Health Security Threats Research Articles

Artemisia campestris L. as a promising source of potential antiviral drugs for SARS-CoV-2: Docking and dynamic simulation studies

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has been considered as global public health security threats. Due to its rapid spread, high mortality rate and unavailability of treatment, we need to find a potent drug against SARS-CoV-2. Natural products are useful agents for the discovery of new potential drugs to combat coronavirus. Artemisia campestris, an aromatic plant widely used in traditional medicine, particularly in southern region of Algeria, is recognized for its essential oils and phenolics compounds possessing a wide range of biological activities. This study selected sixty-nine compounds from this plant to determine their binding interactions with the SARS-CoV-2 main protease (Mpro) and receptor-binding domain of the spike (S-RBD) protein, by using computational methods. Rutin, isoquercetin, and quercetin-3-O-glucuronide were shown to be the most potent inhibitors for Mpro and S-RBD with docking scores and Ki values ranging from -16.06 to -10.67 Kcal/mol and 0.005 to 30.01 nM, respectively. Evaluation of ADMET pharmacokinetic properties and the drug likeness in silico revealed that only 3,5-dicaffeoylquinic acid, 3–4–5-tricaffeoylquinic acid, isorhamnetin-3-O-glucoside, and rubescensin A could be more effective drugs against COVID-19. Molecular dynamics (MD) simulations (100 ns) and MM-GBSA calculations confirmed the stability of ligand-protein complexes via hydrogen bonding interactions with crucial residues. The analysis of structural parameters (RMSD, RMSF, H-bonds, Rg, and SASA) indicates that 3,4,5-tricaffeoylquinic acid and rubescensin A compounds have good stability and significant binding affinity with the Mpro and S-RBD protein. Taken together, our findings confirm that Artemisia campestris as a plausible source of anti-SARS-COV-2 phytochemicals and suggest that may play important role in this activity.

Factors associated with COVID-19 vaccine hesitancy and uptake among populations in the West department of Haiti.

The COVID-19 pandemic in Haiti led to increased challenges for a population concurrently dealing with natural and social disasters, poor quality health care, lack of clean running water, and inadequate housing. In 2022, the population of Haiti was 11.4 million. While half a million vaccines for COVID-19 were donated by the United States to the government of Haiti, less than 5% of the population agreed to be vaccinated. This resulted in thousands of unused doses that were diverted to other countries. The purpose of this study was to evaluate population characteristics related to vaccine uptake in order to inform future interventions to improve COVID-19 vaccine uptake as well as inform strategies to safeguard against future global health security threats. This was a mixed-methods, cross-sectional study conducted in the West Department of Haiti within peri-urban communes. Participants consisted of adults in this setting responding to a survey from June 15 to July 18, 2022. The survey assessed demographic information, household characteristics, religious beliefs, past vaccine use, and current COVID-19 vaccine status. Multivariate regression modeling was conducted to assess predictors of vaccine hesitancy. Qualitative focus group discussion participants were recruited and focus group discussions were conducted between August-September 2022 among community groups, religious leaders and health professionals to provide additional, community-level context on perceptions of the COVID-19 pandemic and vaccines. A total of 1,923 respondents completed the survey; of which a majority were male (52.7%), between the age of 18-35 (58.5%), had a medical visit within the last year (63.0%) and received the COVID-19 vaccine (46.1%). Compared to those who had been COVID-19 vaccinated, participants who had not been vaccinated were more likely to be male (57.7% vs 46.8%, p < .0001), have completed secondary education (30.5% vs 16.6%, p < .001), unemployed (20.3% vs 7.3%, p < .0001) and had a medical visit 3 or more years ago (30.2% vs 11.2%, p < .0001). Unvaccinated COVID-19 participants were also more likely to have never received any other vaccine (36.1% vs22.5%, p < .0001), have a religious leader speak out against the vaccine (20.0% vs 13.1%, p < .0001), not believe in the effectiveness of the vaccine (51.2% vs 9.1%, p < .0001) and did not trust the healthcare worker administering the vaccine (35.2% vs 3.8%, p<0.0001). These results show that targeted interventions to religious leaders and health care workers on how to engage with the community and share clearer messages around the COVID-19 vaccination may result in increased vaccine uptake. Results also shed light on how activities surrounding vaccinations can be tailored to meet client needs addressing the misinformation encountered to achieve greater health impact thereby safeguarding the population against future global health security threats.

Preventing the re-establishment of malaria during the COVID-19 pandemic in Sri Lanka: implications for health security

BackgroundThe COVID-19 pandemic—with its first reported case in Sri Lanka in March 2020—had the potential to impact the risk of re-establishing malaria, a disease which was eliminated from Sri Lanka in 2012. Post-elimination, the country remains highly vulnerable to a return of malaria on account of high vector mosquito densities and the inflow of imported malaria cases.MethodsParallels between COVID-19 and malaria after its elimination as health security threats were drawn, and the many ways in which the COVID-19 pandemic impacted the prevention of re-establishment of malaria programmes in the country in 2020 were examined. The implications of this experience for global health security are analysed.ResultsIn 2020, imported malaria cases were fewer than in the previous 3 years, due to restrictions on international travel. Yet, a high level of malaria case and entomological surveillance was sustained through surveillance strategies modified to focus on quarantine centers, in response to the pandemic. As a result, more imported malaria cases were detected by active case detection than by passive surveillance. Some of the operational shifts adopted by the Anti Malaria Campaign were moving rapidly into functioning as an intersectoral player by reinforcing its collaborations with the Ministries of Aviation and Defense, switching to the use of online communication systems, and integrating and synergizing its field activities with the COVID-19 control programme.ConclusionsThe experience highlights the need for disease control programmes to be agile, flexible and responsive, and underscores the importance of maintaining even a lean focal programme for diseases such as malaria after they have been eliminated. Sustaining public health leadership and robust technological capacities in communication and data management were paramount in preventing the disruption of the malaria prevention programme during the pandemic and sustaining the malaria-free status of the country.

Nutritional Indices Predict All Cause Mortality in Patients with Multi-/Rifampicin-Drug Resistant Tuberculosis.

Multidrug- and rifampicin-resistant tuberculosis (MDR/RR-TB) with high mortality remains a public health crisis and health security threat. This study aimed to explore the predictive value of nutritional indices for all-cause mortality (ACM) in MDR/RR-TB patients. We retrospectively recruited MDR/RR-TB patients between January 2015 and December 2021, randomly assigning them to training and validation cohorts. Patients were divided into high nutritional risk groups (HNRGs) and low nutritional risk groups (LNRGs) based on the optimal cut-off value obtained from receiver operating characteristic (ROC) analyses of the hemoglobin-albumin-lymphocyte-platelet (HALP) score, prognostic nutritional index (PNI), and controlling nutritional status (CONUT) score. In the training cohort, Kaplan-Meier survival curves and Log rank tests were used to compare overall survival (OS) between the groups. Cox risk proportion regression analyses were used to explore the risk factors of ACM in patients with MDR/RR-TB. The predictive performance of ACM was assessed using area under the curve (AUC), sensitivity and specificity of ROC analyses. A total of 524 MDR/RR-TB patients, with 255 in the training cohort and 269 in the validation cohort, were included. Survival analyses in the training cohort revealed significantly lower OS in the HNRGs compared to the LNRGs. After adjusting for covariates, multivariate analysis identified low HALP score, low PNI and high CONUT score were independent risk factors for ACM in MDR/RR-TB patients. ROC analyses demonstrated good predictive performance for ACM with AUCs of 0.765, 0.783, 0.807, and 0.811 for HALP score, PNI, CONUT score, and their combination, respectively. Similar results were observed in the validation set. HALP score, PNI, and CONUT scores could effectively predict ACM in patients with MDR/RR-TB. Hence, routine screening for malnutrition should be given more attention in clinical practice to identify MDR/RR-TB patients at higher risk of mortality and provide them with nutritional support to reduce mortality.

Possible Outbreak of Newcastle Virus Infection in the Face of Increasing Trend of Backyard Poultry Farm Management Interface in Nigeria: A Public Health and Food Security Threat

Introduction: Newcastle disease is a highly contagious illness and one of the "notifiable illnesses" on the World Health Organization list for Animal Health (OIE) Outcome. There are constantly new cases being reported as new NDV isolates from around the world. Newcastle disease poses a significant global economic threat to the poultry sector, causing highly contagious and transmissible diseases in birds with huge food security threat among the weak and vulnerable developing and underdeveloped countries Aim: The aim of this article borders on bringing to light the risk of possible Newcastle disease outbreak in Nigeria due to increasing poor management of poultry farms and poultry waste product. Furthermore, it will also underscore and outline various ways which can be adopted to prevent this poultry disease which is of great public health, economic and food security protection importance. Method/Methodology: This is a systematic review of published research articles focusing on Newcastle disease, epidemiology, pathogenicity, transmission and factors that can play important roles in the possible outbreak of the disease in poultries. Studies reviewed comprise of cross-sectional, prospective, longitudinal and observational studies. The study approach follows the systematic review of peer-reviewed published articles as well as online publications and articles derived from various databases with search keywords relevant to the topic of discourse. Findings and Results: The findings in this study highlight the endemicity of Newcastle virus disease in various part of the country, and how the severity of the disease is influenced by host characteristics, viral properties, and environmental factors. The study pointed out critical evidence-based possible reasons that could promote a new round of Newcastle disease epidemic outbreak as a result of poor poultry management practices such as high bird densities, poor poultry infrastructure, lack of quarantine of sick birds, mixed species rearing, free range system of poultry, poor waste disposal, lack of expertise, and insufficient biosecurity outcomes. However, the lack of education and awareness among farmers exacerbates the problem, hindering preventive measures. The complexity is increased by difficulties with vaccination, unrestrained bird movement through trading with neighboring countries and interstate, and a lack of diagnostic facilities. The consequences of an outbreak extends beyond financial losses to potential disruptions in the poultry supply chain, food security risks, and public health concerns. Conclusion and Recommendation: The growing difficulties in poultry management methods increases the serious public health concern posed by a possible Newcastle Virus epidemic outbreak in Nigeria. A paradigm shift in poultry farming practices is necessary to address this problem. A comprehensive strategy that incorporates infrastructural development, regulatory frameworks, and education in order to strengthen the poultry industry is needed, so as to address and prevent the looming public health and food security crises that may break out from the above scenario

Leveraging collaborative research networks against antimicrobial resistance in Asia.

Antimicrobial resistance (AMR) is a global health security threat requiring research collaboration globally and regionally. Despite repeated calls for international research collaboration in Asia, literature analyzing the nature of collaborative AMR research in Asia has been sparse. This study aims to describe the characteristics of the AMR research network in Asia and investigate the factors influencing collaborative tie formation between organizations. We carried out a mixed-methods study by combining social network analysis (SNA) and in-depth interviews. SNA was first conducted on primary data to describe the characteristics of the AMR research network in Asia. Exponential random graph models (ERGMs) were then used to examine the influence of factors such as organization type, country affluence levels, regional proximity and One Health research on collaborative tie formation among organizations. In-depth interviews were conducted with network participants to provide contextual insights to the quantitative data. The results reveal that the research network exhibits a core-periphery structure, where a minority of organizations have a significantly higher number of collaborations with others. The most influential organizations in the network are academic institutions from high-income countries within and outside Asia. The ERGM results demonstrate that organizations prefer to collaborate with others of similar organization types, country-based affluence levels and One Health domains of focus, but also with others across different World Health Organization regions. The qualitative analysis identified three main themes: the challenges that impede collaboration, the central role of academic institutions, and the nature of collaborations across One Health domains, giving rise to important empirical milestones in understanding AMR research in Asia. We thus recommend leveraging academic institutions as "integrators" to bridge differences, increasing funds channelled towards research capacity building to alleviate structural barriers to collaboration, streamlining collaborative mechanisms to overcome cumbersome administrative hurdles, and increasing efforts to establish trust between all organizations.

International health security

The paper proposes the classification of health security as one of the non-military security dimensions of the second generation, determined more by globalization processes than by the end of the Cold War (first generation). The cognitive goal of the article is to identify and analyse the elements of the structure of international health security such as 1) the essence and specificity of securitization of threats to health security; 2) health security threats; 3) the referent object or whom it concerns; and 4) measures to ensure it. Specific to this dimension is the political motivation for its securitization. In the world of interrelated and global mobilities, what is significant for health security is the diversity of the development level, preferred values, and, consequently, the diversity of sensitivity and susceptibility of national healthcare systems to cross-border threats.

642. The impact of novel E1:M407I mutation on replicative fitness of the Chikungunya virus ECSA-IOL strain during infection of mammalian and mosquito cells,

Abstract Background Chikungunya virus (CHIKV) is an Alpha virus which is transmitted by Aedes genus of mosquitoes. It causes febrile illness with severe arthralgia, myalgia and rashes. Since 2000, the re-emergence of this pathogen have made it a global health security threat as it has caused severe form of diseases with epidemics of large magnitude and also spread to European and American continent. Studies have identified different point mutations in E1 and E2 region associated with virulence and infectivity, which is behind these severe epidemics. Pakistan reported first CHIKV outbreak with more than 30,000 infections from its largest city in 2016 which is already endemic for Dengue virus (DENV). Methods 32 CHIKV PCR-positive serum samples were collected from molecular pathology section of DUHS followed by RNA extraction and amplifcation of E1 region by PCR. The amplified products were prurified and sanger sequenced by BigDye termination method. Mutation analyses &amp; Bayesian phylogeny was done by bioinformatic tools. CHIKV E1:M407I mutation was cloned in to CHIKV wild type infectious cDNA clone plasmid (SL-CK-1) by site directed mutagenesis (SDS). In vitro viral RNA was synthesized after plasmid linearization, which was electroporated into VERO-CCL-81 cells. M407I mutant virus was recovered from the culture, titrated by plaque assay and sanger sequenced to confirmed the M407I mutation. Viral competition assay was performed in mammalian and mosquitoes cell lines to determine the relative replicative fitness of mutant CHIKV virus over wild type. Results Sequence analysis revealed 7 unique mutations in E1 including one mutation (M407I) in more than half of the sequenced samples. Phylogenetic analyses revealed this outbreak was caused by CHIKV-IOL genotype with possible inception from India. Virus competition assay showed relative replicative fitness for CHIKV E1:M407I mutant in Vero-CLL-81 and AAG2 cells have greater advantage while in C6/36, it has slight advantage over wild type virus. Conclusion This study reports a novel mutations in E1 protein of CHIKV with fitness advantage over wild type strain. Phylogeny revealed the outbreak was caused by A226-IOL strain with possible origin from ancestral strain of Indian outbreak. Disclosures All Authors: No reported disclosures

Population health as a component of public security: the experience of the European Union and Ukraine

The scientific article, taking into account the original concept of public safety, examines the European experience and domestic approaches to public health protection in a comprehensive, risk-oriented and preventive mode. The urgency of the investigated issues is shown not only in national, but also in international dimensions. The EU initiative on health security (2020-2025), which aims to create a regional workforce responsible for the prevention and control of infectious disease challenges and strengthen regional cooperation to overcome cross-border health security threats, has been positively evaluated. It is established that the outbreak of COVID-19 in the world has created new "opportunities" for organized criminal groups, given that law enforcement agencies are actively involved in resolving crisis situations in order to reduce the further spread of viral infection.&#x0D; From the standpoint of legal comparative analyses, the Ukrainian approach to public health protection within the national public safety program is highlighted. In particular, in Ukraine, the sphere of public security includes relations related to compliance with quarantine rules and the fight against particularly dangerous infectious diseases and epidemics. It was noted that the task of the Ukrainian authorities in the context of countering the spread and consequences of the corona crisis was not only the introduction of administrative and strengthening of criminal liability, but also the introduction at the local level of clear and specific rules of conduct during quarantine and timely and full communication of their content to the population.&#x0D; It is emphasized that the duty of citizens during large-scale threats to health is to strictly comply with regulations and requirements of competent authorities. It was determined that this directly depends, first of all, on the clear interaction of such state institutions as the bodies of the National Police, the State Emergency Service, the National Guard, local self-government bodies, communal enterprises, health care institutions, transport, human rights organizations, public associations for the protection of law and order among themselves and with the public.

The African Union and Emerging Patterns of Global Health Governance

Abstract During the global COVID-19 pandemic, the shortcomings and inequities in the global health system were amplified. International actors lost faith in the major global health institutions, and there was intense competition amongst states for critical supplies and vaccines. During these challenging circumstances, the African Union (AU) and its specialized technical institute (now autonomous agency) the Africa Centres for Disease Control and Prevention (Africa CDC), led a multi-faceted response to combat COVID-19 in Africa and advocate for the African region globally. Beyond responding to the immediate crisis, the AU and Africa CDC recognized that Africa would need to build its capacity to respond to future public health security threats. They embraced the idea of the New Public Health Order for Africa to build public health institutions and workforces, expand manufacturing of critical medical supplies, increase public health resources, and build balanced and respectful partnerships ("Call to Action: Africa's New Public Health Order" 2022). In the years since the emergence of COVID-19, the AU and Africa CDC seized on the momentum created by the pandemic to build public health institutions and to take concrete action to begin to implement their vision for a New Public Health Order for Africa. This article focuses on how the response of the AU and Africa CDC to COVID-19 is driving an evolution in public health within Africa and the emerging impacts on global health governance more generally. It demonstrates that Africa is creating a space between state-based public health and global health governance by regionalizing public health to enhance Africa’s capacity and agency.

Cartridge Based Nucleic Acid Amplification Test, an Important Diagnostic Tool for Tuberculosis both Pulmonary and Extra-Pulmonary Tuberculosis

Tuberculosis (TB) is an infectious disease caused by Mycobacterium tuberculosis (MTB), one of the top 10 causes of death worldwide (ranking above HIV/AIDS). About a quarter of the world's population is infected with TB and thus at risk of developing TB disease. The Global TB Report 2019 states that in 2018 a total of 1.5 million people died from TB, an estimated 10 million (range, 9.0–11.1 million) people fell ill worldwide.(1) Eight countries accounted for two-thirds of the total, with India leading the count, followed by China, Indonesia, the Philippines, Pakistan, Nigeria, Bangladesh, and South Africa.(1) Multidrug-resistant TB (MDR-TB) remains a public health crisis and a health security threat. The WHO estimates that there were 484 000 new cases with resistance to rifampicin (RIF) – the most effective first-line drug, which accounts for 78% MDR-TB cases. The MDR-TB burden largely falls on three countries – India, China, and the Russian Federation. About 6.2% of MDR-TB cases had extensively drug-resistant TB (XDR-TB) in 2018. Worldwide, only 56% of MDR-TB patients are currently successfully treated. Globally, TB incidence is falling at about 2% per year. This needs to accelerate to a 4%–5% annual decline to reach the 2020 milestones of the End TB Strategy.

Region 1 RDHRS Disaster Telehealth System

Introduction:Disasters can quickly overwhelm a healthcare system’s capacity and exacerbate existing gaps in access to specialty care. The Region 1 RDHRS has developed a disaster telehealth system. This presentation will highlight how a proof of concept developed into a prototype system, and how it is becoming operational. We will elaborate on the barriers of implementing a telehealth system to provide access to acute consultation with disaster-relevant specialists, and the steps the Region 1 RDHRS is taking to develop solutions.Method:An RDHRS is a tiered system across states and regions created to deliver a more coherent and comprehensive response to health security threats. A key RDHRS capability is providing disaster telehealth services to target gaps in healthcare coverage, allowing providers to access disaster-relevant clinical expertise in the immediate aftermath of a catastrophic no-notice event.The Region 1 RDHRS disaster telehealth system can rapidly mobilize a national pool of volunteer specialists to support overwhelmed local providers at the point of care. This system is flexible to support a range of disasters and easy to navigate without prior training. The system is device-agnostic and functions on existing telecommunication systems without requiring new hardware/software installation.Results:Operationalizing a telehealth system to deliver acute episodic unscheduled care across state lines is fraught with challenges. We collaborated with various subject matter experts to develop solutions that allow for rapid volunteer verification, training, and mobilization. Despite advances driven by COVID-19, barriers related to license portability, liability protection, and credentialing of volunteer specialists across state lines remain complex. We are developing disaster waivers and template documents that can be rapidly implemented via executive action at state and regional levels.Conclusion:The Region 1 RDHRS team is collaborating with the other pilot sites within the RDHRS program to develop a unified national disaster telehealth response based on this model.

Emerging Pathogenic Viral Infections of the Eye.

Global health security threats and the public health impact resulting from emerging infectious diseases including the ongoing COVID-19 pandemic and recent Ebola virus disease outbreaks continuously emphasize the need for a comprehensive approach to preparedness, management of disease outbreaks, and health sequelae associated with emergent pathogens. A spectrum of associated ophthalmic manifestations, along with the potential persistence of emerging viral pathogens in ocular tissues, highlight the importance of an ophthalmic approach to contributing to efforts in the response to public health emergencies from disease outbreaks. This article summarizes the ophthalmic and systemic findings, epidemiology, and therapeutics for emerging viral pathogens identified by the World Health Organization as high-priority pathogens with epidemic potential.

Health system adaptions to improve care for people living with non-communicable diseases during COVID-19 in low-middle income countries: A scoping review.

During the COVID-19 pandemic, access to health care for people living with non-communicable diseases (NCDs) has been significantly disrupted. Calls have been made to adapt health systems and innovate service delivery models to improve access to care. We identified and summarized the health systems adaptions and interventions implemented to improve NCD care and their potential impact on low- and middle-income countries (LMICs). We comprehensively searched Medline/PubMed, Embase, CINAHL, Global Health, PsycINFO, Global Literature on coronavirus disease, and Web of Science for relevant literature published between January 2020 and December 2021. While we targeted articles written in English, we also included papers published in French with abstracts written in English. After screening 1313 records, we included 14 papers from six countries. We identified four unique health systems adaptations/interventions for restoring, maintaining, and ensuring continuity of care for people living with NCDs: telemedicine or teleconsultation strategies, NCD medicine drop-off points, decentralization of hypertension follow-up services and provision of free medication to peripheral health centers, and diabetic retinopathy screening with a handheld smartphone-based retinal camera. We found that the adaptations/interventions enhanced continuity of NCD care during the pandemic and helped bring health care closer to patients using technology and easing access to medicines and routine visits. Telephonic aftercare services appear to have saved a significant amount of patients' time and funds. Hypertensive patients recorded better blood pressure controls over the follow-up period. Although the identified measures and interventions for adapting health systems resulted in potential improvements in access to NCD care and better clinical outcomes, further exploration is needed to establish the feasibility of these adaptations/interventions in different settings given the importance of context in their successful implementation. Insights from such implementation studies are critical for ongoing health systems strengthening efforts to mitigate the impact of COVID-19 and future global health security threats for people living with NCDs.

Identifying and addressing challenges to antimicrobial use surveillance in the human health sector in low- and middle-income countries: experiences and lessons learned from Tanzania and Uganda

BackgroundAntimicrobial resistance (AMR) is a global health security threat and is associated with increased morbidity and mortality. One of the key drivers of AMR is the inappropriate use of antibiotics. A key component of improving antibiotic use is conducting antimicrobial use (AMU) surveillance.MethodsUSAID Medicines Technologies and Pharmaceutical Services Program has supported the implementation of antimicrobial stewardship activities, including setting up systems for AMU surveillance in Tanzania and Uganda. Results from both countries have been previously published. However, additional implementation experience and lessons learned from addressing challenges to AMU surveillance have not been previously published and are the subject of this narrative article.ResultsThe team identified challenges including poor quality data, low digitalization of tools, and inadequate resources including both financial and human resources. To address these gaps, the Program has supported the use of continuous quality improvement approaches addressing gaps in skills, providing tools, and developing guidelines to fill policy gaps in AMU surveillance. Recommendations to fill these gaps, based on the Potter and Brough systematic capacity building model have been proposed.ConclusionsStrengthening AMU surveillance through using a capacity-building approach will fill gaps and strengthen efforts for AMR control in both countries.

Design, Implementation, and Evaluation of an N95 Respirator Decontamination and Reuse Program for Healthcare Workers During the COVID-19 Pandemic

Early in the COVID-19 pandemic, substantial disruptions in personal protective equipment (PPE) supply chains forced healthcare systems to become resourceful to ensure PPE availability for healthcare workers. Most worrisome was the global shortage of N95 respirators. In response, a collaboration between the Department of Infection Control and Healthcare Epidemiology and the Department of Biosafety at the University of Texas Medical Branch developed a PPE recycling program guaranteeing an adequate supply of respirators for frontline staff. The team successfully developed and implemented a novel workflow that included validated decontamination procedures, education, and training programs as well as transportation, labeling, and storage logistics. In total, 15,995 respirators of various types and sizes were received for recycling. Of these, 12,752 (80%) were recycled. Following the program's implementation, we surveyed 134 frontline healthcare workers who overwhelmingly graded our institution's culture of safety positively. Overall impressions of the N95 respirator recycling program were mixed, although interpretation of those results was limited by a lower survey response rate. In an era of increasing health security threats, innovative recycling programs like this one may serve as a model for other health systems to respond to future PPE supply chain disruptions.

"Digital global health diplomacy" for climate change and human security in the Anthropocene.

The COVID-19 pandemic has now affected everyone, threatening every aspect of our well-being with over 617597680 confirmed cases, including 6532705 deaths globally. The context of the Anthropocene is the backdrop for the novel, interlinked, systemic, and global threats. Anthropocene is a term proposed to designate the era in which human beings have become predominant drivers of planetary change, drastically altering the planet's biosphere. The concept of global health diplomacy (GHD), which connects the domains of health and international relations, has a critical role in advancing human security. Thus, there is a need for new forms of diplomacy, which is critically important in this complex intermestic and interdependent Anthropocene era, where globalization has inevitably linked nations and population health. This paper introduces, analyzes, and attempts to define "Digital Global Health Diplomacy" (DGHD), which has gained great momentum during this COVID-19 pandemic with concurrent health and human security threats. The application of digital formats to the existing traditional structures for dialogue has become a more popular tool recently. Furthermore, digital means are being used during the COVID-19 pandemic to share the health diplomacy discourse at subnational, supranational, international, regional, and global platforms. DGHD reminds us again of the criticality of this multidisciplinary concept involving the contributions of diplomats, global health specialists, digital technology experts, economists, trade specialists, international law, political scientists, etc., in the global policymaking process. If used effectively by trained global health diplomats through innovative digital platforms, DGHD has a great scope of delivering results faster and has more reach than the traditional approach.

Neuronal Cellular Nanosponges for Effective Detoxification of Neurotoxins.

Neurotoxins attack and destruct the nervous system, which can cause serious health problems and security threats. Existing detoxification approaches, such as antibodies and small molecule antidotes, rely on neurotoxin's molecular structure as design cues and require toxin-specific development for each type of toxins. However, the enormous diversity of neurotoxins makes such structure-based development of antitoxin particularly challenging and inefficient. Here, we report on the development and use of neuronal membrane-coated nanosponges (denoted "Neuron-NS") as an effective approach to detoxifying neurotoxins. Specifically, Neuron-NS act as neuron decoys to lure neurotoxins, bind with and neutralize the toxins, and thus block them from attacking the host neuron cells. These nanosponges detoxify neurotoxins regardless of their molecular structures and therefore can overcome the challenge posed by toxin structural diversity. In the study, we fabricate Neuron-NS by coating the membrane of Neuro-2a cells onto polymeric cores. Meanwhile, we select tetrodotoxin (TTX) as a model neurotoxin and demonstrate the detoxification efficacy of the Neuron-NS in a cytotoxicity assay, a calcium flux assay, and a cell osmotic swelling assay in vitro. Additionally, in mouse models of TTX intoxication, the Neuron-NS significantly enhance mouse survival in therapeutic and prophylactic regimens without showing acute toxicity. Overall, the Neuron-NS contribute to the current detoxification arsenal with the potential to treat various injuries and diseases caused by neurotoxins.

FOLLOW UP CASES OF BEDAQUILINE IN XDR-TB PATIENTS: NOVEL CASE SERIES

Tuberculosis (TB) is one of the top 10 causes of death and the leading cause from a single infectious agent. Multidrug-resistant TB (MDR-TB) remains a public health crisis and a health security threat. Aglobal total of 2,06,030 people with multidrug or Rifampicin-resistant TB (MDR/RRTB) were detected and notied in 2019. Bedaquiline to be used to treat drug resistant TB.The drug is available as part of second line treatment for patients suffering from MDR-TB and XDR-TB. The drug recently underwent clinical trials at the national level in certain hospitals for safety and efcacy.Because XDR TB is resistant to the most potent TB drugs, the remaining treatment options are less effective, have more side effects, and are more expensive3.

Synthesis of new 3-(4-methyl-2-arylthiazol-5-yl)-5-aryl-1,2,4-oxadiazole derivatives as potential cytotoxic and antimicrobial agents

Globally cancer is the second leading cause of death; a drug that can cure cancer with the utmost negligible side effects is still a distant goal. Due to increasing antibiotic resistance, microbial infection remains a grave global health security threat. The ongoing coronavirus pandemic increased the risk of microbial and fungal infection. A new series of 3-(4-methyl-2-arylthiazol-5-yl)-5-aryl-1,2,4-oxadiazole (7a-t) have been synthesized. The structure of synthesized compounds was confirmed by the spectrometric analysis. The newly synthesized compounds were screened for cytotoxic activity against breast cell lines MCF-7 and MDA-MB-231. Against the MCF-7 ​cell line compounds 7f, 7 ​g and 7n showed excellent activity with GI50 0.6 ​μM to <100 ​nM concentration. Compound 7b showed good activity against MDA-MB-231 ​cell line with GI50 47 ​μM. The active derivatives 7b, 7e, 7f, 7 ​g and 7n were further evaluated for cytotoxicity against the epithelial cell line derived from the human embryonic kidney (HEK 293) and were found nontoxic. The thiazolyl-1,2,4-oxadiazole derivatives were also screened to evaluate theirs in vitro antimicrobial potential against Escherichia coli (NCIM 2574), Proteus mirabilis (NCIM 2388), Bacillus subtilis (NCIM 2063), Staphylococcus albus (NCIM 2178), Candida albicans (NCIM 3100) and Aspergillus niger (ATCC 504). Amongst the 7a-t derivatives, six compounds 7a, 7d, 7f, 7n, 7o, 7r showed good antifungal activity against C. albicans and eight compounds 7c, 7d, 7 ​g, 7h, 7i, 7k, 7l and 7o showed good activity against A. niger. The potential cytotoxic and antifungal activity suggested that the thiazolyl-1,2,4-oxadiazole derivatives could assist in the development of lead compounds for the treatment of cancer and microbial infections.