Poor Surveillance Research Articles

Perceived drivers of the Ebola virus disease outbreak in Mubende and Kassanda districts, Uganda: a qualitative study

IntroductionDuring the most recent Ebola virus disease (EVD) outbreak in Uganda, a cluster of community deaths with epidemiological linkages to the first reported case were identified to have occurred in...

Leishmaniasis in Tuscany: investigation of hidden human cases and comparison with canine incidence

Abstract The Mediterranean basin hosts endemic areas for leishmaniasis, mainly attributable to the presence of sand flies. Leishmaniasis has gained importance in Europe due to climate change, globalisation and migration. For at least the last 10 years in Tuscany, Italy, there has been an important discrepancy between official notifications of visceral and cutaneous leishmaniasis cases in humans and the number of hospital admissions, highlighting an important underestimation, despite mandatory notification. Moreover, official reports have increased alarmingly in the last three years. Human leishmaniasis does not always require hospitalisation: it often presents cutaneous manifestations, whereas in the immunocompetent individual it may not occur at all. For this reason, it is reasonable to assume that the number of cases is higher than the number of hospitalisations. The project aims to investigate the underreporting of human leishmaniasis cases from 2014 to 2023 by analysing laboratory diagnoses (considering any laboratory test that, according to the Italian Ministry of Health guidelines, is useful to identify a ‘confirmed case’, thus serological tests; parasitological tests; culture tests; PCR). To estimate the extent of underreporting, the capture-recapture method will be used, taking into account laboratory data, official reports and hospital data. Subsequently, a comparison will be made with the incidence, in the same territory, of veterinary cases, particularly in dogs, using data obtained from the Lazio-Tuscany Zooprophylactic Institute, to compare the trend of human and canine cases over time. Analyses are in progress and the results will be presented at the conference. Poor surveillance leads to ineffective prevention policies. The impact of the project is to strengthen the leishmaniasis surveillance system in Tuscany in order to reinforce prevention systems and face emergencies. Key messages • Due to climate change, globalization, and migration, there has been an increase in diagnoses of vector-borne diseases, including Leishmaniasis. • Leishmaniasis surveillance need to be strengthened in order to enhance prevention systems and address emergencies.

A serial case of Japanese encephalitis in West Kalimantan

Japanese encephalitis (JE) is an important, vaccine-preventable cause of viral encephalitis in Asia. This medical condition has a high morbidity and mortality rate, remains an under-recognized cause of encephalitis, with high rate of mortality and severe sequelae in children, especially in West Kalimantan. However, poor surveillance has made the burden difficult to quantify, hindering decisions about subsidized vaccine introduction. In this serial case, the most common clinical presentations of JE were fever, altered mental status, seizures, vomiting, and positive meningeal irritation signs or pathologic reflexes. The JE mortality rate was as high as 40%. These highlight the need of disease surveillance, diagnostic kits supply, and health education to increase public disease awareness.

Late effects surveillance adherence among young adult childhood cancer survivors: A population-based study.

Lifelong, guideline-based monitoring for late effects is recommended for childhood cancer survivors (CCS). We examined rates of receiving surveillance tests among at-risk young adult CCS in a population-based study (n=253; 50% Hispanic/Latino; mean post-treatment interval 14.5years, range: 5-22). Adherence rates were 36.1%, 31.9%, and 36.4% among those indicated for cardiac (n=119), thyroid (n=68), and breast (n=66) surveillance, respectively, indicating that poor surveillance among long-term CCS is widespread. Receipt of any of these surveillance tests was positively associated with being in follow-up care, having any health insurance (vs. none), and receiving education about need for follow-up with surveillance (all p-values less than.05).

Barriers and facilitators of visceral leishmaniasis case management in the Amhara Region, Northwest Ethiopia: an exploratory qualitative study

BackgroundVisceral leishmaniasis (VL) is among the world’s most serious public health threats, causing immense human suffering and death. In Ethiopia, little is known about the barriers and facilitators of visceral leishmaniasis case management. This study aimed to explore such barriers and facilitators in the Amhara Regional State, Northwest Ethiopia.MethodsAn exploratory qualitative study was conducted on 16 purposively selected patients and key informants from May 8 to June 2, 2023. The study participants were recruited using the maximum variation technique. The interviews were audio recorded, transcribed verbatim, and translated into English. Thematic analysis was employed using Atlas.ti 9 software with a blended approach of both deductive and inductive coding.ResultsThe study identified a variety of issues that hinder the success of visceral leishmaniasis case management. Treatment centers face frequent interruptions of medicinal supplies, a lack of funding, and a lack of trained healthcare providers. A lack of support from health authorities, including weak supervision and feedback systems, is also a source of concern. Most patients receive treatments after significant delays, which is primarily due to low awareness, poor surveillance, and misdiagnosis by healthcare workers. The case management is further constrained by malnutrition, VL-HIV co-infection, and other comorbidities. Despite these issues, we found that effective collaboration between hospital units and VL treatment centers, acceptance by hospitals, and the caring attitude of healthcare workers play a positive role in facilitating the program’s effectiveness.ConclusionsDespite the existence of certain efforts that facilitate the program’s effectiveness, VL remains largely neglected, with little government attention or intervention. Such inattention is the root cause of most of the issues. Despite limited resources, most issues could be resolved with cost-effective strategies if health authorities at all levels have the will and commitment to do so.

Antibiotic use patterns and trends in the FDMN population and rural Bangladeshi population: a cross-sectional study

Global antibiotic resistance is a pressing issue, especially in Bangladesh, due to its widespread use, poor surveillance, and high treatment costs. This study compared antibiotic use between Rohingya and rural Bangladeshi residents, aiming to predict the frequency and tendency of commonly used antibiotics across different community levels. This was a cross-sectional descriptive study using a questionnaire. It involved Cox's Bazar camp, Tangail, and Bogura rural areas. Most participants were male, with 46.8% graduates and 20.8% untrained from mixed economic backgrounds. The study revealed that 62% adhered to doctors' orders, 28.5% followed pharmacists' recommendations, 6% sourced antibiotics from various places, 3% self-medicated, and 1% relied on advice from friends or relatives. Alarmingly, 25.3% did not complete their antibiotic courses. Age, region, advisor status, and education level were correlated with antibiotic use (P<0.05), whereas socioeconomic status was not. The most commonly used medications among both rural and FDMN populations were azithromycin, ciprofloxacin, amoxicillin, and metronidazole. These findings highlight gaps in antibiotic use and adherence, with many not completing their treatments. Despite educational and economic variations, there is a general lack of concern about AMR, emphasizing the need for better awareness of and adherence to guidelines. Asian J. Med. Biol. Res. 2024, 10(3), 122-130

Canada's Medical Assistance in Dying System can Enable Healthcare Serial Killing.

The Canadian approach to assisted dying, Medical Assistance in Dying (MAiD), as of early 2024, is assessed for its ability to protect patients from criminal healthcare serial killing (HSK) to evaluate the strength of its safeguards. MAiD occurs through euthanasia or self-administered assisted suicide (EAS) and is legal or considered in many countries and jurisdictions. Clinicians involved in HSK typically target patients with the same clinical features as MAiD-eligible patients. They may draw on similar rationales, e.g., to end perceived patient suffering and provide pleasure for the clinician. HSK can remain undetected or unconfirmed for considerable periods owing to a lack of staff background checks, poor surveillance and oversight, and a failure by authorities to act on concerns from colleagues, patients, or witnesses. The Canadian MAiD system, effectively euthanasia-based, has similar features with added opportunities for killing afforded by clinicians' exemption from criminal culpability for homicide and assisted suicide offences amid broad patient eligibility criteria. An assessment of the Canadian model offers insights for enhancing safeguards and detecting abuses in there and other jurisdictions with or considering legal EAS. Short of an unlikely recriminalization of EAS, better clinical safeguarding measures, standards, vetting and training of those involved in MAiD, and a radical restructuring of its oversight and delivery can help mitigate the possibility of abuses in a system mandated to accommodate homicidal clinicians.

Factors responsible for the re-emergence of Monkeypox and implications for global health

The eradication of smallpox in 1980 and the subsequent discontinuation of smallpox vaccination have resulted in a decline in immunity against orthopoxviruses. As a result, Monkeypox (Mpox) has reappeared as a significant virus with implications for public health. This article aims to determine some of the factors responsible for the re-emergence of Mpox and its implications for global health. A thorough literature search for this present article was conducted through a search of databases and journals, including the WHO and CDC websites, using keywords such as “Monkeypox”, “Re-emergence”, “Prevalence”, “Risk factors”, “Implications” and “Global Health” to find articles published from 2003 to 2023. We found that Mpox recently occurred in several countries in America, Europe, and Asia, including the United States of America (USA), Brazil, Spain, Colombia, Mexico, the United Kingdom (UK), Germany, and Pakistan, between 2022 and 2023. The rise in Mpox cases was also seen, with incidences documented in Western Europe (2599 cases, accounting for 42.76% of the total), Southern Europe (1932 cases, representing 31.79% of the total), Northern Europe (1487 cases, comprising 24.46% of the total), and Eastern Europe (59 cases, making up 0.97% of the total). Possible factors implicated in the re-emergence of MPOX include; the expansion of the human population, increased same sexual intercourse, and poor epidemiological surveillance. etc. The re-emergence of Mpox in the world is a difficult issue that requires world leaders to take a diverse approach to control the disease. World leaders and scientists must pursue natural compounds with antiviral properties. Hopefully, natural products will give alternate therapy alternatives for preventing infection transmission between humans and limiting virus proliferation in host organisms.

Increase in GPIHBP1 expression in advanced stage colorectal cancer indicates poor immune surveillance.

Glycosylphosphatidylinositol (GPI)-anchored high-density lipoprotein-binding protein 1 (GPIHBP1) plays a crucial role in fatty acid metabolism, which is involved in the progression of colorectal cancer (CRC). The aim of this study was to determine the expressional variations of GPIHBP1 in CRC at different stages and to verify whether this protein affects the shaping of the immune microenvironment of cancer cells. Variations of GPIHBP1 messenger RNA (mRNA) levels were first analysed using The Cancer Genome Atlas (TCGA) database. Protein levels of GPIHBP1 in cancer nest cells, stromal cells or surrounding normal tissues from 68 patients with CRC were checked by immunohistochemistry. Infiltration of immune cells such as macrophages, myeloid-derived suppressor cells (MDSCs), CD8+ and CD56+ cells was parallelly stained in the same tissues. Ectopic GPIHBP1 expressed colonic tumour cells were transplanted into the back of mice. Tumour growth and immune cell infiltrations were also observed. Compared with those in healthy tissues, GPIHBP1 mRNA and protein levels decreased in the patients with CRC at Dukes A-B stage but gradually increased in the patients at Dukes C-D stage. GPIHBP1 in foci or stroma was positively correlated with recruited macrophages or MDSCs and negatively correlated with recruited CD8+, CD56+ or granzyme+ cells. The mice injected with GPIHBP1 overexpression cells bore large tumours. Histological analysis confirmed the infiltration of many macrophages and MDSCs but less CD8+ T or CD56+ cells. The increased expression of GPIHBP1 is involved in the progression of CRC. High GPIHBP1 level of advanced CRC indicates efficient immune evasion in tumour microenvironment.

Bacterial etiologies, antimicrobial susceptibility pattern and associated factors among patients suspected sterile body site infections at Debre Markos Comprehensive Specialized Hospital, Northwest Ethiopia.

Sterile body locations are usually associated with clinical urgency and life-threatening illnesses, and they are typically contaminated with diverse bacterial etiologies. If the bacteria acquire resistance to antimicrobial drugs, the public health crisis will only worsen. In developing countries, drug-resistant bacteria are common because of poor surveillance, diagnostic capacity, and control measures. Early diagnosis, and assessing the drug resistance and factors associated with infection are important to combat the drug resistance and treatment. This study aimed to assess the bacterial etiologies, antimicrobial susceptibility pattern, and possible associated factors among patients suspected of sterile body sites. A hospital-based cross-sectional study was conducted from June 2022 to August 2022 at Debre Markos Comprehensive Specialized Hospital in Amhara regional state, Ethiopia. One hundred seven study participants were selected using consecutive convenient sampling techniques. A structured questionnaire was used to collect socio-demographic and clinical data. Gram stain was done for a preliminary report and inoculated into blood agar, MacConkey agar, and chocolate agar and incubated aerobically and micro aerobically at 37°C for 24 h. Antimicrobial susceptibility testing was done by the modified Kirby Bauer's disk diffusion method. Data were analyzed using bivariate and multivariate logistic regression was used. A p-value less than 0.05 is considered as statistically significant. The overall magnitude of sterile body site infection among study participants was 7.5% (14/187). The majority of the isolates were Gram-negative bacteria with the predominant species Enterobacter cloacae accounting for 28.57% (4/14). Among isolates 78.57%(11/14) of them were multidrug-resistant isolates. Being inpatient, co-morbidity, and alcohol consumption were significantly associated with sterile body site infection. In our study, Gram-negative bacteria were the predominant bacteria that infects sterile body fluid. The prevalence of multi-drug resistance bacteria isolates was significantly high. Therefore, before prescribing an empirical treatment, a medical professional should identify the bacterial etiology of sterile body fluids and the susceptibility of microbes to the drug.

Perceptions and digitalisation of outbreak management in UK health services: A cross-sectional survey.

Global challenges arise from infectious diseases which represent significant challenges to the provision of healthcare, requiring efficient management procedures to limit transmission. Evaluating current outbreak management processes within UK healthcare services is essential for identifying strengths, weaknesses, and potential improvements. This study aimed to assess infection prevention and control (IPC) practitioners' access to outbreak management (OM) data. Secondary objectives involved determining IPC practitioners' perceptions of outbreak management processes and the state of digitalisation of OM in the UK. National cross-sectional survey data were collected to evaluate current outbreak management approaches. To supplement this, information requests were sent to the 10 largest teaching and research NHS hospital trusts in England. The survey received 55 responses with 53 considered for analysis. Out of 10 NHS trusts, nine provided completed FOI responses, while one was unable to provide data. The study offers unique insights into prevailing outbreak management practices within UK health services. Although positive perceptions surround key outbreak management stages, concerns arise, including varying confidence levels in surveillance processes' robustness, efficacy of management interventions, and communication effectiveness. The study highlights challenges with OM processes in the UK, including issues like poor surveillance and delayed outbreak detection. Positive practitioner perceptions contrast with concerns over data collection, follow-up, and limited digitalisation, relying on basic tools like Excel and Word, hindering retrospective learning.

Follow-up compliance in patients undergoing abdominal aortic aneurysm repair at Veterans Affairs hospitals

ObjectiveThe Society for Vascular Surgery guidelines recommend annual imaging surveillance following endovascular aneurysm repair (EVAR) and every 5 years following open surgical repairs (OSR) of abdominal aortic aneurysms (AAAs). Adherence to these guidelines is low outside of clinical trials, and compliance at Veterans Affairs (VA) hospitals is not yet well-established. We examined imaging follow-up compliance and mortality rates after AAA repair at VA hospitals. MethodsWe queried the VA Surgical Quality Improvement Program database for elective infrarenal AAA repairs, EVAR and OSR, then merged in follow-up imaging and mortality information. Mortality rate over time was derived using Kaplan-Meier estimation. Generalized estimating equation with a logit link and a sandwich standard error estimate was performed to compare the probability of having annual follow-up imaging over time between procedure types and to identify variables associated with follow-up imaging for EVAR patients. ResultsOur analysis included 11,668 patients who underwent EVAR and 4507 patients who underwent OSR at VA hospitals between the years 2000 and 2019. The 30-day mortality rate for EVAR and OSR was 0.37% and 0.82%, respectively. OSR was associated with lower long-term mortality after adjusting age, sex, American Society of Anesthesiologists classification and preoperative renal failure with an adjusted hazard ratio of 0.88 (95% confidence interval, 0.84-0.92; P < .01). Of surviving patients, the follow-up imaging rate was 69.1% by 1 year post-EVAR. The follow-up rate after 5 years was 45.6% post-EVAR compared with 63.6% post-OSR of surviving patients. A history of smoking or drinking, baseline hypertension, and known cardiac disease were independently associated with poor follow-up after EVAR. ConclusionsPatients undergoing elective open AAA repair in the VA hospital system had lower long-term mortality compared with patients who underwent endovascular repair. Compliance with post-EVAR imaging is low. Patient factors associated with poor post-EVAR imaging surveillance were smoking within the last year, excess alcohol consumption, and cardiac risk factors including hypertension, prior myocardial infarction, and congestive heart failure.

Whole genome sequencing unravels cryptic circulation of divergent dengue virus lineages in the rainforest region of Nigeria

ABSTRACT Dengue is often misclassified and underreported in Africa due to inaccurate differential diagnoses of nonspecific febrile illnesses such as malaria, sparsity of diagnostic testing and poor clinical and genomic surveillance. There are limited reports on the seroprevalence and genetic diversity of dengue virus (DENV) in humans and vectors in Nigeria. In this study, we investigated the epidemiology and genetic diversity of dengue in the rainforest region of Nigeria. We screened 515 febrile patients who tested negative for malaria and typhoid fever in three hospitals in Oyo and Ekiti States in southern Nigeria with a combination of anti-dengue IgG/IgM/NS1 rapid test kits and metagenomic sequencing. We found that approximately 28% of screened patients had previous DENV exposure, with the highest prevalence in persons over sixty. Approximately 8% of the patients showed evidence of recent or current infection, and 2.7% had acute infection. Following sequencing of sixty samples, we assembled twenty DENV-1 genomes (3 complete and 17 partial). We found that all assembled genomes belonged to DENV-1 genotype III. Our phylogenetic analyses showed evidence of prolonged cryptic circulation of divergent DENV lineages in Oyo state. We were unable to resolve the source of DENV in Nigeria owing to limited sequencing data from the region. However, our sequences clustered closely with sequences in Tanzania and sequences reported in Chinese with travel history to Tanzania in 2019. This may reflect the wider unsampled bidirectional transmission of DENV-1 in Africa, which strongly emphasizes the importance of genomic surveillance in monitoring ongoing DENV transmission in Africa.

Nigeria’s Public Health Response to Infectious Diseases in the Wake of Climate-Related Emergencies.

Infectious disease outbreaks remain a significant public health challenge worldwide, particularly in low- and middle-income countries. Over the past few decades, the number and intensity of these outbreaks have been worsened by climate change because increased temperatures, changes in precipitation, and extreme weather conditions promote disease transmission. This paper explores the effect of climate change on infectious diseases in Nigeria with special reference to malaria, cholera, and Lassa fever from the year 2014 to 2023. Nigeria’s susceptibility to climate shocks combined with a weak health care system makes it a good example of how climate change affects the health of people in the developing world. By integrating historical information and climate information, this study shows how climate factors including floods, droughts and high temperatures have led to the spread of infectious diseases. This work confirms that climate change phenomena affect the availability and distribution of rainfall that, in turn, has resulted in the expansion of durations and breeding grounds for vectors such as mosquitoes and other disease-carrying organisms hence increasing vector borne diseases such as malaria. Furthermore, floods have been known to contaminate water sources hence frequent incidence of water borne diseases such as cholera. The study also evaluates the extent of these outbreaks across the regions, with North-eastern Nigeria having the highest burden because of climate-induced displacement and disrupted water sources. However, the problems of poor funding, poor disease surveillance, and poor access to health care especially in the rural areas have remained a major challenge in Nigeria’s public health system in its efforts to contain these climate related health disasters. The findings therefore call for the implementation of climate-health policies and sustainable development planning to address the increasing risks of climate sensitive diseases in Nigeria. Given the increasing impacts of climate change on health systems globally, the results of this study underscore the need to develop climate-resilient health systems especially in the developing world sub-Saharan Africa.

Profile of Acute Poisoning and Its Outcome in Children Admitted to a Tertiary Care Hospital in Northeast India: A Cohort Study

Introduction: Acute poisoning in children is an important public health problem. It is a significant paediatric emergency in both developing and developed countries, leading to preventable morbidity and mortality. While there is substantial research literature on acute childhood poisoning from developed countries, there is a lack of data from developing countries like India due to inadequate and poor surveillance of poisoning-related data. Aim: To investigate the clinical and epidemiological profile, as well as the outcome, of acute poisoning in children admitted to the paediatric emergency department of a tertiary care hospital in Northeast India. Materials and Methods: This prospective cohort study was conducted in the Paediatrics department of Assam Medical College and Hospital, Dibrugarh, Assam, India, from April 1, 2021, to March 31, 2022. All children under the age of 12 years who presented to the paediatric department with a history of exposure to toxic substances were included in the study. The admitted children were assessed in terms of demographic variables, type of poison, route of poisoning, time of presentation, circumstances of poisoning, storage place of poison, clinical presentation, and interventions provided. Data were presented as mean and frequency. Results: A total of 78 children under 12 years of age were enrolled in the study, with a mean age of three years and three months at presentation. The majority of cases (96.2%) involved accidental poisoning, while a small proportion (3.8%) was due to suicidal poisoning. Of the two reported cases of suicidal poisoning, one involved a male child and the other involved a female child. Both children were above six years of age. The most common causes of poisoning were kerosene (34.6%), organophosphorus compounds (10.3%), and liquid mosquito repellents (9.1%). Conclusion: This study revealed both unintentional and intentional poisoning cases, with a high prevalence of accidental poisoning observed in children below three years of age. Kerosene was identified as the most common cause of childhood poisoning.

Prevalence and Associated Factors of Dengue Virus Circulation in the Rural Community, Handeni District in Tanga, Tanzania.

Dengue virus is among the most important re-emerging arbovirus that causes global public health attention. Dengue has historically been thought of as an urban disease that frequently occurs in rapidly urbanized settings. However, dengue has become more widespread in rural regions in recent years. Understanding the changing dengue epidemiology in different geographical settings is important for targeted intervention. In Tanzania, dengue fever is not frequently reported because of the poor surveillance infrastructure, underestimation, and a lack of consideration of dengue as a priority. Therefore, the true burden as well as the risk factors for increased transmission has not been fully ascertained, particularly in rural areas. A cross-sectional community-based study was conducted in June 2021, involving a total of 362 participants of all age groups. We investigated the prevalence of acute dengue infection, seroprevalence, and associated factors among the community in three villages of the rural Handeni district. The prevalence of acute dengue infection (based on PCR) was 2.2% (8/362). Dengue-specific IgM and IgG antibodies were detected in 3.3% (12/362) and 5.2% (19/362) of the participants, respectively. Adult participants who were having vegetation around their houses were more likely to be DENV seropositive (AOR = 2.4, CI = 1.88-4.18, p value = 0.05). Children living in houses with garbage pit around their households were less likely to be DENV seropositive (AOR = 0.13, CI = 0.03-0.56, p value <0.01). DENV continues to circulate in rural Tanzania, causes an alarming situation, and necessitates prompt public health action to enhance vector surveillance and control in rural communities.

Terminology and methods used to differentiate injury intent of hospital burn patients in South Asia: a systematic scoping review protocol

BackgroundThe greatest proportion of burn injuries globally occur in South Asia, where there are also high numbers of intentional burns. Burn injury prevention efforts are hampered by poor surveillance data on injury intent. There is a plethora of local routinely collected data in the research literature from South Asia that could be used for epidemiological purposes, but it is not known whether the definitions and methods of differentiation of injury intent are sufficiently homogenous to allow valid study comparisons.MethodsWe will conduct a systematic scoping review to understand terminology and methods used to differentiate injury intent of hospital burn patients in South Asia. The objectives of the study are to: determine the breadth of terminology and common terms used for burn injury intent; to determine if definitions are comparable across studies where the same term is used; and to appraise the rigour of methods used to differentiate burn injury intent and suitability for comparison across studies. The databases Embase, MEDLINE, CINAHL, PsycINFO, and PakMediNet will be searched. Screening and data extraction will be completed independently by two reviewers. To be included, the article must be as follows: peer reviewed, primary research, study cutaneous burns, based on hospital patients from a country in South Asia, and use intent terminology or discuss a method of differentiation of injury intent. Results will be restricted to English language studies. No date restrictions will be applied. A plain language summary and terminology section are included for non-specialist readers.DiscussionResults will be used to inform stakeholder work to develop standardised terminology and methods for burn injury intent in South Asia. They will be published open access in peer-reviewed journals wherever possible.Systematic review registrationThis review has been registered with the Open Science Framework (https://doi.org/10.17605/OSF.IO/DCYNQ).

Drug Counterfeiting: Key Factors Affecting Vulnerable People in the World

Drug counterfeiting has been a major problem for the government and regulatory agencies since the beginning of the 20th century. Most of the drug counterfeiting reported is in countries where a high demand for drugs combines with poor surveillance, quality control, regulation, and education to make it easy for criminals and cartels to supply it to the market through illegal sources. These fake medications are frequently produced in hazardous conditions, with insufficient, excess, or no active ingredients, and/or by using potentially harmful and even fatal chemicals. Counterfeit drugs mostly affect vulnerable sections of society due to their social and economic conditions. Some critical factors, such as insufficient or no health insurance coverage, disparities with racial and ethnic minorities, government policies, low income, lack of education, and uncontrolled online pharmacies, tend to attract them towards counterfeit drugs. This article explains the key risk factors of counterfeit drugs operating in legal environments and reviews recent adverse cases in the pharmaceutical supply chain.

Homeobox Gene Expression Dysregulation as Potential Diagnostic and Prognostic Biomarkers in Bladder Cancer.

Homeobox genes serve as master regulatory transcription factors that regulate gene expression during embryogenesis. A homeobox gene may have either tumor-promoting or tumor-suppressive properties depending on the specific organ or cell lineage where it is expressed. The dysregulation of homeobox genes has been reported in various human cancers, including bladder cancer. The dysregulated expression of homeobox genes has been associated with bladder cancer clinical outcomes. Although bladder cancer has high risk of tumor recurrence and progression, it is highly challenging for clinicians to accurately predict the risk of tumor recurrence and progression at the initial point of diagnosis. Cystoscopy is the routine surveillance method used to detect tumor recurrence. However, the procedure causes significant discomfort and pain that results in poor surveillance follow-up amongst patients. Therefore, the development of reliable non-invasive biomarkers for the early detection and monitoring of bladder cancer is crucial. This review provides a comprehensive overview of the diagnostic and prognostic potential of homeobox gene expression dysregulation in bladder cancer.

Irrational use of antibiotics and factors associated with antibiotic resistance: Findings from a cross-sectional study in Bangladesh.

Irrational antibiotic (AB) usage poses a serious concern to third-world countries because of poor surveillance, lack of information, and patients' propensity for self-medication. Additionally, the unpredictability of the coronavirus disease 2019 (COVID-19) pandemic promoted the abuse of ABs, which accelerated the prevalence of antibiotic resistance (ABR). The primary aim of this study was to assess the pattern of AB usage and irrational use of ABs-related potential factors associated with ABR among the students and teachers of a leading public university of Bangladesh. A cross-sectional web-based survey was conducted among the students and teachers (n = 783) of the selected university, from January 1 to February 28, 2022. Descriptive statistics, χ 2 test, and logistic regression analysis were employed to analyze the collected data. The regression analysis supported that male participants had a 34% lower experience of acquiring ABR than female respondents (adjusted odds ratio [AOR] = 0.66, 95% confidence interval [CI] = 0.448, 0.973; p = 0.036). The 1st/2nd-year level students had more than two times higher experience with ABR than the master's or higher-class students (AOR = 2.149, 95% CI = 1.047, 4.412; p = 0.037). The participants who took ABs for 4-6 days showed more than two times ABR experience than those who took ABs for above 10 days (AOR = 2.016, 95% CI = 1.016, 4.003; p = 0.045). Respondents who finished their AB medication (dose completion) had a 57% less chance of acquiring ABR than the participants who did not complete their dose. This study found that irrational use of ABs is more prevalent among the youth and female participants. At this stage, there is an urgent need for comprehensive statutory AB control rules, as well as measures for appropriate information, education, and surveillance throughout different groups of Bangladesh.