Financial Conflicts Of Interest Research Articles

Botulinum toxin as a promising surgical strategy for chronic anal fissure: do the dose and injection site matter? Comparison of doses and injection sites of botulinum toxin for chronic anal fissure: A systematic review and network meta-analysis of randomized controlled trials

Chronic anal fissure (CAF) often shows a considerable reluctance to heal for the hypertonia and spasm of the internal sphincter. CAF pain is very intense and sharp and always described as tearing, knife-cut or passing broken glass. Lateral internal sphincterotomy remains the preferred treatment modality of all surgical options with high healing rates ranging from 88 to 100%, followed by incontinence rates ranging from 8 to 30% which can have a significant impact on a person’s quality of life.1 Botulinum toxin (BT) has been widely used in the treatment of CAF due to its ability to promote healing and lower risk of incontinence. However, there is still no consensus on the BT dose and injection site which are associated with the curative effect. Vitoopinyoparb et al.2 performed a systematic review and network meta-analysis of randomized controlled trials and identified that low-dose (≤20 U) BT was optimal, and injection out of the fissure site improved short-term outcomes while injection each side of the fissure site tended to reduce recurrence in the long run. It is of great interest to provide a relatively standard protocol to guide anorectal surgeons in the management of BT. BT, as a temporary chemical sphincterotomy, can lead to the blockade of acetylcholine release and cause short-term paralysis of internal sphincter muscle to reduce the anal tone. Based on our clinical experience, the higher the BT dose (within 100 U in general), the higher the healing rate of CAF. According to the survey conducted by the American Society of Colon and Rectal Surgeons, dose above 50 U of BT appeared to correlate with higher success rate and healing rate.3 Maria et al.4 has confirmed that higher doses can improve the healing rate without increasing complications or side effects. However, a meta-analysis including 18 clinical trials concluded that the healing rate decreased with the increase of the BT dose (P=0.048), but the incontinence rate (P=0.048) and recurrence rate (P=0.002) increased slightly with the increase of the BT dose5. Another meta-analysis involving 1577 patients from 34 prospective studies showed that the healing rates ranged from 33 to 96% the BT with the reported BT doses ranging from 5 to 150 IU across the analyzed studies. However, there was no correlation between postoperative healing rate and BT dose (P=0.0708), and the rates of postoperative complications and fecal incontinence were not found to be in a dose-dependent manner.6 Conflicts over BT dose selection often cause confusion among anorectal surgeons. In this network meta-analysis, Vitoopinyoparb and colleagues found that low-dose (≤20 U) BT was optimal based on 27 randomized controlled trials, providing high-level evidence on this regard. Based on the existing knowledge, most studies recommend injecting BT into internal sphincter in three or four quadrants around the anal canal. We also believe that BT should be injected into the internal sphincter because the fundamental pathogenic is hypertonia and spasm of the internal sphincter in CAF. As Brisinda et al.4 said, the internal sphincter is readily visible and easier to inject than the external sphincter. To improve the healing rate, we usually inject the BT both outside the fissure and on each side of the fissure. A study which included 50 CAF patients showed that injections on both sides of the anterior midline were more effective than those on the posterior midline.7 In this study, the short-term healing rate of external injection was better than that of both sides of the fissure, while the long-term recurrence and incontinence of bilateral injection were less.1 In general, we believe these results of this study have high value for clinical application, and large multicenter randomized controlled studies should be advocated to further confirm the findings. Ethical approval Not applicable. Sources of funding This study is funded by the Shenkang Clinical Three-Year Action Plan (major research) (grant no. SHDC2020CR2007A), and the National Natural Science Foundation of China (81774112). Authors’ contribution H.X.: design and write the commentary. W.Y.: review the commentary. Z.M.: design, review, and revise the commentary. 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) None. Guarantors Zubing Mei, Hao Xu.

Marburg virus disease outbreak amid COVID-19 pandemic: an emerging concern in Ghana, West Africa.

Marburg virus disease outbreak amid COVID-19 pandemic: an emerging concern in Ghana, West Africa.

Newly outbreak of Nipah virus: epidemiology, symptoms, transmission, diagnostic testing, treatment, and global health concern

Newly outbreak of Nipah virus: epidemiology, symptoms, transmission, diagnostic testing, treatment, and global health concern

Tomato flu outbreak in India: a need for precautionary measures in dental treatment.

Dear Editor, As of 21 August 2022, India has recorded 82 cases of Tomato flu (TF) in youngsters under the age of 5 and 26 cases in children aged below 10. This has alerted people all around the world to the possibility of a fresh epidemic in India. It may be a complication of childhood dengue or chikungunya fever rather than a viral infection1. It may be a novel strain of the viral hand, foot, and mouth disease caused by Coxsackie virus2,3. Children are primarily vulnerable since viral infections are common in them; but, if they are not treated and avoided, they may also have harmful consequences on adults4. The TF is very contagious, much like other influenza types. Close touch is the most probable means of transmission. Its primary signs and symptoms resemble those of chikungunya, including high fever, rashes, and agonizing joint pain. The painful, red blisters that spread widely and finally grew to the size of tomatoes gave the disease its name. These blisters resemble those that patients who have the monkeypox virus experience. Additional symptoms and indicators include fatigue, nausea, vomiting, diarrhea, fever, dehydration, joint swelling, and body aches, which are comparable to those of other viral infections. In addition, these symptoms are similar to those of other viral illnesses including dengue4,5. Five to 7 days after the onset of symptoms, confinement must be utilized to stop the virus from spreading. The best preventative strategy involves practicing excellent hygiene, sanitizing the nearby area, and preventing the sick child from exchanging items with other kids who are well. Drug repurposing and vaccination are the most effective and economical ways to protect the general populace against viral infections, especially in children, the elderly, and those with compromised immune systems. There are currently no antiviral drugs or vaccinations that can be used to treat or prevent TF. To better comprehend the morphology of the virus and possible therapeutic options, long-term follow-up is required6. Dental treatment in patients with TF can be very challenging. This infection can start as a rash or blister in perioral and oral mucosa also, in which cases the role of dentists in identifying this in their differential diagnoses and guiding the patients to appropriate medical care becomes paramount. Active dental treatment including endodontic, periodontic, prosthodontic, and restorative procedures should be deferred until complete recovery. However, emergency extraction procedures should be carried out with total personal protection equipment. Biomedical waste and tissues should be properly discarded by protected incineration. Antibiotics and analgesics can be prescribed to manage pain. Patients should be instructed to practice meticulous oral hygiene with individual toothbrushes. These toothbrushes should be discarded immediately after recovery from TF illness. In India, with 70% population distributed in the rural areas with dental clinics of less stringent practices followed, the spread of TF is largely expected. Therefore, a proper guidelines is essential to curb its transmission. To enlighten clinicians, medical personnel’s and other hospital staff’s readers further, we share a few more additional suggestions that are followed at our dental clinic. It’s crucial to use protective gear, such as personal protective equipment and N95 respirators while working with procedures that create aerosols. Restricting the use of tower fans, air blowers, and air conditioners in hospitals. Reducing the number of outpatient visits by giving high priority to patients who need urgent care, such as trauma patients. Instead of communal treatment space, patients who require treatments should get them in a private setting. Patients with suspected or confirmed TF should postpone elective dental operations until they are no longer infectious. Limited contact with all tools and supplies used to treat TF patients. Equipment used in patient care must be adequately sterilized. Overall, restraining the spread of TF in outpatient and trauma units, maintaining regular surgical volumes, and providing treatment to all patients regardless of health should be the key healthcare objectives. Ethical approval None. Sources of funding None. Authors’ contribution All authors devised the concept, performed the literature search, and drafted the letter. 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) None. Guarantor None. Data Statement None.

Amid COVID-19 and monkeypox: tomato flu outbreak in India

Amid COVID-19 and monkeypox: tomato flu outbreak in India

An update on current understanding of the epidemiology and management of the re-emerging endemic Lassa fever outbreaks

An update on current understanding of the epidemiology and management of the re-emerging endemic Lassa fever outbreaks

Applications of machine learning for coronary artery bypass grafting: correspondence.

Highlights The current data have shown a promising capacity for using machine learning (ML) in cardiac surgical procedures and care, especially in coronary artery bypass grafting (CABG) surgery. ML can be used as a platform to develop artificial intelligence-based tools with proper efficiency for other similar surgeries. According to present technology, the development of a prospective concept faces a significant technical challenge. To clarify the future direction of using ML in CABG, further studies are required to evaluate ML accuracy in CABG surgical diagnostic and therapeutic approaches. Dear Editor, Coronary artery bypass grafting (CABG) is a typical surgical procedure for treating coronary heart disease by using autologous arteries or veins as grafts to bypass coronary arteries partially or wholly obstructed by atherosclerotic plaque1. In this regard, many approaches were developed to improve the efficiency of the surgical procedure. However, machine learning (ML), as a part of the development of artificial intelligence, has emerged as a methodological approach that might be useful in assessing CABG risk and successes. Also, ML can be used to learn from data iteratively and identify patterns while minimizing human intervention and user input bias during or after the surgical procedure2. In the current study, by searching PubMed and Scopus databases, the studies that included using ML for CABG surgery were obtained, involving 23 studies. Then, the ML algorithm and assessment criteria were statistically analyzed using ‘the R programming language’ under the ggsankey, ggplot2, dplyr, and readxl libraries. According to the extracted data, the first application of ML in CABG surgery refers to 2016, and most of the studies were conducted in 2022. Also, the ‘R’ statistical analysis revealed that the ‘XGBoost’ algorithm of ML is regarded as the most used algorithm among achieved studies. In addition, the prediction of CABG surgery survival and outcome is the most targeted task of the ML tool (Fig. 1).Figure 1: Conceptual diagram of using machine learning in coronary artery bypass grafting powered by ‘R’. ANN, artificial neural network; C4.5, decision tree algorithm; EML, ensemble machine learning; GBM, gradient-boosting machine; KNN, k-means clustering; LOS, length of stay; LR, logistic regression; RF, random forest; SHC, stochastic hill-climbing; SVM, support vector machine; XGBoost, extreme gradient boosting.Extreme gradient boosting (XGBoost) is widely used to obtain state-of-the-art results in diverse fields with acceptable accuracy3. According to clinical studies, the XGBoost algorithm a has fast calculation speed and wide application in clinical data. With the assistance of the XGBoost algorithm, complex and diverse medical data can be processed to meet the requirements of timeliness and accuracy of assisted diagnosis4. In light of the obtained data, XGBoost can be regarded as a robust algorithm for managing and predicting CABG postoperative survival, outcomes, expenditures, and major bleeding. However, the current data revealed that the XGBoost was not used to predict criteria such as myocardial function, length of stay, or prognostic evaluations. However, the current data revealed that the XGBoost was not used to predict criteria such as myocardial function and length of stay; accordingly, the XGBoost may be considered a promising algorithm for evaluating and predicting the criteria. On the other hand, prognostic evaluations of CABG postoperatively were recognized as an emerging target for using ML in recent years. Despite their importance, capable algorithms such as XGBoost have not met prognostic criteria yet. Therefore, the postoperative prognostic evaluation can be regarded as an acceptable target for ML-related prediction tools based on algorithms such as XGBoost. In sum, the current data have shown a promising capacity for using ML in cardiac surgical procedures and care, especially in CABG surgery. In addition, ML can be used as a platform to develop artificial intelligence-based tools with proper efficiency for other similar surgeries; however, according to the present technology, the development of a prospective concept faces a significant technical challenge5. Finally, to clarify the future direction of using ML in CABG, further studies are required to evaluate ML accuracy in CABG surgical diagnostic and therapeutic approaches. Ethical approval This study is a type of correspondence. This article does not require any human or animal subjects to acquire such approval. Sources of funding No funding. Author contribution All authors involved in conceptualization, data curation, writing – original draft preparation, writing – reviewing and editing, visualization, supervision. 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) This study is a type of correspondence and does not include human participants. 1. Name of the registry: not applicable. 2. Unique identifying number or registration ID: not applicable. 3. Hyperlink to your specific registration (must be publicly accessible and will be checked): not applicable. Guarantor Samad Karkhah. Data statement All data are available in the manuscript. Provenance and peer review Not commissioned, internally peer-reviewed.

Usutu virus: a Flavivirus on the rise amid COVID-19 and monkeypox

Usutu virus: a Flavivirus on the rise amid COVID-19 and monkeypox

The ongoing surge of dengue amidst a multidemic era in Pakistan

Dengue fever has been one of the unresolved problems around the globe since the 1950s. Recently, it has become endemic in more than 100 countries, resulting in more than 390 million cases causing up to 36,000 deaths annually around the globe. About half of the world’s population is at risk due to the sharp increase in dengue incidence worldwide1. The causative agent of this disease is a virus belonging to a family of Flaviviridae (single-strand RNA viruses), transmitted by the female Aedes mosquito that breeds in water. The disease is more common in humid, rainy climates, with stagnant water, and crowded urban populations. It has 4 serotypes (DENV-1, DENV-2, DENV-3, DENV-4), and 1 or more serotypes can cause this illness. However, infection with any serotype will give lifelong immunity to that particular serotype2. Every year, Pakistan faces the dengue surge mostly in or after the heavy monsoon, from July to October. Dengue virus (DENV) has been endemic since 2011 throughout the country and has caused many deaths during the last decade. The disease has significantly expanded during the last few years in the country, reporting 22,938 cases in 2017 and 48,906 cases in 20213. This year monsoon rains in Pakistan were catastrophic due to a lack of proper infrastructure, and a substandard health care system. Currently, Pakistan is facing yet another surge in dengue cases along with various other infectious diseases secondary to flood catastrophes. The stagnant and contaminated flood water in the country is flourishing the vector activity4. The infected patients present with high-grade fever, vomiting, headache, body pain, and rashes. These patients are often misdiagnosed due to some similar other common illnesses like malaria and Coronavirus Disease 2019 (COVID-19)1,5. In addition, the ongoing COVID-19 pandemic is resulting in a divergence of attention6. According to the latest reports, Pakistan in 2022 has reported 7951 cases in Sindh, 4921 in Punjab, 6625 in Khyber Pakhtunkhwa, and 1991 cases in the national capital Islamabad with peak cases reported in September alone. More than 75% of the patients presenting to the hospital are reported to have dengue7. In addition, the disease is putting an enormous economic burden on patients being treated in government setups, nearing 10,000 tks (22,864 pkr) ~US$94, too high for a low-middle income country like Pakistan, where the minimum wage is as less as US$103 as of 20228. Also, a few reports on a general public survey stated that people are trying to cure their dengue illness with papaya leaves, which often worsens the disease as papaya leaves cause diarrhea9. Although it is a difficult time for Pakistan to handle this multidemic era and catastrophic conditions due to floods. With World Health Organization (WHO) aid, the Pakistan government and health authorities should implement strategic and effective measures to counter this dengue surge. Various preventive measures for dengue prevention, that is, removing stagnant water from ponds and lakes, application of spray for killing the mosquito larvae, providing mosquito nets to the general public, and availability of common medicines. Also, community education and awareness on vector control interventions like maintaining proper living hygiene, and the use of repellents are strongly recommended. Ethical approval None. Sources of funding None. Author contributions Sidhant O.: conceptualization and literature search. Sidhant O., Simaran O. A.O., and K.O.: wrote the manuscript. Sidhant O., A.A., and K.U.: review the editing. A.A.: formatting and referencing. 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 Sidhant Ochani.

Human Monkey pox virus in Democratic Republic of the Congo: a potential health threat?

Human Monkey pox virus in Democratic Republic of the Congo: a potential health threat?

The main recommendations to fight human infections caused by avian influenza A (H5) and the way forward in Ecuador

Dear Editor, Influenza viruses are one of the viruses of public health importance because of their propensity of causing epidemics and pandemics. Waterfowls have been shown to be the main natural reservoirs of influenza viruses and humans, as the hosts are often infected with avian influenza viruses such as avian influenza A (H5)1. Last year, November 30, 2022, the health authorities of Ecuador declared a health emergency of 3 months outbreak of avian influenza A (H5) virus in their country, and an epidemiological alert in December 2022 was indicated after the detection of an outbreak of avian flu in poultry farms in the Andean province of Cotopaxi, Ecuador. This outbreak has extended to January 2023, thus prompting them to inform the World Health Organization about the scourge of avian influenza A H5 infection. They reported a case of human infection with avian influenza A (H5) in a 9-year-old girl from a rural area in Ecuador on January 9, 2023. So far, this is the first case of human infection caused by the avian influenza A (H5) virus reported in Ecuador but also in Latin America. This case of human infection has been linked to exposure to poultry animals2. Human cases of infection with avian influenza viruses are usually the result of exposure to life or dead infected poultry as well as contaminated environments3. Currently, bird flu is an incurable disease without treatment. At this stage, there is in fact no sufficiently effective vaccine with marketing authorization2. Hence, posing more public health challenges to the Ecuadorian communities and the world at large. The public health measures such as; health education about the signs and symptoms of avian influenza virus A (H5), good hand hygiene practices, good food handling, etc., should be well implemented at both the rural and urban centres in Ecuador. Emergency preparedness, surveillances and disease control strategies should be closely observed to avoid further infections of avian influenza A H5 and a pandemic that may arise. Also, at each entry and exit points in the country, surveillance, and control strategies should be imposed among travelers as well as restrictions on commercial travel. Also, rapid detection of infection should be done immediately there is a suspected case of avian influenza A H5 in the country. Travelers should avoid contact with animals in markets and should also avoid frequenting places or places that appear to be contaminated with animal faeces. Travelers should strictly adhere and comply to barrier measures, such as; washing their hands often with soap and water or with hydroalcoholic solutions, covering their mouth and nose, avoiding touching their eyes frequently. They should also practice good food safety and personal hygiene measures. These measures would serve to preventing a future pandemic or even an epidemic of avian influenza A (H5). Finally, the Government of Ecuador through its Ministry of Public Health in collaboration and in partnership with the World Health Organization (WHO) and the Centre for Disease Control (CDC) as well as the Food and Agriculture Organization (FAO) should put more efforts in strengthening the health facilities and equipments in Ecuador. Such facilities would include; mobile clinics, diagnosis for rapid detection of infection for a close surveillance of avian influenza in the country. Ethical approval None. Sources of funding None. Author contribution A.A.: conceptualization of ideas and manuscript preparation. A.A., M.O.O., C.B., H.C., J.O., K.L., H.E., F.K.: writing. M.O.O.: supervision; review and comments; and data curation. 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) None. Guarantor Aymar Akilimali. Provenance and peer review Not commissioned, externally peer reviewed.

Nanomaterials based on chitosan for skin regeneration: an update.

Nanomaterials based on chitosan for skin regeneration: an update.

Recent outbreak of zika virus in India amid ongoing COVID-19 and monkeypox outbreak: A call for action.

Recent outbreak of zika virus in India amid ongoing COVID-19 and monkeypox outbreak: A call for action.

Therapeutic potential of Carica papaya leaf extract for the treatment of dengue

To the Editor, The acute infectious illness dengue is spread by mosquitoes and has a high death and morbidity rate affecting people of all ages and is spread by mosquito bites, most frequently by the Aedes aegypti and Aedes albopictus species1. In Asia, dengue is currently the top cause of hospitalization and fatalities among individuals, and about 70% of dengue illness cases worldwide are found in Asia2. Historically in Pakistan alone, dengue has been identified as a significant public health issue with several outbreaks reported in 2010, 2017, 2019, and 2020. In 2022, between January 1 and September 27, Pakistan has once again seen a resurgence of dengue with a total of 25,932 confirmed cases and 62 fatalities3. The treatment of dengue involves supportive care with increased fluid intake and antipyretics. However, with the increasing burden of dengue on hospitals in Pakistan, people have transitioned to seek other remedies such as papaya leaves, goat milk, guava, and neem tree leaves4. There has been a dramatic rise in demand for papaya leaf juice across Pakistan because of the recent dengue outbreak. The community quickly adopted the use of papaya in the treatment of dengue because of its perceived positive impact on the platelet count in the opinion articles, news stories, and blogs that have begun to appear in print, social media, and national media4. Despite the lack of specialized medication, papaya leaf extract (PLE) is a natural remedy for dengue. Patients who drink plant juice frequently report fewer symptoms of dengue fever and improved general health. The primary active compound in PLE that contributes to the anti-thrombocytopenic action and increases the patient’s blood platelet count is carpaine5. Numerous studies that have been published have found a connection between platelet count and the prognosis of dengue6. Furthermore, papaya leaf extract can boost the immune system and lower inflammation7. According to a meta-analysis, a viable option for raising the platelet count in dengue patients was Carica papaya leaf extract8. However, patient mortality, safety parameters, and side effects were not taken into consideration in this study which leaves doubts about implementing it into actual clinical practice. Even though these studies show that PLE has anti-thrombocytopenic capabilities, it is still unclear how effective PLE is at treating dengue symptoms. Results from another investigation showed that rats’ liver and reproductive systems were negatively impacted by papaya aqueous extract9. In another research, adult male rats’ sperm counts, sperm viability, and testosterone levels all significantly decreased. In addition, female rats also showed infertility issues along with an increase in maternal mortality10. Although the aforementioned trials used animals, it is still necessary to conduct descriptive studies to identify and assess the chemical components of the leaves, their concentrations, and their toxic side effects to properly utilize papaya plant parts and to commercialize the appropriate products for nutraceutical uses. Although papaya leaf has effective anti-thrombocytopenic properties, people using it may experience nausea and vomiting. Furthermore, the usage of papaya or its leaves does not benefit dengue patients in any way and can instead lead to diarrhea11. Given that dengue patients already require enough fluids, this might be fatal. Patients who lose excessive fluid risk developing hypovolemic shock. Multiorgan failure, disseminated intravascular coagulopathy, and gastrointestinal bleeding are also risks of protracted shock12. Considering the negative effects of PLE on patients suffering from dengue, it should be contraindicated to use papaya leaf to reduce death and morbidity. In conclusion, until descriptive research and clinical trials are carried out to ascertain its treatment effectiveness, the use of PLE for treating dengue symptoms in patients with dengue fever must be contraindicated. Insecticide-treated textiles, the use of mosquito repellent coils, the use of bed nets while in bed even during the day, and the development of the habit of wearing full-sleeve shirts and pants must all be encouraged. The general public must be informed and warned about the dangers and possible side effects of using papaya leaves during dengue fever. Ethical approval None. Sources funding None. Author contribution A.N. was involved in the study concept, the collection of the data, drafting, literature review, data validation, supervision, and editing of the manuscript. R.T. was responsible for the literature review and revising the manuscript for important intellectual content. 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. Clinical trial registration None. Data availability statement None. Patient consent statement None.

Wastewater surveillance as an epidemiological tool at mass gathering events: A FIFA World Cup Qatar 2022 perspective and implication to other mass gathering events.

Dear Editor, The ongoing FIFA World Cup 2022 hosted by Qatar is one of the most popular and largest international mass gathering (MG) sports events in the world1. Genomic investigations over the past year have revealed cryptic, ominous transmission of severe acute respiratory syndrome coronavirus 2, monkeypox, poliovirus, influenza, and antibiotic-resistant microbes at MG events. Qatar’s public health authorities have spent a lot of time and effort preparing and planning to ensure the health and safety of millions of international and national spectators, athletes, and organizers. However, there are still several major public health challenges, both perceived and real, that threaten global health security. The FIFA World Cup in 2022 is taking place during the ongoing global outbreaks of coronavirus disease 2019, monkeypox, antibiotic-resistant bacteria, influenza, respiratory syncytial virus, and drug-resistant tuberculosis, among others. Recently, a new hybrid virus formed from fusion of influenza A and respiratory syncytial virus is a worrying development2. Therefore, the risk of transmission of infectious diseases, amplification, and local and international spread of known and unknown pathogens during and after the FIFA World Cup remains significant. Historically, pathogens transmitted by the waterborne and fecal-oral routes have been evaluated through wastewater-based surveillance (WBS)3. Wastewater surveillance is more sensitive and cost-effective than clinical or epidemiological surveillance4. WBS was used in the polio eradication effort and has most recently been used for tracking the spread of severe acute respiratory syndrome coronavirus 2 and its variants2. In particular, there is no consensus on wastewater monitoring techniques and standardized global protocols for collecting and analyzing data4. There remains an urgent need to develop a global consensus for standardized global guidelines for sampling methods, sample pretreatment, and quantification, which is very practical at these times. WBS for pre-empting potential disease outbreaks could provide crucial information when used together with rapid detection laboratory techniques such as genomics and biosensors5,6. Early detection of disease outbreaks during MG events provides host countries with unique opportunities to develop evidence-based decisions for timely scientific-based public health interventions. Since a sample of wastewater reflects the entire contributing population, wastewater-based epidemiology can be used to learn about the spread of gastrointestinal and other viruses at the community level without the need to test many people7. Independent of the appearance of clinical symptoms or socioeconomic biases related to case reporting, WBS has been shown to be effective in detecting infection and transmission in the population. Adopting wastewater surveillance for infectious diseases during the FIFA World Cup 2022 and other future MG events could serve as an important tool to early alert the host country and global public health authorities (Fig. 1). Movements of attendees of MG events across Qatari municipalities should be wastewater-based epidemiology-based decisions, and consequent vaccination, countermeasures, and nonpharmaceutical interventions could be required. The wastewater-based epidemiology enabled Qatar officials to conduct a health survey during tournament days at a community level. Furthermore, it would give other countries an indication of potential pathogens being brought in by returning travelers8. WBS provides a powerful platform for detecting emerging and re-emerging viruses, antimicrobial resistance pathogens, and antimicrobial resistance genes. Its potential to alert host countries and global health authorities to imminent or emerging waterborne disease will add further to preparedness and proactive prevention control plans in place. Ultimately, this perspective is novel for MGs in the midst of mega sporting events, which should be further studied and considered.Figure 1: Wastewater surveillance as an epidemiological tool amidst the mega sporting events.Ethical approval Not applicable. Sources of funding None. Authors contribution A.R.A.S., A.A.M., P.C., and O.P.C. developed the original draft; A.M., B.K.P., and R.S. reviewed and edited the manuscript. All authors read and approved the final manuscript. Conflict of interest 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 R. Sah.

Emerging and re-emerging viral diseases, predisposing risk factors, and implications of international travel: a call for action for increasing vigilance and imposing restrictions under the current threats of recently emerging multiple Omicron subvariants.

Emerging and re-emerging viral diseases, predisposing risk factors, and implications of international travel: a call for action for increasing vigilance and imposing restrictions under the current threats of recently emerging multiple Omicron subvariants.

African care for congenital central nervous system disorders: Falling far short of global management standards?

African care for congenital central nervous system disorders: Falling far short of global management standards?

Hepatitis in India: challenges, efforts, and recommendations

Hepatitis in India: challenges, efforts, and recommendations

Multicountry cholera outbreak alert in Kenya: Current efforts and recommendations

Multicountry cholera outbreak alert in Kenya: Current efforts and recommendations

Bloom syndrome: an oral potentially malignant disorders aiding in malignancy vigour.

Bloom syndrome: an oral potentially malignant disorders aiding in malignancy vigour.