Financial Conflicts Of Interest Research Articles

Misuse of antibiotics in COVID-19: a neglected threat in Pakistan

Antibiotics are a range of powerful medications utilized for the treatment of bacterial infections. Although, misuse can result in a mass epidemic of antibiotic-resistant infections across the world. Antibiotic resistance is a ubiquitous phenomenon owing to the poor management of dosage, overuse due to a lack of public awareness, and increased negligence of physicians in prescribing antibiotics. Furthermore, the World Health Organization (WHO) has declared anti-microbial resistance to be among the top 10 threats to the global public1, making it an indisputable issue of global health. In Pakistan, a study declared that ~88% of COVID-19 patients were using multiple antibiotics for treatment with no culture tests indicative of the need for antibiotic therapy2. Moreover, in a study of hospitalized COVID-19 patients, it was concluded that ~8% of all COVID-19 patients suffered from concurrent bacterial infections, however, up to 90% of the patients received antibiotic therapy3. These alarming figures demonstrate the dire need of intervention at a national level, to prevent the rapid emergence of an endemic of antibiotic-resistant infections. Furthermore, the incidence of antibiotic-resistant infections has seen a sharp rise within the past decade4, largely due to the imprudent use of antibiotics. The unregulated misuse of antibiotics can result in a new strain of fatal infection, triggering a relentless endemic in the face of a pandemic. Statistical models predict approximately 5 million deaths in a year (mostly caused by Escherichia coli) due to rising antibiotic-resistant infections worldwide, creating an overwhelming global burden of infections5. This burden is unaffordable for developing countries like Pakistan, which cannot pay the price of catastrophic socio-economic constraints created by the warfare of 2 active outbreaks. With the looming threat of nationwide antibiotic-resistant infections, it is exceedingly important to initiate early intervention. National health authorities should impose strict regulations on pharmacies, clinics, and hospitals, wherein COVID-19 patients are not encouraged for antibiotic therapy unless evidently indicated. Moreover, physicians should comprehensively counsel their patients regarding the grave consequences of antibiotic misuse, especially during COVID-19 infections, where use has not been indicated. Local awareness programs must also be utilized, encouraging the general population to decrease their misuse of antibiotics. With persistent intervention, we hope to reduce the rise of new menacing endemics nationwide. Ethical approval Not Applicable. Sources of funding None. Author contribution Conceptualization: Muhammad Omar Larik; Literature Search: Muhammad Omar Larik; Creation of First Draft: Muhammad Omar Larik, Muhammad Ashhal Iftekhar, Daniyal Muhammad Alam, Omema Ansari, Mozaena Ansari; Creation and Review of Final Draft: Muhammad Omar Larik. All authors have approved the final mauscript. Conflict of interest disclosure The authors declare that they have no financial conflict of interest with regard to the content of this report. Research registration unique identifying number (UIN) Not Applicable. Guarantor Muhammad Omar Larik. Assistance with the study None. Provenance and peer review Not commissioned, externally peer-reviewed.

Outbreak of measles: threatening India’s goal to achieve elimination

Outbreak of measles: threatening India’s goal to achieve elimination

Novel gonorrhea strain in the United States of America leading to increase of sexually transmitted diseases load: is it an outcome of inexorable process of developing antibiotic resistance?

Novel gonorrhea strain in the United States of America leading to increase of sexually transmitted diseases load: is it an outcome of inexorable process of developing antibiotic resistance?

Upsurge of measles in South Africa: cause for alarming concern

Upsurge of measles in South Africa: cause for alarming concern

Re-emergence of canine influenza in the United States of America; a call for One Health approach; a letter to the editor

Re-emergence of canine influenza in the United States of America; a call for One Health approach; a letter to the editor

Child neurodevelopmental disorders in armed conflict country, case of DR Congo: long-term trauma impact on brain development in childhood: review

Child neurodevelopmental disorders in armed conflict country, case of DR Congo: long-term trauma impact on brain development in childhood: review

Mental health impact of the catastrophic 2023 earthquake on Turkish youth: psychological distress amidst humanitarian crisis

On February 6, 2023, Türkiye was struck by a devastating earthquake with a magnitude of 7.8, a natural disaster of enormous destruction. As a result, many citizens succumbed to mortality, suffered immense physical and psychosocial harm, and the properties of the survivors suffered severe damage. Adolescents and the youth sector in particular are at an increased risk of developing psychiatric disorders1. Hence, policymakers and stakeholders need to pay attention to this understudied sector to prevent and manage health care issues associated with the recent earthquakes. Because of their rapid appearance, ferocity, and devastation, earthquakes exert unequivocal stress events2. Previous studies have demonstrated that posttraumatic stress disorder (PTSD) is frequently linked to earthquakes, which have a significant psychological influence on individuals and hinder their early return to normal activities while prolonging unpleasant emotions3. Moreover, prior traumatic encounters and childhood abuse have a significant impact on the mental health of adolescent survivors3. Recalling fear, triggering memories, or experiencing panic and anxiety is one of the most notable effects of the possibility and persistence of PTSD. These symptoms have a rapid impact on mental health and, according to studies and personal experience, are associated with the initiation and risk of developing PTSD3. In addition, this disorder comprises mood disorders, such as dysthymia and anxiety, with the diagnosis being connected to the existence of PTSD following the earthquake3. The majority of adolescent survivors’ experience intrusive flashbacks and posttrauma ruminations, also known as event-related ruminations, which result from the shaking of beliefs after excruciating occurrences2. Adolescents may experience varying levels of trauma following the earthquake, with one of the most significant elements influencing the intensity being the loss of family members and the damage of homes, which causes a dramatic change in their lives2,3. Adolescent trauma survivors are thought to focus more on the negative aspects of traumatic cues as a result of automatic ruminations that reduce an individual’s ability to avoid them. The most recent earthquake in Türkiye since 1939 had the largest recorded magnitude, and it damaged an area of around 400 km24. The chronicity of adolescent survivors’ mental health and quality of life are impacted by postearthquake difficulties including eviction, destroyed homes, or injuries. These variables are more likely to be subjected to harsher conditions in the aftermath of the traumatic event3. According to a study, those who have experienced partial or full PTSD symptoms for 2 years may continue to experience them for the following 10 years5. The Turkish government faces a serious task in constructing a suitable plan to aid the afflicted youth alongside heal those affected and develop a prosperous generation. In response to the rising prevalence of adolescent mental health issues, the World Health Organization (WHO) is assisting the Turkish government through its regional concept of operations, working in partnership with the Turkish Ministry of Health to provide mental health services throughout all impacted areas4. It is advised to conduct a structured examination of adolescent psychological distress symptoms. This may be achieved by interviewing teenagers, preferably without their parents present to prevent emotional bias and distress disguise. This mediates a secure clinical setting in which to discuss their traumatic experience to receive appropriate care6. Moreover, following the early emergency comeback, children and caregivers will warrant additional specialized trauma healing interventions that will be crucial in assisting youth in maintaining their well-being while also being impacted by the risk and protective factors that came with the Türkiye earthquake7. Offering extensive training for mental health professionals is highly advised, so that the symptoms of PTSD and other disorders are revealed more rapidly, and hence managed more sufficiently6. Not only should face-to-face therapy be offered, but also eHealth methods should be adopted to expand the range of benefited adolescents throughout all regions of Türkiye6. There is a need to break the stigma surrounding mental health, that acts as a barrier preventing individuals from seeking help. Moreover, community and political engagement and improvement of disaster management goals accountability and identifying gaps are essential steps. Through sustained research identification of predictors may help formulate postdisaster relief and rehabilitation efforts to further reduce the psychological distress in such a humanitarian crisis. Ethical approval Not applicable. Sources of funding The authors have not received any financial support for this manuscript. Author’s contribution O.U.: conceptualization, project administration, writing—review and designing. H.A.: reviewing the first draft and revising. J.W.: reviewing and editing. All authors approved the final manuscript and submission. Conflicts of interest disclosure The authors declare that they have no financial conflict of interest with regard to the content of this report. Research registration unique identifying number (UIN) Abubakar Nazir. Guarantor Abubakar Nazir. Data availability statement Not applicable.

Need for innovation: laser sutures

In this modern era there is dire need of awareness regarding sutureless surgical procedures. Globally 310 million surgeries are performed each year1. Using thread and needle for suturing is still as common as using legs to walk. This method is not near to ideal because of risk of contamination, infections, scar marks, needle trauma, and reopening of tissues if the stitches are not held tight2. The prevention of wound infections after surgical procedures is of great interest for every surgical discipline, in order to improve the quality of patient care. And the best way to prevent suture-related complications is to have sutureless procedures. A number of sutureless methods have developed over the time which includes fibrin glue, cyanoacrylates, scaffolds and bio-inspired adhesives3. The sutureless technique which is receiving increasing attention is Photochemical Tissue Bonding (PTB), which can also be called laser sutures. PTB is a novel tissue repair technique that causes the proteins on tissue surfaces to crosslink by using visible light and a photosensitizing dye. This technique has been successfully demonstrated in a number of tissue repair models4. This suture-replacement technique is able to close incisions nearly instantaneously without damaging tissue. It gives minimum scar, is time saving, has more accuracy, causes less infections and is less user dependent as compared with typical sutures. This technique does not provide promising results on the skin but also has been tested for vascular and nervous repairs5. Therefore I think it’s high time that surgeons should consider using this in their practice. Ethical approval None. Sources of funding None. Author contribution Misbah Kaleem: Conception of work along with final draft. Musaddiq Kaleem: Editing draft and reviewed article. Conflict of interest disclosure The authors declare that they have no financial conflict of interest with regard to the content of this report. Research registration unique identifying number (UIN) None. Guarantor None.

Global helium shortage leading to the shutting of imaging modalities is the world’s next medical crisis-driving factors, future of helium-free magnetic resonance imaging systems, and alternatives to magnetic resonance imaging

Global helium shortage leading to the shutting of imaging modalities is the world’s next medical crisis-driving factors, future of helium-free magnetic resonance imaging systems, and alternatives to magnetic resonance imaging

Candida auris: a growing threat to global health

Candida auris (C. auris) belongs to the Candida genus and is a fungal yeast resistant to multiple drugs. It is highly virulent and evades current therapeutic remedies. It was first discovered in a Japanese hospital in 2009 from a patient’s external auditory canal1. C. auris infection has a high worldwide mortality, which ranges from 30% to 60%, and is frequently associated with bloodstream infections2. The rapid spread of C. auris infection occurred after 2009. The Centers for Disease Control and Prevention (CDC) has estimated the presence of C. auris isolates in 41 countries, typically in hospital settings, as of March 20203. CDC also reported outbreaks of infections with C. auris in 47 countries globally on February 15, 20214. The United States reported 2377 clinical cases and 5754 screening cases from January 2022 to December 20225. Twenty-six isolates of C. auris from India were different genetically and phenotypically from the ones found in Japan and Korea, which provided evidence for C. auris’s ability to mutate and its resistance to Azoles6. The mechanism of C. auris virulence factors is relatively unknown. According to genomic comparison, C. auris has the ability to adapt to different environments. Two mechanisms of its pathogenesis have been identified, which include hydrolytic enzyme production and attack host cells and tissues. It can also form biofilms that protect it from antifungal drugs and increase its ability in nosocomial transmission4. C. auris can be spread in health care facilities such as hospitals and nursing homes through direct patient-to-patient contact. Contaminated surfaces are a significant culprit in the spread when a person comes in contact with them. As C. auris colonizes the skin and can be transmitted into the environment, both properties make it easily transmissible. Population susceptible are immunocompromised people, recently hospitalized patients in areas where C. auris is endemic; catheter use, extended stay in ICU, previous history of antimicrobial exposure, and resistance to antifungal therapy7. Identifying this pathogen is tricky as the methods used to determine the yeast in laboratories often must be corrected for other fungi. Detection of C. auris requires reliable sampling procedures from the most common sites of colonization, including the axillae and groin. Nares, external auditory canals, urine, rectum, catheter sites, and vagina also serve as colonization sites8. Making use of water and soaps or using a hand sanitizer with a 60% alcohol content is effective in preventing infection. Health care workers should take proper precautions to use gowns and gloves in the hospital setting. Regular disinfection and cleaning of surfaces prevent the survival of C. auris. When referring a patient with C. auris, the health care facility on the receiving end should be informed of the patient’s infection or colonization status to take appropriate measures promptly9. The steadily rising incidence of C. auris outbreaks poses a significant public health threat. C. auris outbreaks are a challenge to control due to poor routine diagnostic detection, prompt transmission, and resistance to disinfection techniques. It is now a leading cause of fungal infections in many medical setups with high mortality rates. Rapid detection methods that provide reliable identification and diagnosis, as well as control measures and necessary precautions, will help contain the spread of C. auris in health care systems. Ethical approval None. Consent for publication None. Sources of funding None. Author contributions The conceptualization was done by H.F. and H.S.R. The literature and drafting of the manuscript were conducted by H.F., A.M.S., F.R., and B.S.R. The editing and supervision were performed by H.S.R. All authors have read and agreed to the final version of the manuscript. Conflict of interest disclosures The authors declare that they have no financial conflict of interest with regard to the content of this report. Research registration unique identifying number (UIN) Not applicable. Guarantor All authors take responsibility for the work, access to data and decision to publish. Provenancer and Peer review Not commissioned, externally peer reviewed.

The first case of Echinococcus canadensis found in a moose in Norway: What does it entail?

The first case of Echinococcus canadensis found in a moose in Norway: What does it entail?

Psilocybin therapy: A novel approach to treating depression

Psilocybin therapy: A novel approach to treating depression

Pivotal role of CHWs in prevention, early detection and control of outbreaks: neglected key primary players; a call to action

Pivotal role of CHWs in prevention, early detection and control of outbreaks: neglected key primary players; a call to action

Alarming case of avian influenza A (H5) in humans: call for urgent action in Ecuador

Alarming case of avian influenza A (H5) in humans: call for urgent action in Ecuador

Poster 302: The Influence of Industry Affiliation on PRP Randomized Controlled Trials

Objectives: Industry funding and corporate sponsorship have played a significant role in the advancement of medical research and technology. However, this relationship raises concerns of how industry association may bias research findings and influence perception of results. As novel therapies continue to emerge, it is necessary to evaluate the literature for reliable and evidence-based clinical research before implementing these therapies into practice. The purpose of this study was to determine whether industry affiliation plays a role in the outcome of randomized controlled trial (RCT) studies investigating platelet-rich plasma (PRP) versus hyaluronic acid (HA), corticosteroids (CS), or placebo for knee osteoarthritis (OA). Methods: A search of the PubMed, Cochrane, and MEDLINE databases for RCTs of Level 1 or 2 evidence published from 2011 to present comparing PRP versus HA, CS or placebo for the treatment of knee OA was performed by two independent reviewers. To determine industry affiliation, the conflicts of interest, funding and disclosure segments of publications were assessed and all authors were reviewed through the AAOS Disclosure and Open Payments databases. Industry affiliation by financial conflicts of interest were identified as license or royalty fees, paid consultant fees, advisory position or speaker, employee, stock options, or research funding from companies that synthesize PRP or manufacture devices to administer PRP. Studies were classified as industry affiliated (IA) or non-industry affiliated (NIA). The outcomes of each study were rated as favorable, analogous, or unfavorable according to predefined criteria based on previously published protocols and also statistical significance by comparing patient reported outcome measures. Favorable studies showed superior results, analogous studies demonstrated no significant difference, and unfavorable studies had inferior outcomes when comparing PRP to HA, CS or placebo. Results: A total of 37 (6 IA and 31 NIA) studies were available for analysis. All studies were of level 1 (67.6%) or level 2 (32.4%) evidence, with no statistically significant difference between IA and NIA studies (p = 0.4443). Nineteen (51.4%) studies reported PRP as favorable compared to other treatments, while 18 (48.6%) studies showed no significant differences between PRP and other treatments. No studies showed worse outcomes with PRP compared to HA, CS, or placebo. There was no significant difference in qualitative conclusions between the IA and NIA cohorts, with the IA cohort having 3 favorable studies and 3 analogous studies, while the NIA group included 16 favorable studies and 15 analogous studies (p = 0.8881). When comparing IA versus NIA studies, using 6 and 12-month WOMAC and IKDC scores, there were no significant differences in outcome measures. Conclusions: The results of this study demonstrate largely favorable and analogous results with PRP compared to other intra-articular injection therapies for knee OA in randomized controlled trial studies. Qualitative conclusions and outcome scores were found to not be associated with industry affiliation. Although the results of this study suggest there is no influence of industry association on RCTs involving PRP, it is still necessary to carefully evaluate pertinent corporate affiliations in published literature. [Table: see text][Table: see text][Table: see text]

Equatorial Guinea on a very high alert as Marburg virus spreads: an urgent rising concern

The filoviridae family of viruses, which comprises the more well-known Ebola virus, also includes the Marburg virus (MARV). An African fruit bat is thought to harbor the virus, where following laboratory workers in Frankfurt, Germany, Marburg, Germany, and Belgrade, Yugoslavia (now Serbia), contracted the MARV leading to its initial identification in 1967. Humans may contract the virus and exhibit the syndrome, as can other primates1. Notwithstanding disagreements on the origin, the majority of the evidence refers to Uganda2. In addition to the Democratic Republic of the Congo, Angola, Uganda, the United States, Guinea, Uganda, and Ghana, outbreaks have also been documented in South Africa, Kenya, and Angola since 1967. Equatorial Guinea only recently confirmed its first MARV epidemic outbreak on February 13, 20231. Humans may contract the virus through direct contact with infected individuals alongside bat saliva, urine, or excrement. Contact with said infected animals, such as primates, may also cause human infection3. Hy viral transmission with blood, saliva, or other bodily fluids of the infected individual, the virus may disseminate within populations. Possessing a mortality rate of ~90%, the MARV infection has symptoms that are comparable to those of other viral hemorrhagic fevers, resulting in major bleeding, shock, organ failure, and death3. There are presently no clinically authorized treatments or vaccines to prevent or treat MARV disease, respectively. Palliation is occasionally considered when conservative measures have failed3. The current Marburg virus outbreak in Equatorial Guinea and efforts to curb the virus The deaths are said to have occurred between January 7 and February 7. Moreover, as of 13 February 2023, there are 16 suspected cases of Marburg virus disease (MVD) in Equatorial Guinea4. Meanwhile, 2 potential Marburg disease cases were discovered on Monday in Olamze, a commune near the Equatorial Guinea border, by Cameroonian authorities5. In response, WHO convened the MARV vaccine consortium to evaluate several potential vaccine candidates. Also, the WHO is collaborating with the government of Equatorial Guinea to provide rapid emergency response services and has deployed experts to assist with MARV epidemiology, case management, infection prevention, laboratory, and risk communication4. Recommendations Equatorial Guinea took more than a month to announce an outbreak after the reported date of the first mortality caused by the MARV. This highlights a need for rapid diagnosis and a capacity limitation in public health. The western part of Equatorial Guinea needs immediate action to bolster its monitoring system and limit additional virus transmission through contact tracing. In addition, as there are 2 probable cases in Cameroon, immediate action must be enforced to halt the local dissemination of the virus. Further, providing guidance to medical personnel concerning case management alongside access to appropriate diagnostic testing will further dissipate viral transmission. We must reinforce the paramount importance of Personal Protective equipment in health care professionals as is essential for limiting viral spread. The MARV vaccine needs to be developed, and antivirals specific to the virus need to be produced as quickly as possible. To conclude, the government’s efforts towards making sure the public has access to timely, reliable information about the virus should be strengthened, at the same time it would also be beneficial for the global community to launch campaigns to raise public knowledge about the MARV globally through the mass and social medias. Ethical approval None. Sources of funding None. Author contribution None. Conflict of interest disclosures The authors declare that they have no financial conflict of interest with regard to the content of this report. Research registration unique identifying number (UIN) None. Guarantor None.

CRISPR gene technology—the next best thing in medicine

CRISPR gene technology—the next best thing in medicine

Carica papaya extract: a new leaf in treating dengue?

Carica papaya extract: a new leaf in treating dengue?

Marburg virus: a potential outbreak on the horizon?

Marburg virus: a potential outbreak on the horizon?

Need for stable quality control and drug pharmacopeia in African pharmaceutical settings: a new way to independent drug production

For years now, Africa are on the verge of a shortage of drug production1,2, quality control of traditional/indigenous plants, and imported drugs due to limited stable pharmacopeia availability specifically for African herbs, drugs, and plants. Therefore, we write this piece to raise and put African Union stakeholders into action to see the need to have a stable quality control drug pharmacopeia in Africa. In the course of advancing sustainable drug discovery and development, many countries are making indelible efforts through the implementation of policies regulating medicines. Pharmacopoeia is a reverenced compendium of regulations and official standards for the qualitative and quantitative compositions of medicines and manufacturing of drugs3. Unlike the British Pharmacopoeia (BP), United States Pharmacopoeia (USP), and European Pharmacopoeia (Ph. Eur.), the African Union (AU) has 2 pharmacopeias: the African Pharmacopoeia (169 traditional plants) and African Herbal Pharmacopoeia (51 traditional plants), which have detailed botanical description of medicinal plants and quality control protocols of traditional medicines that should be followed for chemical analysis and medicinal development of the selected African traditional plants4,5. However, this pharmacopeia does not have regulations and official standards for the quality and quantitative composition of other unlisted indigenous plants and imported drugs for quality control analysis in African settings. The limitations of the indigenous continental monograph silently promote the deindustrialization of pharmaceutical manufacturing and productivity in Africa. Lack of indigenous regulatory compendial influences poor manufacturing practice and inappropriate processes in the supply chain that support substandard and falsified medicines in many low-middle incomes countries in Africa6. The AU Commission and other indigenous pharma experts should take the lead and actions toward the development of full standard pharmacopeia for all indigenous/traditional plants to promote pharma industrialization and improve standardization of quality medicine7, and quality control of drug composition and traditional medicine in Africa, and for Africans without compromising on international standards. A collative review of the USP, Ph. Eur., and BP can provide the right direction for a start to look inward as Africans to provide a working draft that could advance the frontiers of good manufacturing practice, quality controls, proper marketing authorization and appropriate supply chain of medicines and herbal products in the AU. Regular training for experts or professionals would support the drive and sustainability of these regulations to help the government and other competent authorities in various African countries. Ethical approval None. Sources of funding None. Author contribution V.N.N.: conceptualized the study. V.N.N., A.T.A., and F.A.A.: draft manuscript, review editing, formatting, and referencing. Conflict of interest disclosure The authors declare that they have no financial conflict of interest with regard to the content of this report. Research registration unique identifying number (UIN) N/A. Guarantor Victor N. Nweze. Provenance and peer review Not commissioned, externally peer reviewed.