Portal Of Entry Research Articles

Robot-assisted mitral valve surgery may be supported by patient-specific planning aid in port placement

Robotic-assisted mitral valve surgery is gaining renewed popularity in the global surgical community. Appropriate patient-specific planning is pivotal for the safety and effectiveness of this procedure. One main step in this perspective is represented by the choice of placement of four ports in the right chest, for the introduction of robotic arms. Individual anatomical features (e.g., chest morphology and position of the mitral valve inside the chest) may determine inadequate surgical exposure, conversion to open procedure, or refusal for the technique. Currently, and contrary to robotic-assisted procedures in other surgical specialties, there is no dedicated approach or tool for patient-specific planning aimed at formally addressing these issues preoperatively. Herein, we present a dedicated, comprehensive method entailing: a homemade algorithm for rib segmentation (deep learning approach) and identification of intercostal spaces / candidate port entry sites; semiautomatic definition of a target working volume (mitral valve); definition of dedicated Performance Measure J* based on each potential triad of thoracic ports entry sites. We propose the dedicated J* parameter to better indicate the optimal patient-specific entry port solution than other parameters (h_e, ic, CCI and E). Prospective clinical studies should be based on the J* parameter. We hypothesize that this approach, dedicated to the requirements of robotic-assisted mitral valve surgery, may enhance the safety and the diffusion of this surgical strategy.

Trend in Infective Endocarditis in Bulgaria: Characteristics and Outcome, 17-Years, Single Center Experience.

Infective endocarditis (IE) remains a difficult disease to diagnose and treat, with a persistently high mortality rate. There is a lack of recent data on IE in Bulgaria over the last decades. This study is retrospective, single-centered, and includes 270 patients diagnosed with IE for the period 2005-2021. We compared two periods, 2005-2015 (n = 119) and 2016-2021 (n = 151), to find the characteristics changes. The study included 177 (65.5%) male patients. In the second period, there is a significant increase in age from 62 (44-73) to 67 (53-75), (p = 0.023); in the Charlson comorbidities index (CCI) from 3 (1-4) to 4 (2-6), (p = 0.000); in cases with chronic kidney diseases (CKDs) from 15 (12.6%) to 55 (36.9%), (p = 0.001); coronary arterial diseases (CADs) from 20 (16.85%) to 44 (29.1%), (p = 0.018); and atrial fibrillation (AF) from 13 (10.9%) to 36 (23.8%), (p = 0.006). Ejection fraction decreased significantly in the second period from 63 (56-70) to 59 (51-66), (p = 0.000). Almost half of the patients 123 (45.6%) had no known predisposing cardiac condition, and 125 (46.3%) had an unknown port of entry. IE was community-acquired in 174 (64.4%), healthcare-associated in 72 (26.7%), and injection-drug-use-related IE in 24 (8.9%). The study population included 183 (67.8%) native valve IE, 85 (31.5%) prosthetic IE, and 2 (0.74%) intracardiac-device-related IE. The hemocultures were positive in 159 (59.6%), and the most frequent pathogenic agent was staphylococci-89 (33.3%) (Staphylococcus aureus-44 (16.5%) and coagulase negative staphylococci-45 (16.8%)). Only 54 (20%) of patients underwent early surgery. The all-cause 30-day mortality rate was 67 (24.8%). There is no significant difference between the two periods in terms of the characteristics listed above. The profile of IE in Bulgaria has changed with increasing age and comorbidity, changing predisposing cardiac conditions, and entry door. The most common pathogen was the Staphylococcus spp. The 30-day mortality rate remains high.

Thoracic aortic pseudoaneurysm: Inside its pathophysiology.

Our aim was to investigate pathophysiology of pseudoaneurysm of the thoracic aorta, an acute or chronic pathology, respectively, secondary to blunt thoracic trauma and aortitis, or complicating a deep penetrating aortic ulcer, intraparietal hematoma, aortic aneurysm, and even aortic graft, often with atherosclerosis as a common background. Given the relative rarity of this disease, an "inductive" retrospective method made it possible to retrieve clinical, radiological, and histopathological elements, which were mutually compared and validated through a "deductive" process of reinterpretation. We have identified three main structural constituents of this disease: a cavity, a single blood entry port, communicating with the aortic lumen, and a pseudocapsule. It is often caused by a chronic degenerative pathology of the intima and medial layers of the aorta, typically involving elastic fibers and smooth muscle cells, with possible intermediate stages of deep aortic ulcer or intraparietal hematoma. Otherwise, the acute onset may be secondary to acute aortitis or aortic injury. Today, thanks to the current angiographic tools represented by 3-D high resolution multidetector CT and MRI angiography, the diagnosis of thoracic aortic pseudoaneurysm is easier, as well as its surgical indications.

Bacteremia caused by Desulfovibrio desulfuricans with the intestinal tract as the portal of entry: two case reports and a literature review

BackgroundDesulfovibrio desulfuricans (D. desulfuricans), a commensal anaerobic gram-negative rod endemic to the soil environment and human gastrointestinal tract, rarely causes bloodstream infections. We report two rare cases of bacteremia caused by D. desulfuricans in which the intestinal tract was the portal of entry. In addition, we summarize findings on D. desulfuricans.Case presentationCase 1: A 51-year-old man presented to the emergency department with the chief complaints of fever and right lower abdominal pain. He was admitted to the hospital with ascending colonic diverticulitis and received empirical antibacterial therapy with piperacillin/tazobactam. Blood culture revealed D. desulfuricans. The patient was discharged after 2 weeks of antimicrobial therapy. Case 2: A 95-year-old woman presented to our hospital with a chief complaint of fever. Owing to an elevated inflammatory response and pyuria, the patient was diagnosed with pyelonephritis and treated with ceftriaxone. Klebsiella pneumoniae was detected in her urine culture, while D. desulfuricans was detected in her blood culture. The patient was then treated with ampicillin/sulbactam for 14 days. The fecal occult blood test result was positive, suggesting a colonic mucosal lesion, such as a malignant tumor, may have been the portal of entry for D. desulfuricans bacteremia. Previous literature reviews indicate that D. desulfuricans bacteremia often results from liver or renal abscesses, intestinal lesions, among others, serving as the portal of entry. Although no specific underlying disease has been reported, it is more common in the older population. We encountered two cases of D. desulfuricans bacteremia and combined them with 15 cases from previous studies to explore the characteristics of the disease. The proportion of patients aged \\documentclass[12pt]{minimal} \\usepackage{amsmath} \\usepackage{wasysym} \\usepackage{amsfonts} \\usepackage{amssymb} \\usepackage{amsbsy} \\usepackage{mathrsfs} \\usepackage{upgreek} \\setlength{\\oddsidemargin}{-69pt} \\begin{document}$$\\:\\ge\\:$$\\end{document}60 years was 73.7%; overall, 73.7% had gastrointestinal complications, and 63.2% had abdominal symptoms at the time of presentation.ConclusionsWe encountered two rare cases of D. desulfurican bacteremia. This type of bacteremia is more common in elderly people over 60 years of age and is often associated with hepatobiliary and gastrointestinal diseases.

Assessing Worker Exposure to Vehicle Exhaust Emissions and Self-Reported Exposure Symptoms at the Lebombo Port of Entry, in Mpumalanga, South Africa

Assessing Worker Exposure to Vehicle Exhaust Emissions and Self-Reported Exposure Symptoms at the Lebombo Port of Entry, in Mpumalanga, South Africa

A Ten-Year Review of Neonatal Tetanus Seen in a Tertiary Health Facility in Sokoto North-Western Nigeria: Before and During the Covid-19 Pandemic

Background: Neonatal tetanus (NNT) remains among the leading cause of preventable morbidity and mortality among neonates in Nigeria. Nigeria remains among the countries carrying the global NNT burden. At the onset of the COVID-19 pandemic, reports have predicted that the pandemic will significantly impact on the health system globally, and low-resource countries where vaccination programs fared even worse are likely to see a surge in vaccine-preventable diseases during and after COVID-19 pandemic. Aims: To determine the prevalence, yearly trend, risk factors, and outcome of NNT cases seen in the Special Care Baby Unit (SCBU) of Usmanu Danfodiyo University Teaching Hospital (UDUTH), Sokoto, Nigeria over a ten year period: before and during COVID-19 pandemic. Methods: This was a retrospective study. Data was retrieved from all the case notes of neonates admitted with a clinical diagnosis of NNT into the SCBU of the UDUTH, Sokoto from 1st January, 2013 to 31st December, 2022. The data obtained was analyzed using SPSS version 21. Results: During the 10 years period of the study, NNT accounted for 0.4% of admissions. The majority 15(57.0%) of the mothers of the neonates with NNT were from rural areas, 15(56.0%) had no antenatal care (ANC), and only 10(37.0%) of the mothers received vaccination against tetanus. All the mothers were from lower socio-economic classes. Most 17(63.0%) of the neonates were delivered at home by traditional birth attendants. The umbilical cord was the portal of entry in 26(96.0%) of cases, while 1(4.0%) followed traditional uvulectomy. Cord care was done using hot water fermentation in more than half of the neonates 17(63.0%), while only 1(4.0%) of the mothers used chlorhexidine gel for cord care. The case- fatality rate was 6(22.0%). the yearly trend showed an increased incidence of NNT admissions in 2022. Conclusion: The study showed that NNT is still a public health problem, with an increased scourge during the COVID-19 pandemic, which can be tackled through health education of mothers via mass media, improving the quality and access to ANC services, tetanus toxoid vaccination, hospital delivery and avoidance of traditional uvulectomy particularly in rural areas by the Sokoto state government. Antenatal and vaccination services should be given priority in response to future pandemics to sustain gains of the SDG 3.

Distribution and accumulation of UV filters (UVFs) and conservation status of Posidonia oceanica seagrass meadows in a prominent Mediterranean coastal tourist hub

This study investigates the presence and impact of UV filters in Posidonia oceanica meadows in Formentera, a Mediterranean tourist hotspot. It highlights the distribution of inorganic (TiO2 and ZnO) and organic UV filters (UVFs) in different environmental matrices, their accumulation in seagrass tissues and their impact on the seagrass health.In the overlying and canopy waters of P. oceanica, Zn concentrations surpassed Ti, with three organic UVFs (benzophenone-3 [BP-3], avobenzone and homosalate [HMS]) consistently detected. Ti concentrations were generally higher than Zn in rhizosphere sediments, along with recurrent presence of octocrylene, HMS, 2-ethylhexyl methoxycinnamate (EHMC), and 4-methylbenzylidene camphor (4-MBC). Maximum Zn concentrations were found in canopy waters (3052.9 ng L−1). Both Ti and Zn were found in all P. oceanica tissues and leaf epiphytes across all study sites. Additional UVFs like octocrylene, avobenzone, and BP-8 were also detected in P. oceanica tissues and epiphytes. Elevated levels of octocrylene in leaf epiphytes (2112.1 ng g−1 dw) and avobenzone in leaves (364.2 ng g−1 dw) and leaf epiphytes (199.6 ng g−1 dw) were observed in the Port of La Savina, the island's main entry port. Octocrylene concentrations (up to 2575 ng g−1 dw) in rhizosphere sediments near sewage discharge points exceeded reported maxima, highlighting wastewater treatment plants as significant sources of organic UVFs. Correlational analyses suggested that the accumulation of octocrylene, avobenzone, and BP-3 negatively impacted P. oceanica's conservation status, affecting global density, density at 100 % cover, and leaf morphometry. Positive correlations were observed between leaf polyphenols (antioxidants) and concentrations of avobenzone, benzophenone-8 (BP-8), and BP-3, indicating potential oxidative stress induced by UVFs in P. oceanica.Our study underscores the pervasive presence of UV filters in P. oceanica habitats, with implications for seagrass health and conservation, especially in areas of high tourism and sewage discharge.

Cross-Sectional Retrospective Epidemiological Study of 9-1-1 Calls to the El Paso, Texas, and Ciudad Juárez International Border Crossing

The El Paso-Juárez metroplex comprises one of the world's busiest international land border crossings. Although prior studies have described prehospital care along the US-Mexico border, the epidemiology of 9-1-1 calls to the El Paso-Juárez border crossings has not been previously reported. Investigators sought to evaluate responses by emergency medical services (EMS) at El Paso-Juárez ports of entry (POE). Methods: This cross-sectional, retrospective study evaluates prehospital care provided by EMS at three international bridges in El Paso. The El Paso Fire Department (EPFD) provided data for all encounters between February 2017 and January 2023. This included date, POE, patient demographics, chief complaint, computer-aided dispatch (CAD), provider impression (diagnosis), and time out of service. Results: Over the study period, 8,407 encounters occurred at one of the three El Paso-Juárez POE, averaging 1,680 per year or 140 calls per month. The busiest month was July, with a median of 132 encounters. 45% of these calls took place at the Paseo Del Norte POE. The study population comprised 59% Hispanics, 4129 (49%) male, and 4266 (51%) female, from 0 to 103 years of age. The most common diagnosis was neurological (1,908, 22.7%), GI/GU (1,263, 15%), and injury or trauma (1117, 13%). 6,420 hours were spent responding to POE calls, the average call resulting in a 46-minute out-of-service time. Conclusion: This was the first study to investigate the epidemiology of prehospital care provided by EMS at the El Paso-Juárez international border crossing. A total of 8,407 prehospital EMS encounters occurred over the study period, which is expected to grow. We found roughly equal proportions of male and female patients with a wide range of ages. The most common diagnoses were weakness, abdominal pain, and non-traumatic pain. The results of this study could be utilized to enhance the quality of EMS offered at international border crossings.

Molecular Identification of Mycobacterium leprae in the Leprosy Patients.

Several discoveries about leprosy indicate that Mycobacterium leprae transmission mainly occurs by inhalation, and the nose is a major port of entry and exit. Molecular probes have shown certain potential for the detection and identification of M. leprae in patients. The aim of this study was to identify M. leprae in nasal swab specimens using polymerase chain reaction (PCR)-based assays followed by gene sequencing methods. This observational study examines 64 anterior nasal swab samples taken from pretreatment leprosy patients, on-treatment and completed leprosy treatment in Bulukumba, South Sulawesi, Indonesia. samples were analyzed by molecular detection methods according to the standard methods at the Clinical Microbiology Laboratory of Hasanuddin University. Descriptive statistics were utilized to summarize patient demographics and outcomes. This study uses PCR to detect the M. leprae deoxyribonucleic acid (DNA) from nasal swab specimens. Data were collected from 64 patients with a percentage of male patients 51.54%. Based on the age category, the group 45-46 years was the most frequent (39.05%). PCR detection proline-rich antigen gene of a 531 bp DNA fragment from M. leprae, was positive in eight patients, and they were multibacillary. Furthermore, PCR was positive in 5 (31.25%) of 16 new leprosy patients, 2 (8.69%) of 23 on-treatment patients, and 1 (4%) of 25 treatment completed patients. Based on the results of the phylogenetic tree and analysis of 8 positive results detected by M. leprae from leprosy patients, almost all samples have a level of similarity, except for sample Ua7. M. leprae cannot grow in vitro, so molecular diagnostic tools were used to confirm the disease. This study predominantly of males with the age above 45 years of age being the most common. Eight M. leprae were positive from nasal swab leprosy patients. The sequencing findings provide insight into the genetic diversity of the genus M. leprae, so it is necessary to consider the detection of whole-genome sequence.

Continuum of global to local dispersal frameworks highlights the increasing threat of pine wilt disease in China

The global introduction of human-mediated trade and local dispersal through transport or natural pathways are major processes and contributors to biological invasion. To effectively prevent and manage biological invasion, global introduction pathways and local dispersal processes of biological invasions need to be considered as a continuum of global to local dispersal (CGLD). However, there has been no unified CGLD framework developed that simultaneously considers global introduction pathway dynamics and multiple local dispersal processes with human-mediated and natural pathways to guide the development of effective management priority strategies for pine wilt disease. In this study, we constructed a CGLD framework to evaluate the global introduction and local dispersal risks of pine wilt disease. This is an invasive forest pathogen caused by the pine wood nematode (PWN) Bursaphelenchus xylophilus, which causes severe harm to forestry ecosystems worldwide. The global introduction network dynamics has indicated that the introduction pressure of PWN continually increased during 2003–2016. The highest-risk source country and entry port were the United States and Jiangsu ports, respectively. The local dispersal modes of PWN were mainly presented a random structure with lots of “in-filling” dispersal events during 2010–2021. The PWN populations in China have gradually dispersed to non-analogous climatic regions compared to those in the native and other invasive ranges. The dispersal risk areas of PWN primarily cover southwestern, eastern, central, and northeastern China. Such integration can facilitate more accurate prediction of global introduction and local dispersal pathway risk of biological invasion and provide vital guidance for designing management priority strategies to prevent invasion.

Border Barriers and Illicit Trade Flows

Abstracts The number of fortified borders around the world has risen precipitously. This surge in walls is an important part of the larger globalization “backlash,” as countries react to the unwanted consequences of economic openness and globalization, with a rise in illicit trade and smuggling being a prominent example. Despite the prominence of the idea that walls are built to combat illicit flows, no research systematically explores how walls generally affect illicit trade. This is a notable omission for at least two reasons. First, the most prominent explanations for wall construction put combating illicit trade front and center. Second, recent work that finds walls significantly reduce legal trade argues that this finding derives from border fortifications diverting illegal trade to ports of entry, which leads to more inspection, security, and transaction costs. We develop a new measure of illicit trade flows using over five decades of product-level data and provide a battery of evidence that shows border barriers increase illicit flows at ports of entry.

Unusual Cutibacterium acnes splenic abscess with bacteremia in an immunocompetent man: phylotyping and clonal complex analysis

BackgroundCutibacterium acnes is an anaerobic bacterium mostly implicated in cutaneous and body-implant infections. Splenic abscess is a rare entity and C. acnes abscesses have only exceptionally been reported. We describe a spontaneous splenic C. acnes abscess in an immunocompetent man with no predisposing factors or identified portal of entry. His isolates were subjected to single-locus sequence typing (SLST) to explore their genetic relatedness and better understand this rare infection.Case presentationA splenic abscess was diagnosed on a computed-tomography scan in a 74-year-old man with chronic abdominal pain. No risk factor was identified. Abscess-drained pus and post-drainage blood cultures grew C. acnes. SLST of abscess and blood isolates showed that they belonged to the same C. acnes SLST type C1 found in normal skin and rarely in inflammatory skin disease. Specific virulence factors could not be identified.ConclusionC. acnes abscesses are extremely rare and can develop in immunocompetent patients without an identifiable portal of entry. Molecular typing of clinical isolates can help confirm infection (versus contamination) and enables genetic background comparisons. Further research is needed to understand C. acnes tropism and virulence.

Concentrations and Oxidative Potential of PM2.5 and Black Carbon Inhalation Doses at US–Mexico Port of Entry

Located between Mexico and the US, the San Ysidro/El Chaparral Land Port of Entry (SYPOE) is one of the busiest border crossings in the world. People with activities at the SYPOE are exposed to vehicular pollutants, especially particles with aerodynamic diameters < 2.5 µm (PM2.5) and black carbon (BC), both associated with adverse health effects. This study presents the first PM2.5 and BC concentration measurements collected on the Mexican side of the SYPOE. The oxidative potential (OP) for PM2.5 and the inhalation dose of BC for people at the border were also evaluated. Autumn and winter showed the highest PM2.5 concentrations (at 28.7 μg m−3 and 28.2 μg m−3, respectively). BC concentration peaked in the winter of 2017 (at 5.7 ± 6 μgm−3), demonstrating an increase during periods with low wind speeds. The highest OPDTT of PM2.5 was reached in winter, with a value of 18.5 pmol min−1 µg−1 (0.6 nmol min−1m−3). The highest average daily inhalation dose for pedestrians was registered in the autumn of 2018 (5.9 μg for a 60-min waiting time), whereas, for workers, it was in the winter of 2017 (19 μg for a 10-h shift on average). Decreasing waiting times for pedestrians and adjusting work schedules for border workers on high concentration days could ameliorate environmental justice.

Comparative study of Candidiasis among Single and Married women at Rwanda Military Hospital

Background: Genital tract is the portal of entry for numerous sexually and non-sexually trans­mitted diseases. A number of bacterial and non-bacterial infections exist that affect the female reproductive tract and cause vaginal discharge. Candida species are among im­portant opportunistic pathogens causing candidiasis in human worldwide. These yeast species are of public health concern nowadays. Aim: This study aimed at comparing the prevalence of candidiasis among single and married women attending Rwanda Mili­tary Hospital. The study population comprises of single and married women. Methodology: This was a retrospective study where data was collected from Rwanda Military Hospital. Results: The re­sults of this study showed that the incidence of candidiasis was higher in married women when compared with single women. The prevalence of candidiasis in married women was 128(74.4%), while in single women is 44(25.6%). It was observed in this study that the distribution of candidiasis among married and single is statistically sig­nificant (p<0.05). Results also show that out of 172 single and married women, more cases of candidiasis were observed within the age range of 21-30 years, 66 (44.2%) were infected with candida albicans, 31-40 years had a prevalence of 55(32%) and 11-20 years had a prevalence of 13(7.6%). The overall of cases of candida other than C. albicans observed was 15.1%. Conclusion: This study showed that married and single women are predisposed to candidiasis. It is therefore important to give opportunistic pathogens like Candida species attention in women especially among married ones as they are mostly affected by this candidiasis. Keywords: Candidiasis, C. albicans, Vaginal discharge, Urinary tract infection, bacterial vaginosis, aerobic vaginitis.

A Novel Endoscopic Approach for Treating Breast Cancer: Haigui-1 Hole.

Endoscopic surgery is an effective technique for preserving the nipple and areola, as well as for sentinel lymph node biopsy and breast implant reconstruction. However, the technical challenges associated with endoscopic surgery have limited its widespread adoption. In the normal single-port endoscopic surgery, the ultrasonic knife was accessed through the retractor. In our modified procedure, a tiny 5mm incision was made at the lateral margin underneath the breast, serving as the second entry port for the ultrasonic scalpel, which was referred to as the "Haigui-1 hole". Preoperative and postoperative indicators such as blood loss, operative time, and postoperative drainage volume were collected. Differences between parameters were compared using Student's t test. Endoscopic surgery with the assistance of the "Haigui-1 hole" led to preserved breast aesthetics with minimal scarring. Moreover, "Haigui-1 hole" surgery significantly reduced the operation time, intraoperative bleeding, and postoperative drainage volume compared to normal single-port endoscopic surgery. The "Haigui-1 hole" procedure, which involves the addition of a second entrance to improve the maneuverability of the ultrasonic knife, is worthy of further promotion.

On alert for Ebola: public health risk assessment of travellers from Uganda to the USA during the 2022 outbreak.

On 20 September 2022, the Ugandan Ministry of Health declared an outbreak of Ebola disease caused by Sudan ebolavirus. From 6 October 2022 to 10 January 2023, Centers for Disease Control and Prevention (CDC) staff conducted public health assessments at five US ports of entry for travellers identified as having been in Uganda in the past 21days. CDC also recommended that state, local and territorial health departments ('health departments') conduct post-arrival monitoring of these travellers. CDC provided traveller contact information, daily to 58 health departments, and collected health department data regarding monitoring outcomes. Among 11 583 travellers screened, 132 (1%) required additional assessment due to potential exposures or symptoms of concern. Fifty-three (91%) health departments reported receiving traveller data from CDC for 10 114 (87%) travellers, of whom 8499 (84%) were contacted for monitoring, 1547 (15%) could not be contacted and 68 (1%) had no reported outcomes. No travellers with high-risk exposures or Ebola disease were identified. Entry risk assessment and post-arrival monitoring of travellers are resource-intensive activities that had low demonstrated yield during this and previous outbreaks. The efficiency of future responses could be improved by incorporating an assessment of risk of importation of disease, accounting for individual travellers' potential for exposure, and expanded use of methods that reduce burden to federal agencies, health departments, and travellers.

An Exploration of Police Corruption at Durban Harbour Port of Entry in South Africa

This study delves into the pervasive issue of police corruption within a critical context of the Durban Harbour port of entry in South Africa. Police corruption poses a significant challenge to the integrity of law enforcement functioning of ports. This research highlights the role of inadequate training, resource constraints, bureaucratic inefficiencies, and lack of oversight as a significant contributing factor. It emphasises the necessity of enhancing organisational accountability, improving training programmes, and fostering a culture of ethical conduct to mitigate corruption. Lastly, this article recommends that addressing police corruption at the Durban Harbour port of entry demands a holistic and interdisciplinary approach involving law enforcement agencies, government bodies, civil society, and the private sector. The insights gained from this investigation can inform targeted interventions and policy reforms to fortify the integrity of law enforcement and enhance the security and efficiency of harbour port operations.

Novel insights into immune stress markers associated with myxosporeans gill infection in Nile tilapia (molecular and immunohistochemical studies).

Nile tilapia (Oreochromis niloticus) is valued in aquaculture because of its quick development and ability to thrive in various environments. Myxosporeans are among the fish parasites that affect fish productivity, as they impact fish growth and reproduction, resulting in large fish deaths in farms and hatcheries. This study has been focused on morpho-molecular identification for the myxosporean parasites infecting Nile tilapia from three governorates in Egypt and assessment of gene expression of different cytokines (Interleukin-1βeta (IL-1β), major histocompatibility complex class II (MHC-II), and clusters of differentiation 4 (CD-4) and 8 (CD-8)) in tissues. Additionally, this work aimed to correlate the developed histopathological alterations and inflammatory reactions in gills with immunohistochemical expression of inducible nitric oxide synthase (iNOS) and tumor necrosis factor-alpha (TNF-α). Finally, the infected fish's cortisol levels and blood glucose were assessed. Results of BLAST sequence analysis of the 18S rRNA for the collected protozoans confirmed Myxobolus agolus, M. brachysporus, M. tilapiae, and Henneguya species. The molecular characterization of the immunological status of gills revealed marked upregulation of different inflammatory cytokines in the gills of infected fish. There was a significantly increased serum cortisol and glucose level in infected fish compared with control, non-infected ones. Severe histopathological alterations were observed in the infected fish gills, associated with increased expression of iNOS and TNF-α and related to myxosporean infection. The present study provides new insights into oxidative stress biomarkers in Nile tilapia infected with Myxosporeans and elucidates the gill's immune status changes as a portal of entry for protozoa that contribute to tissue damage.

Response of the Bureau of Customs (BOC) in Facilitating Cross-Border Movement of Essential Supplies During the COVID-19 Pandemic

COVID-19 pandemic is a global crisis that did not only affect humans but also the global economy, causing a lot of struggles in both the society and the government. The efficient facilitation of cross-border goods in situations like this is very essential as this provides access to food and other important goods. However, given the creation of the Joint Administrative Order (JAO) No. 01-2020, an order expediting the clearance of relief consignments that enter the Philippines during a state of calamity, questions have been raised if the implemented facilitation of cross-border goods were effective or not. Anchoring from JAO No. 01-2020, the study aimed at measuring the works done by customs brokers in facilitating the cross-border movement of essential supplies during the COVID-19 pandemic. It also assessed the level of effectiveness of the measures implemented by the Bureau of Customs (BOC) in facilitating the cross-border movement of essential supplies during COVID-19 pandemic. Employing descriptive-survey design, and snowball non-random sampling technique, the study employed 31 customs brokers as respondents of the study. All respondents have transacted or handled essential supplies from the port of entry at Ninoy Aquino International Airport (NAIA) before and during the pandemic. Frequency count and weighted mean were used to analyze the data. Based on the results, the measures stated in JAO 01-2020 were rated “applied” by the respondents. Specifically, the Duty and Tax Treatment for Relief Consignments, the Expediting Clearance and Movement of Containers, and the Regular Processing of Relief Consignment during a Local State of Calamity were all rated "applied". While the Simplified Cargo Clearance Process for Relief Consignment was rated "highly applied". In term of effectiveness, the “Duty and Tax Treatment for Relief Consignments," the “Expediting Clearance and Movement of Containers," the "Simplified Cargo Clearance Process for Relief Consignment", and "the Regular Processing of Relief Consignment during a Local State of Calamity" were all rated “effective” by the respondents. These findings suggest that the measures indicated in JAO No. 01-2020 were effectively implemented by the customs brokers. However, there may be areas for improvement, particularly in streamlining processes and addressing logistical challenges to further enhance the effectiveness and efficiency in supply chain management during crises like the COVID-19 pandemic.

Is SARS-CoV-2 elimination or mitigation best? Regional and disease characteristics determine the recommended strategy.

Public health responses to the COVID-19 pandemic varied across the world. Some countries (e.g. mainland China, New Zealand and Taiwan) implemented elimination strategies involving strict travel measures and periods of rigorous non-pharmaceutical interventions (NPIs) in the community, aiming to achieve periods with no disease spread; while others (e.g. many European countries and the USA) implemented mitigation strategies involving less strict NPIs for prolonged periods, aiming to limit community spread. Travel measures and community NPIs have high economic and social costs, and there is a need for guidelines that evaluate the appropriateness of an elimination or mitigation strategy in regional contexts. To guide decisions, we identify key criteria and provide indicators and visualizations to help answer each question. Considerations include determining whether disease elimination is: (1) necessary to ensure healthcare provision; (2) feasible from an epidemiological point of view and (3) cost-effective when considering, in particular, the economic costs of travel measures and treating infections. We discuss our recommendations by considering the regional and economic variability of Canadian provinces and territories, and the epidemiological characteristics of different SARS-CoV-2 variants. While elimination may be a preferable strategy for regions with limited healthcare capacity, low travel volumes, and few ports of entry, mitigation may be more feasible in large urban areas with dense infrastructure, strong economies, and with high connectivity to other regions.