TB is quite rare, of which oral TB lesions account to less than 1% and exists as primary and secondary lesions. In recent times, the number of cases reported with extrapulmonary TB is on the rising trend due to an increase in the number of immunocompromised patients. To highlight the extrapulmonary oral TB lesion, we hereby present a case report on oral TB.

Investigating the CYP2E1 Potential Role in the Mechanisms Behind INH/LPS-Induced Hepatotoxicity.

Tuberculosis (TB) is one of the oldest infectious diseases that affected humankind and remains one of the world’s deadliest communicable diseases that could be considered as global emergency, but the discovery and development of isoniazid (INH) in the 1950s paved the way to an effective single and/or combined first-line anti-TB therapy. However, administration of INH induces severe hepatic toxicity in some patients. Previously, we establish a rat model of INH hepatotoxicity utilizing the inflammatory stress theory, in which bacterial lipopolysaccharide (LPS) potentially enhanced INH toxicity. These enhancing activities ranged between augmenting the inflammatory stress, oxidative stress, alteration of bile acid homeostasis, and CYP2E1 over-expression. Although pre-treatment with dexamethasone (DEX) helped overcome both inflammatory and oxidative stress which ended-up in alleviation of LPS augmenting effects, but still minor toxicities were being detected, alongside with CYP2E1 over expression. This finding positively indicated the corner-stone role played by CYP2E1 in the pathogenesis of INH/LPS-induced liver damage. Therefore, we examined whether INH/LPS co-treatment with CYP2E1 inhibitor diallyl sulfide (DAS) and DEX can protect against the INH/LPS-induced hepatotoxicity. Our results showed that pre-administration of both DAS and DEX caused significant reduction in serum TBA, TBil, and gamma-glutamyl transferase levels. Furthermore, the histopathological analysis showed that DAS and DEX could effectively reverse the liver lesions seen following INH/LPS treatment and protect against hepatic steatosis as indicated by absence of lipid accumulation. Pre-treatment with DAS alone could not completely block the CYP2E1 protein expression following INH/LPS treatment, as appeared in the immunoblotting and immunohistochemistry results. This is probably due to the fact that the combined enhancement activities of both INH and LPS on CYP2E1 protein expression levels might resist the blocking probabilities of DAS. In the meantime, addition of DEX to the DAS/INH/LPS combination caused a significant reduction in CYP2E1 protein expression as revealed by the immunoblotting and fading coloration in immunohistochemistry results. Thus, addition of DEX and DAS together caused strong protection against INH/LPS-induced hepatic damage. These findings reveal the potential therapeutic value of combining DAS and DEX with INH in TB management for reducing the potential risk and incidences of hepatotoxicity.

Metabolites from endophytic Aspergillus fumigatus and their in vitro effect against the causal agent of tuberculosis

ABSTRACT Tuberculosis (TB) remains one of the most deadly communicable infectious diseases, causing 1.4 million deaths in 2015 worldwide due to many conditions, including the inadequate treatment and the emergence of multidrug-resistant strains of the causal agent, Mycobacterium tuberculosis. Therefore, drugs developed from natural sources, as microorganisms and plant extracts, are a frequent target for the research and discovery of antimicrobial compounds. The current study started the characterization of compounds produced by an Aspergillus fumigatus isolated from copaíba (Copaifera multijuga) that efficiently inhibits M. tuberculosis by releasing the compounds into the fermentation broth under specific culture conditions. A preliminary assay was carried out with a correlate species, M. smegmatis, aiming to detect an antimicrobial effect related to A. fumigatus fermentation broth. The direct use of this substrate in antibiosis assays againstM. tuberculosis H37Rv strain (ATCC 27294) allowed the detection of antimicrobial activity with a minimal inhibitory concentration of 256 μg mL-1, demonstrating that purification processes developed by the Biotage Flash Chromatography System are robust and reliable techniques for purification of compounds from natural sources. Also, this chromatographic system can be used in combination with specific biochemical tests, improving the search for reliable results. We conclude that this fraction can express a broad action range, inhibiting both Mycobacterium species used as target organisms.

Seasonal behavior and forecasting trends of tuberculosis incidence in Holy Kerbala, Iraq.

Pulmonary tuberculosis (PTB) remains major public health problem over the world. Cities witnessing religious event throughout of the year like Kerbala/Iraq require great efforts to minimize the incidence of deadly communicable diseases like TB. The aim of this study is to model the monthly incidence rates of PTB cases in Kerbala/Iraq. This is a retrospective study in which records of confirmed PTB patients whom they referred to the chest and respiratory illnesses center of Holy Kerbala governorate were obtained. Monthly registered new smear-positive PTB cases from January 2010 to December 2016 were analyzed. Seasonal autoregressive integrated moving average (SARIMA), SARIMA-exponential smoothing method (ETS), SARIMA-neural network autoregressive, and SARIMA-adaptive neuro-fuzzy inference system (SARIMA-ANFIS) were used for forecasting monthly incidence rate of TB in Kerbala, Iraq. Mean absolute percentage error, root mean square error, and mean absolute square error were used to compare the models, and Akaike information criterion (AIC) and Bayesian information criterion (BIC) were used to selected best model. The trend of PTB incidence showed a seasonal characteristic, with peaks in spring and winter. Predicted estimates using all models proposed to forecast the number of PTB cases from 2016 to 2018 showed that the PTB cases indicated marginal decrease trends and best forecasted in SARIMA-ANFIS model (the lower AIC and BIC values, 712.69 and 731.05, respectively). Seasonal characteristic of PTB incidence was observed with peaks during spring and winter. Forecasting of PTB incidence between the period 2016 and 2018 showed marginal decrease trends, and the best forecasting model was SARIMA-ANFIS model.

Factors affecting tuberculosis case detection in Kersa District, South West Ethiopia

BackgroundTuberculosis is one of the deadly communicable diseases which claim the lives of millions in the world. Early case detection and prompt treatment cures the patients, breaks the transmission and improves the control program. ObjectiveThe aim of this study was to investigate the factors affecting tuberculosis case detection in Kersa District, south west Ethiopia. MethodFacility based cross sectional study design was employed in four directly observed treatment short course service providing public health centers. Three hundred eighty four patient folders were reviewed. In-depth interviews was conducted with 18 health care workers including heads of health centers, tuberculosis focal persons, clinicians, laboratory technicians, tuberculosis program coordinator and head of health office. ResultSignificant number, 135(35.2%) of tuberculosis suspects were not requested for microscopic examination of sputum smear, the laboratory results 21(8.4%) of requested patients were not recorded in both patient folders and laboratory registers. Only 10 (4.4%) of those examined and recorded were smearing positive. Participants described that the shortage and irregular supply of acid fast bacilli reagents and consumable, inadequate infrastructures, frequent electricity interruption, shortage of trained care providers, negligence of care providers, weakness of laboratory quality assurance system and poor health information use culture were major factors for low case identification. ConclusionThe resource shortage, electricity interruption, low commitment of care providers, weak quality assurance practice and poor health information use culture were major factors for low tuberculosis case identification and should be considered.

A study on co-morbidities and treatment outcome based on updated definitions among tuberculosis patients registered at a tuberculosis unit, Bangalore

Background: Tuberculosis remains one of the world‘s deadliest communicable diseases and a major public health problem and is a most common opportunistic infection in people living with HIV. The treatment outcome of Tuberculosis is influenced by numerous factors of which presence of co-morbidities is one of the factors. The present study was done with following objectives, to assess the proportion of co-morbidities and treatment outcome of the Tuberculosis cases registered for DOTS treatment at the Tuberculosis unit.Methods: A Descriptive study was conducted at a Tuberculosis Unit in Bangalore with 80 subjects selected by purposive sampling satisfying inclusion &amp; exclusion criteria. Data was collected using a pretested semi structured proforma administered to all the study subjects by trained investigators. Data regarding socio demographic profile, profile of tuberculosis, medical co-morbidities which the subjects were suffering were collected and these patients were followed up till their treatment completion and outcome of treatment was given based on new WHO definitions.Results: The present study showed that, 38 (47.50%) of the study subjects had one or the other comorbidities with chronic obstructive pulmonary disease being the most common 18(22.5%) followed by Diabetes 13(16.25%). On determining the treatment outcome of the study subjects the overall treatment success rate was 86.25% which included the cured and treatment completed subjects. However there was no statistically significant (p = 0.614) association between treatment success and presence of comorbidity.Conclusions: The cure rate among the tuberculosis patients, following DOTS therapy was found to be slightly less than the RNTCP standards.

Transcriptome analysis of mycobacteria in sputum samples of pulmonary tuberculosis patients.

Pulmonary tuberculosis, the disease caused by Mycobacterium tuberculosis, still retains a top rank among the deadliest communicable diseases. Sputum expectorated during the disease continues to be a primary diagnostic specimen and also serves as a reservoir of bacteria. The expression pattern of mycobacteria in sputum will lead to an insight into bacterial adaptation at the most highly transmissible stage of infection and can also help in identifying newer diagnostic as well as drug targets. Thus, in the present study, a whole genome microarray of Mycobacterium tuberculosis was used to elucidate the transcriptional profile of mycobacteria in the sputum samples of smear positive pulmonary tuberculosis patients. Overall, the mycobacteria in sputum appeared to be in a low energy and low replicative state as compared to in vitro grown log phase M. tb with downregulation of genes involved in ATP synthesis, aerobic respiration and translational machinery. Simultaneously, downregulation was also seen in the genes involved in secretion machinery of mycobacteria along with the downregulation of genes involved in the synthesis of phthiocerol dimycocerosate and phenol glycolipids. In contrast, the majority of the genes which showed an upregulation in sputum mycobacteria were of unknown function. Further identification of these genes may provide new insights into the mycobacterial behavior during this phase of infection and may help in deciphering candidates for development of better diagnostic and drug candidates.

Tuberculosis. Digging deep in the soul of humanity

Tuberculosis (TB) is one of the oldest infectious diseases that affected humankind. A quintessential social disease, TB remains one of the world's deadliest communicable diseases, with still a high mortality and burden of disease. Social representations of TB focus on aspects associated to feelings and manifestations awakened by the disease, sometimes reinforcing stigmas and prejudices about the way of perceiving TB. TB is a historic disease now reborn with a deeper social stigma. Despite the modest reduction in TB incidence worldwide, its incidence is still rising in certain crisis-affected populations like refugees, and in those bearing high prevalence of HIV, persisting poverty, especially in the developing world. Fear and stigma may appear justified with the increasing rates of multi-drug resistant (MDR) TB, and now extremely drug resistant (XDR) TB. However, stigmatization of TB poses serious obstacles to current TB control efforts, as socio-cultural aspects can influence adherence to TB treatment.

Optimizing treatment outcome of first-line anti-tuberculosis drugs: the role of therapeutic drug monitoring

Tuberculosis (TB) remains one of the world's deadliest communicable diseases. Although cure rates of the standard four-drug (rifampicin, isoniazid, pyrazinamide, ethambutol) treatment schedule can be as high as 95-98% under clinical trial conditions, success rates may be much lower in less well resourced countries. Unsuccessful treatment with these first-line anti-TB drugs may lead to the development of multidrug resistant and extensively drug resistant TB. The intrinsic interindividual variability in the pharmacokinetics (PK) of the first-line anti-TB drugs is further exacerbated by co-morbidities such as HIV infection and diabetes. Therapeutic drug monitoring has been proposed in an attempt to optimize treatment outcome and reduce the development of drug resistance. Several studies have shown that maximum plasma concentrations (C max), especially of rifampicin and isoniazid, are well below the proposed target C max concentrations in a substantial fraction of patients being treated with the standard four-drug treatment schedule, even though treatment's success rate in these studies was typically at least 85%. The proposed target C max concentrations are based on the concentrations of these agents achieved in healthy volunteers and patients receiving the standard doses. Estimation of C max based on one or two sampling times may not have the necessary accuracy since absorption rate, especially for rifampicin, may be highly variable. In addition, minimum inhibitory concentration (MIC) variability should be taken into account to set clinically meaningful susceptibility breakpoints. Clearly, there is a need to better define the key target PK and pharmacodynamic (PD) parameters for therapeutic drug monitoring (TDM) of the first-line anti-TB drugs to be efficacious, C max (or area under the curve (AUC)) and C max/MIC (or AUC/MIC). Although TDM of first-line anti-TB drugs has been successfully used in a limited number of specialized centers to improve treatment outcome in slow responders, a better characterization of the target PK and/or PK/PD parameters is in our opinion necessary to make it cost-effective.

Association between tuberculosis and circulating microRNA hsa-let-7b and hsa-miR-30b: A pilot study in a Chinese population

Tuberculosis remains one of the world's deadliest communicable diseases. Limitations in the current diagnosis tools have heavily slowed down the step to eliminate TB. The objective of this study was to identify potential circulating miRNA associated with tuberculosis (TB) infection and disease development. Agilent human miRNA microarray was used to estimate the circulating levels of 1887 miRNAs among 34 study participants (10 patients with pulmonary TB, 13 controls with latent TB infection and 11 non-infected healthy controls). The identified miRNAs were subsequently verified by real-time qPCR. Target gene prediction and miRNA-gene network construction were further explored. A total of 119 miRNAs were identified to be in different levels between any two groups of the study population by microarray (Fold Change>2, p<0.01). 11 most promising miRNAs were then selected for verification by real-time qPCR. The levels of hsa-let-7b-5p and hsa-miR-30b-5p were confirmed to be significantly up-regulated in pulmonary TB patients as compared to both control groups (p<0.01). Caspase 3 was predicted to be one common target gene for these two miRNAs. None of the selected miRNA was confirmed to be related with the infection status. This pilot study suggested circulating hsa-let-7b and hsa-miR-30b might be associated with TB development by regulating the target genes involved in TLR-NF-kB mediated signal pathway.

The cytopathology of mycobacterial infection.

Mycobacterial infection, tuberculosis (TB) in particular, remains one of the world's deadliest communicable diseases in adults and particularly in children, in low and middle income countries. The combination of human immunodeficiency virus (HIV) and TB is often lethal with TB accounting for 25% of deaths in the HIV population. One of the cornerstones for reducing the TB epidemic is early case detection using high quality diagnostic techniques. Cytology, especially fine needle aspiration biopsy (FNAB) is able to diagnose mycobacterial infection in a rapid and cost-effective manner without requiring surgery, thus allowing appropriate management to be quickly instituted. Confirmatory ancillary tests can effectively be performed on cytologic material. In this review, the pertinent cytomorphology of mycobacterial infection in various exfoliative and FNAB specimens is presented, in both immunocompetent and immunosuppressed patients. In the immunosuppressed, the typical cytomorphology of caseating granulomatous inflammation may not be seen but suppurative necrotic inflammation, mycobacterial spindle pseudotumour or a specimen comprised entirely of necrosis may be seen instead. This review includes discussion of currently available ancillary tests that can be performed on cytologic specimens.

An Update on New Vaccines for Tuberculosis

Tuberculosis (TB) is one of the most common and deadly communicable diseases in the world, infecting approximately one-third of the total human race. The number of drug-resistant TB cases are increasing. The spectrum of resistance varies from single to multidrug and from multidrug to total drug resistance varieties. Human Immunodeficiency Virus (HIV) infection is also responsible for the recent re-emergence of tuberculosis infection worldwide. When drugs are becoming ineffective against Mycobacterium tuberculosis, there is a need to focus more on preventive strategies. Though Bacillus Calmette–Guerin (BCG) vaccine is efficient in preventing miliary and meningeal tuberculosis in children, it is not effective against pulmonary tuberculosis. For prevention of pulmonary tuberculosis, development of new vaccines is the need of time. Several new vaccines are under clinical trials either to replace old BCG or act as a booster for the current BCG vaccine. New vaccines include live Mycobacterial vaccines, its subunit, live vector-based vaccines and killed whole or fragmented vaccines. This review recaps the status of development of pre-clinical tuberculosis vaccines.

Primary tuberculosis of the gingiva: A rare case report

Tuberculosis (TB) is one of the world's deadliest communicable diseases. TB ranks the second leading cause of death from infectious diseases worldwide. India is the highest TB-burdened country, accounting for one-fifth of the global incidence. It may occur as primary or secondary TB. Primary TB affects most commonly the lungs. Oral manifestations are uncommon in primary TB.