Real Burden Research Articles

Antibiotic Resistance Patterns of Pseudomonas aeruginosa Bacterial Species Isolated from Various Clinical Samples

Pseudomonas aeruginosa infections have become a real burden in healthcare settings, contributing substantially to nosocomial infections. The emergence of several drug-resistant strains was the major issue causing massive mortality. Multiple-drug resistant Pseudomonas aeruginosa isolates containing beta-lactamase were becoming more prevalent. Objective: To investigate and characterize the antibiotic resistance patterns of Pseudomonas aeruginosa isolated from different clinical samples. Methods: A total of 618 different clinical samples including blood, pus and urine samples were collected from the patients visiting Indus Medical College Hospital Tando Muhammad Khan, Sindh, Pakistan. All the clinical samples were processed for the isolation of bacterial species using specific culture media. The identification of Pseudomonas aeruginosa strains was achieved based on Gram’s staining and certain biochemical tests including Cetrimide test. Moreover, antibiotic susceptibility testing was determined by Kirby-Bauer disc diffusion method. Results: A total of 452 bacterial strains were isolated and pure cultured from different clinical samples. Among these, 60.62% were Gram-negative and 25% of the total isolates were found to be Pseudomonas aeruginosa strains. Antibiotic sensitivity testing results revealed the highest resistance ratio of Pseudomonas aeruginosa strains against Ticarcillin (46.02%), while Colistin showed the lowest resistance (3.54%). Overall, 14.15% of the isolates of Pseudomonas aeruginosa strains were found to be multi-drug-resistant bacteria. Conclusion: The results of the present study reveal an increased ratio of antibiotic resistance particularly of Ticarcillin, piperacillin and imipenem in Pseudomonas aeruginosa isolated from various clinical samples.

Spotlight on the epidemiology and antimicrobial susceptibility profiles of Vibrio species in the MENA region, 2000-2023.

Recent cholera outbreaks in many countries in the Middle East and North Africa (MENA) region have raised public health concerns and focused attention on the genus Vibrio. However, the epidemiology of Vibrio species in humans, water, and seafood is often anecdotal in this region. In this review, we screened the literature and provided a comprehensive assessment of the distribution and antibiotic resistance properties of Vibrio species in different clinical and environmental samples in the region. This review will contribute to understanding closely the real burden of Vibrio species and the spread of antibiotic-resistant strains in the MENA region. The overall objective is to engage epidemiologists, sanitarians and public health stakeholders to address this problem under the One-health ethos.

Prevalence of occult hepatitis C virus infection (OCI) among hemodialysis patients; a cross-sectional study from Lorestan Province, Western Iran.

Patients with chronic kidney disorders, such as hemodialysis, are at a higher risk of infection with hepatitis viruses than the other population due to high nosocomial transmission by the dialysis units. The incidence of occult HCV infection (OCI) among chronic hemodialysis (CHD) remains controversial and the real burden of HCV in this population may be affected by the rate of OCI. This study aimed to evaluate the prevalence of OCI among patients with CHD from Lorestan province, Western Iran. In this cross-sectional study, whole blood samples were collected from 122 patients with CHD. Subsequently, anti-HCV antibody and HCV-RNA were assessed in serum/peripheral blood mononuclear cells (PBMCs) using Enzyme-Linked Immunosorbent Assay and Real-Time PCR technique, respectively. Out of the 122 patients, 61.15% were male and 38.8% were female. Regarding HCV results, out of the 122 studied patients, 4 cases (3.3%) were positive for anti-HCV IgM Ab and 3 patients (2.47%) for anti-HCV IgG Ab in their serum. Moreover, none of the 122 patients were positive for HCV-RNA in serum samples, while in PBMC samples, two patients (1.6%) tested positive for HCV-RNA, of which one patient was anti-HCV IgG Ab positive. Furthermore, the prevalence of OCI was correlated with the history of blood transfusion and serum level of transaminases (P = 0.012). The results of the current study suggest that there is a potential risk of occult HCV infection among patients undergoing hemodialysis. Therefore, it is necessary to use appropriate molecular techniques for early diagnosis and treatment of these patients.

Prescribing Patterns of Intravenous Artesunate for Severe Malaria and Compliance with National Malaria Treatment Protocol, Gezira State, Sudan

Background: Malaria is a major public health problem in Sudan. Severe malaria, due in majority of cases to P. falciparum, poses a real burden on hospitals. This study aims to describe the prescribing pattern of intravenous artesunate (IV-AS) for severe malaria and compliance with national malaria treatment protocol in Gezira State, Sudan. Methods: The study enrolled severe malaria patients who were admitted to the Wad Madani Teaching Hospital during June – August 2022. Patients were verbally consented and followed at hospital level till discharge. Data was recorded on data collection sheet and analyzed using SPSS version 20. Results: Over three months period, 500 patients were diagnosed as having severe malaria based on clinical criteria and the results of thick blood film. The majority were from rural areas and most of them were male. IV-AS was administered for all patients and 71% of patients discharged after administering three doses of artesunate with no serious adverse effects. In 96.4% of patients, the prescription followed the right dosage schedule. The source of the drug was health insurance fund and private sector in 78.4% and 21.6% respectively. The study investigates the prescribing patterns of intravenous artesunate (IV-AS) for severe malaria and compliance with the national malaria treatment protocol in Gezira State, Sudan. A Chi-Square Test of Independence was used to explore associations between gender and the number of IV-AS doses received, as well as between residence (rural vs. urban) and compliance with the dosage schedule. The results showed no significant association between gender and the number of IV-AS doses received (p = 0.915), and no significant association between residence and compliance with the dosage schedule (p = 0.925). These findings suggest that the prescribing patterns and compliance with the treatment protocol are consistent across different genders and between rural and urban patients. Conclusion: Severe malaria patients were treated with IV-AS according to national malaria treatment guidelines with few exceptions. Most patients discharged after administering three doses of artesunate with no serious adverse side effects. Efforts to establish quality assured microscopy and to maintain the current prescription pattern is highly needed.

Long Neuro-COVID-19: Current Mechanistic Views and Therapeutic Perspectives.

Long-lasting COVID-19 (long COVID) diseases constitute a real life-changing burden for many patients around the globe and, overall, can be considered societal and economic issues. They include a variety of symptoms, such as fatigue, loss of smell (anosmia), and neurological-cognitive sequelae, such as memory loss, anxiety, brain fog, acute encephalitis, and stroke, collectively called long neuro-COVID-19 (long neuro-COVID). They also include cardiopulmonary sequelae, such as myocardial infarction, pulmonary damage, fibrosis, gastrointestinal dysregulation, renal failure, and vascular endothelial dysregulation, and the onset of new diabetes, with each symptom usually being treated individually. The main unmet challenge is to understand the mechanisms of the pathophysiologic sequelae, in particular the neurological symptoms. This mini-review presents the main mechanistic hypotheses considered to explain the multiple long neuro-COVID symptoms, namely immune dysregulation and prolonged inflammation, persistent viral reservoirs, vascular and endothelial dysfunction, and the disruption of the neurotransmitter signaling along various paths. We suggest that the nucleoprotein N of SARS-CoV-2 constitutes a "hub" between the virus and the host inflammation, immunity, and neurotransmission.

Energy production from landfill gas, emissions and pollution indicators–Opportunities and barriers to implementing circular economy

The goal of this research was to test the air emissions resulting from landfill gas combustion in a 250-kW cogeneration unit, in the context of pollutant emission due to the produced electricity. The test results mainly revealed emissions of carbon dioxide, sulfur dioxide, nitrogen oxides, carbon oxides, and dust. The volume of emissions of individual pollutants was compared with the emission values reported from the emission balancing database. The highest emission burdens concerned the production of one MWh of electricity for carbon dioxide 579.80 kgCO2∙MWh−1, carbon monoxide 2.57 kgCO2∙MWh−1, and nitrogen oxides 1.77 kgNOx∙MWh−1. It is worth noting that small cogeneration installations are not covered by emission standards and so they are not equipped with a device for reducing gaseous and particulate pollution. The tests revealed a difference between the actual emissions from the tested installation and the values reported to the national database. The innovation of this study is that it demonstrates the real emission burden of renewable energy in the context of sustainable development. The results can be used as input material for discussion to apply gaseous and particulate pollution reduction systems for cogeneration installations powered by landfill gas, including various types of biogases.

Apakah Beban Kerja Karyawan Benar-Benar Beban Kerja Bagi Karyawan

This research aims to reveal whether workload is truly a burden for employees through a literature review. Workload is often considered a negative factor that can affect employee well-being and performance. However, there is also the view that workload can motivate and increase productivity if managed well. To understand this complexity, this research examines various previous studies that discuss the impact of workload on employee well-being and performance. The methodology used is systematic literature observation of relevant journal articles, books and research reports. The study includes an examination of various industry sectors and work cultures, and considers factors such as stress, management support, work environment and work-life balance. The results of the literature review show that high workload is generally associated with increased stress and decreased employee well-being. However, several studies also indicate that a well-managed workload, complemented by management support and a positive work environment, can increase employee motivation and performance. These findings show that workload can be a real burden if not managed well, but can also be a motivational factor under the right conditions.

Prevalence and associated factors of schistosomiasis among pregnant women in northern Senegal

BackgroundSchistosomiasis remains a public health concern worldwide. It is responsible for more than 240 million cases in 78 countries, 40 million of whom are women of childbearing age. In the Senegal River basin, both Schistosoma haematobium and Schistosoma mansoni are very prevalent in school-age children. However, there is a lack of information on the burden of schistosomiasis in pregnant women, which can cause complications in the pregnancy outcome. This study aimed to determine the prevalence and associated factors of schistosomiasis in pregnant women.MethodsWe conducted a prospective cross-sectional study of pregnant women attending antenatal clinics at the health center of the Senegalese Sugar Company and at the hospital of Richard Toll between August and December 2021. The urine and stool samples collected were examined using microscopy techniques and quantitative polymerase chain reaction (qPCR) to detect the presence of S. haematobium and S. mansoni. The urines were previously tested using urine reagent strips to detect hematuria and proteinuria. Socio-demographical, clinical, and diagnostically data were recorded by the midwife and the gynaecologist. The data were analyzed using a logistic regression model.ResultsAmong the 298 women examined for the infection by microscopic, 65 (21.81%) were infected with urogenital schistosomiasis, 10 (3.36%) with intestinal schistosomiasis, and 4 (1.34%) were co-infected with both types of schistosomiasis. Out of the 288 samples tested by qPCR, 146 (48.99%) were positive for S. haematobium, 49 (35.51%) for S. mansoni and 22 (15.94%) for both species (co-infection). Pregnant women having microscopic haematuria and proteinuria were significantly more infected (p < 0.05).ConclusionThis study has revealed a high prevalence of schistosomiasis in pregnant women in Senegal. The qPCR allowed us to detect more cases compared to the microscopy. There is a need to conduct more studies to understand the real burden of the disease and to set up a surveillance system to prevent pregnancy-related complications.

Quantifying the basic reproduction number and underestimated fraction of Mpox cases worldwide at the onset of the outbreak.

In 2022, there was a global resurgence of mpox, with different clinical-epidemiological features compared with previous outbreaks. Sexual contact was hypothesized as the primary transmission route, and the community of men having sex with men (MSM) was disproportionately affected. Because of the stigma associated with sexually transmitted infections, the real burden of mpox could be masked. We quantified the basic reproduction number (R 0) and the underestimated fraction of mpox cases in 16 countries, from the onset of the outbreak until early September 2022, using Bayesian inference and a compartmentalized, risk-structured (high-/low-risk populations) and two-route (sexual/non-sexual transmission) mathematical model. Machine learning (ML) was harnessed to identify underestimation determinants. Estimated R 0 ranged between 1.37 (Canada) and 3.68 (Germany). The underestimation rates for the high- and low-risk populations varied between 25-93% and 65-85%, respectively. The estimated total number of mpox cases, relative to the reported cases, is highest in Colombia (3.60) and lowest in Canada (1.08). In the ML analysis, two clusters of countries could be identified, differing in terms of attitudes towards the 2SLGBTQIAP+ community and the importance of religion. Given the substantial mpox underestimation, surveillance should be enhanced, and country-specific campaigns against the stigmatization of MSM should be organized, leveraging community-based interventions.

The Impact of Monetary Policy, Inflation Rates, and Foreign Direct Investment on Economic Growth in Developing Countries

This study explores the intricate relationships between monetary policy, inflation rates, and foreign direct investment (FDI) and their collective impact on economic growth in developing countries. Utilizing a comprehensive review of existing literature, this research aims to provide a nuanced understanding of how these macroeconomic factors interact to influence economic development. Monetary policy, often implemented through adjustments in interest rates and money supply, is critical in shaping economic stability and growth. The study reveals that effective monetary policy in developing countries can stimulate economic activity by fostering an environment conducive to investment and consumption. However, the impact of such policies is contingent upon the stability and credibility of the governing institutions, which are often variable in developing regions. Inflation rates, which reflect the general rise in price levels, were found to have a complex relationship with economic growth. Moderate inflation can stimulate spending and investment by reducing the real burden of debt and encouraging consumption. In contrast, high inflation can erode purchasing power and deter both domestic and foreign investment, thereby stifling growth. This study underscores the importance of maintaining inflation within a manageable range to support sustainable economic growth. Foreign direct investment is identified as a key driver of economic development, providing capital, technology transfer, and employment opportunities. The research highlights that FDI can significantly enhance economic growth by supplementing domestic capital, improving infrastructure, and fostering industrial diversification. However, the benefits of FDI are maximized when complemented by stable economic policies and a favorable investment climate. In conclusion, the interplay between monetary policy, inflation, and FDI is crucial in shaping the economic trajectories of developing countries. The study suggests that balanced and coherent policy frameworks are essential to harnessing these factors for sustained economic growth. Future research should explore country-specific dynamics to better understand the differential impacts across various developing economies.

A Machine learning model for predicting sepsis based on an optimized assay for microbial cell-free DNA sequencing

ObjectiveTo integrate an enhanced molecular diagnostic technique to develop and validate a machine-learning model for diagnosing sepsis. MethodsWe prospectively enrolled patients suspected of sepsis from August 2021 to August 2023. Various feature selection algorithms and machine learning models were used to develop the model. The best classifier was selected using 5-fold cross validation set and then was applied to assess the performance of the model in the testing set. Additionally, we employed the Shapley Additive exPlanations (SHAP) method to illustrate the effects of the features. ResultsWe established an optimized mNGS assay and proposed using the copies of microbe-specific cell-free DNA per milliliter of plasma (CPM) as the detection signal to evaluate the real burden, with strong precision and high accuracy. In total, 237 patients were eligible for participation, which were randomly assigned to either the training set (70 %, n = 165) or the testing set (30 %, n = 72). The random forest classifier achieved accuracy, AUC and F1 scores of 0.830, 0.918 and 0.856, respectively, outperforming other machine learning models in the training set. Our model demonstrated clinical interpretability and achieved good prediction performance in differentiating between bacterial sepsis and non-sepsis, with an AUC value of 0.85 and an average precision of 0.91 in the testing set. Based on the SHAP value, the top nine features of the model were PCT, CPM, CRP, ALB, SBPmin, RRmax, CREA, PLT and HRmax. ConclusionWe demonstrated the potential of machine-learning approaches for predicting bacterial sepsis based on optimized mcfDNA sequencing assay accurately.

Detection of prolong excretion of Escherichia albertii in stool specimens of a 7-year-old child by a newly developed Eacdt gene-based quantitative real-time PCR method and molecular characterization of the isolates

Escherichia albertii is an emerging zoonotic foodborne pathogen. The clinical significance of this bacterium has increasingly been recognized worldwide. However, diagnostic method has not yet been established and its clinical manifestations are not fully understood. Here, we show that an Eacdt gene-based quantitative real-time PCR (qRT-PCR) developed in this study is 100% specific and sensitive when tested with 39 E. albertii and 36 non-E. albertii strains, respectively. Detection limit of the real-time PCR was 10 colony forming unit (CFU) and 1 pg of genomic DNA per PCR tube. When E. albertii was spiked with 4 × 100–106 CFU per mL to stool of healthy person, detection limit was 4.0 × 103 and 4.0 CFU per mL before and after enrichment culture, respectively. Moreover, the qRT-PCR was able to detect E. albertii in five children out of 246 (2%) but none from 142 adults suffering from gastroenteritis. All five E. albertii strains isolated carried eae and paa genes, however, only one strain harbored stx2f genes. Long-term shedding of stx2f gene-positive E. albertii in a child stool could be detected because of the qRT-PCR developed in this study which might have been missed if only conventional PCR and culture methods were employed. Furthermore, E. albertii isolated from siblings with diarrhea showed clonality by PFGE analysis. Taken together, these data suggest that the Eacdt gene-based qRT-PCR developed for the detection of E. albertii is useful and will assist in determining the real burden and clinical manifestation of E. albertii infections.

The Burden of Herpes Zoster on Hospital Admissions: A Retrospective Analysis in the Years of 2015-2021 from the Abruzzo Region, Italy.

(1) Background: Herpes zoster (HZ) is a disease caused by the reactivation of the Varicella Zoster Virus (VZV). Clinical reactivation, herpes zoster, takes place in 10-20% of subjects who contracted the primary infection, with a higher risk of developing zoster increasing proportionally with age, especially after 50 years of age. HZ is a common clinical problem, particularly among patients aged over 50 years and immunocompromised patients. Immunocompromised patients and adults could present an atypical and more severe course. In addition, they are at greater risk of complications. For this reason, it is important to understand the real burden of the disease and to identify the subjects who are at higher risk of HZ and its complications, also to direct preventive strategies at the right targets. The aim of the present study is to analyze HZ-related hospitalization trends in Abruzzo in the period of 2015-2021. (2) Methods: Data related to hospital admissions were extracted from the hospital discharge records (HDRs) of the whole region, considering all admissions during the years of 2015-2021. The trends in hospital admissions and length of stay were evaluated and analyzed. (3) Results: A total of 768 hospital discharges with a diagnosis of herpes zoster were registered in Abruzzo during the 7-year study period. During the study period, an increasing trend was observed from the year 2015 to the year 2017, ranging from 8.19 cases/100,000 to 11.5 cases/100,000 (APC (Annual percentage change) +20.8%; 95%CI -2.3; 47.6). After the year 2017, a significantly decreasing trend was observed, reaching 5.46 cases/100,000 in the year 2021 (APC -18.4%; 95%CI -31.5; -12.0). Across the entire study period, an average annual percentage change (AAPC) of -7.0% (95%CI -13.0; -1.3) was observed. (4) Conclusions: Despite the trend of a reduction in hospitalizations, this study highlights that HZ continues to have a great impact on public health. So, it is important to update recommendations for the use of the already available HZ vaccine and to implement new strategies to increase awareness of the prevention of the disease.

Acute Kidney Injury Associated with Severe Leptospirosis: Fatal Re-Emerging Disease in Latin America

Leptospirosis is a re-emerging zoonotic disease that has had an unprecedented impact on most health systems in the world. The spectrum of symptoms is variable and usually ranges from asymptomatic cases to severe manifestations involving multiple organ dysfunction accompanied by jaundice, hemorrhage, meningitis, and acute kidney injury that requires the need for intensive care assistance. Although early antibiotic treatment is usually effective, in severe cases, it may require renal replacement therapy, invasive mechanical ventilation, vasoactive support, and invasive hemodynamic monitoring, increasing the risk of death. In Latin America, the real burden of acute kidney injury in this condition is unknown and may be underestimated due to the rapid progression of the disease, similar to other vector zoonoses, and the low coverage of diagnostic tests in primary care, especially in rural regions. Therefore, below, we review the clinical aspects and describe the scientific, clinical, and therapeutic evidence of acute kidney injury attributed to Leptospira spp. and its relevance in patients with severe leptospirosis in Latin America.

High pre-Delta and early-Omicron SARS-CoV-2 seroprevalence detected in dried blood samples from Kinshasa (D.R. Congo).

Studies on the impact of the COVID-19 pandemic in sub-Saharan Africa have yielded varying results, although authors universally agree the real burden surpasses reported cases. The primary objective of this study was to determine SARS-CoV-2 seroprevalence among patients attending Monkole Hospital in Kinshasa (D.R. Congo). The secondary objective was to evaluate the analytic performance of two chemiluminescence platforms: Elecsys® (Roche) and VirClia® (Vircell) on dried blood spot samples (DBS). The study population (N = 373) was recruited in two stages: a mid-2021 blood donor cohort (15.5% women) and a mid-2022 women cohort. Crude global seroprevalence was 61% (53.9%-67.8%) pre-Delta in 2021 and 90.2% (84.7%-94.2%) post-Omicron in 2022. Anti-spike (S) antibody levels significantly increased from 53.1 (31.8-131.3) U/mL in 2021 to 436.5 (219.3-950.5) U/mL in 2022 and were significantly higher above 45 years old in the 2022 population. Both platforms showed good analytic performance on DBS samples: sensitivity was 96.8% for IgG (antiN/S) (93.9%-98.5%) and 96.0% (93.0%-98.0%) for anti-S quantification. These results provide additional support for the notion that exposure to SARS-CoV-2 is more widespread than indicated by case-based surveillance and will be able to guide the pandemic response and strategy moving forward. Likewise, this study contributes evidence to the reliability of DBS as a tool for serological testing and diagnosis in resource-limited settings.

Knowledge and Practice of Vector Control against Malaria by Mothers of Children Aged 06 to 59 Months Hospitalized for Severe Malaria in the Pediatric Department of the Reference Health Center of Commune I of Bamako

Introduction: Severe malaria is a public health problem that causes a real socio-economic burden in developing countries. It is associated with high but avoidable mortality thanks to preventive and curative measures. Methodology: This is a descriptive and cross-sectional study with a prospective survey for the benefit of mothers of children aged 06 to 59 months hospitalized for serious malaria in the pediatric department of the Reference Health Center of Commune I of Bamako from October 2021 to September 2022. Results: In 12 months, 624 children were hospitalized, including 151 children aged 6 to 59 months suffering from severe malaria. The hospital frequency of severe malaria in this age group from 06 to 59 months was 24.2%. The average age of the mothers interviewed was 27.8 years with a range of 15 to 48 years. Mothers were educated in 84.1%, married in 98.7% and working as housewives in 81.5%. The reason for consulting children was fever (91.4%), anorexia (90.1%), prostration (79.5%). Mothers knew about impregnated mosquito nets and smoke coils as means of prevention against malaria at the same frequency of 99.3%, repellent creams 96.7%, and indoor spraying in 92.7%. In practice, they used smoke coils in 64.2%, repellent cream in 44.4% and mosquito nets impregnated with insecticide in 40.4%. Mothers attributed the cause of malaria to mosquito bites in 91.4%; They had readjusted the way sick children were fed by giving more food than usual (29.8%), splitting meals (21.8%) or using active feeding (14.6%). Most children had severe malaria, neurological form or anemic form at the same proportion of 37.1%. The assessment of the nutritional status of children revealed 18.5% acute malnutrition. The children had received conventional and traditional self-medication in 63.58 and 58.94% of cases respectively before admission. In children, a significant relationship was noted between severe anemic malaria and acute malnutrition (Fisher's exact test = 18.41; p = 0.01). ....

Clinical Characteristics, Outcomes, and Risk Factors for Mortality in Pregnant/Puerperal Women with COVID-19 Admitted to ICU in Turkey: A Multicenter, Retrospective Study from a Middle-Income Country.

Coronaviruses have been the cause of 3 major outbreaks during the last 2 decades. Information on coronavirus diseases in pregnant women is limited, and even less is known about seriously ill pregnant women. Data are also lacking regarding the real burden of coronavirus disease 2019 (COVID-19) infection in pregnant women from low/middle-income countries. The aim of this study was to determine the characteristics and clinical course of COVID-19 in pregnant/puerperal women admitted to ICUs in Turkey. This was a national, multicenter, retrospective study. The study population comprised all SARS-CoV-2-infected pregnant/puerperal women admitted to participating ICUs between 1 March 2020 and 1 January 2022. Data regarding demographics, comorbidities, illness severity, therapies, extrapulmonary organ injuries, non-COVID-19 infections, and maternal and fetal/neonatal outcomes were recorded. LASSO logistic regression and multiple logistic regression analyses were used to identify predictive variables in terms of ICU mortality. A total of 597 patients (341 pregnant women, 255 puerperal women) from 59 ICUs in 44 hospitals were included and of these patients, 87.1% were unvaccinated. The primary reason for ICU admission was acute hypoxemic respiratory failure in 522 (87.4%), acute hypoxemic respiratory failure plus shock in 14 (2.3%), ischemic cerebrovascular accident (CVA) in 5 (0.8%), preeclampsia/eclampsia/HELLP syndrome in 6 (1.0%), and post-caesarean follow-up in 36 (6.0%). Nonsurvivors were sicker than survivors upon ICU admission, with higher APACHE II (p < 0.001) and SOFA scores (p < 0.001). A total of 181 (30.3%) women died and 280 (46.6%) had received invasive mechanical ventilation (IMV). Myocardial injury, the highest SOFA score during ICU stay, LDH levels on admission, the highest levels of AST during ICU stay, average daily dose of corticosteroids, IMV, prophylactic dose anticoagulation (compared with therapeutic dose anticoagulation), PaO2/FiO2 ratio <100, pulmonary embolism, and shock were identified as predictors of mortality. Rates of premature birth (46.4%), cesarean section (53.7%), fetal distress (15.3%), stillbirth (6.5%), and low birth weight (19.4%) were high. Rates of neonatal death (8%) and respiratory distress syndrome (21%) were also high among live-born infants. Severe/critical COVID-19 infection during the pregnancy/puerperal period was associated with high maternal mortality and fetal/neonatal complication rates in Turkey.

Morbidity among the tribal populations of West Bengal: A study based on data collected from the Mobile Medical Clinic.

Tribes are the most socially excluded group in the nation due to their restricted access to healthcare. There are little data on the real burden and distribution of illnesses among tribes. The present study determines the types and patterns of sickness among tribal populations in West Bengal. Five blocks from five districts in West Bengal were used for this cross-sectional study. Between the years 2018 and 2019, 52,189 patients visited these mobile medical clinics (MMCs), but only 36,128 were included in our study. Data were analyzed using the SPSS software (ver. 27.0). Younger age groups (1-25 years) show higher primary registration compared to other age categories; older age groups (>60 years) show higher repeat registration. High prevalence in infectious diseases (44.5% of the total primary registration) and high repeated cases in NCDs (11.5% to 33.2%), which are nearly three times higher than primary cases (Cramer's V test = 0.29; P = .001) are observed. Among the studied MMCs, Binpur II and Matiali MMC have more than two times the risk of gastrointestinal problems, while Madarihat MMC has more than one time the risk. Garbeta II MMC shows more than three times the risk of NCDs (adjusted odds ratio = 3.97; 95% confidence interval: 3.05-5.17) than the other diseases. The present study shows high prevalence of infectious diseases, injury and pain, NCDs, gastrointestinal problems, and vertigo in tribal populations of West Bengal.

The Impact of the Real Estate Tax Reforms on the Tax Burden in the Czech Republic

The article deals with the evaluation of the impact of real estate tax reforms on their tax burden in the Czech Republic in the years 1993–2024. Real estate tax is one of the direct taxes, and in comparison, with income taxes, its importance lies mainly in providing income for local budgets. The unit type of tax rate specifically determines real estate rates. Facts, that tax reform in the area or real estate tax are minimal, the tax burden is often decreasing. As the tax burden decreases, so does the tax revenue. However, when tax reform occurs, this reform is often characterized by a significant increase in the tax burden. This is also evidenced by the last implemented tax reform in 2024 when rates increased by approximately 80%. The previous tax reform occurred in 2010 and increased rates by 100%. Despite this increase, the real tax burden decreased compared to the first analysed year 1993 and the last year 2024. The results of the regression analysis show that inflation is the factor that negatively affects tax revenue. To minimalize a decrease in tax revenue from 2024, a provision containing an inflation coefficient is implemented in the legislation as part of the 2024 reform. Conversely, a reduction in the tax burden was not found for real estate intended for permanent housing in small municipalities with up to 600 inhabitants. On the contrary, there was an increase in the tax burden. Scientific methods such as analysis and comparison, as well as regression and correlation analysis are used to achieve the paper’s goals.

Advocacy for Epilepsy Surgery in Africa: Moroccan Experience of 132 Cases

In Africa, epilepsy is a real burden. Temporal lobe epilepsy is the most common drug-resistant focal epilepsy disorder, and temporal lobectomy are the most common effective treatment on patients with drug-resistant epilepsy. We aim to highlight the Moroccan experience in epilepsy surgery and to ascertain its long-term outcome. Through the results of surgical treatment in our series, we expect to raise awareness of the need of epilepsy surgery in Africa and contribute to its development. We present a retrospective study of 132 patients who underwent surgery for epilepsy from January 2005 to December 2021 at our institution. The presurgical evaluation was based on clinical screening, interictal EEG, VEEG, neuropsychological tests, MRI and Pet Scan in some cases. Data are presented as the median and ranges. For all analyses, P-values < 0.05 were considered statistically significant. Our series includes 132 patients (69 males, 52.27%), median age at surgery was 24 years (range: 1-64). One hundred -fifteen patients (87%) were operated for temporal lobe epilepsy, among them, 98 (85%) had anterior temporal lobectomy, and 17 (15%) had a lesionectomy. Seventeen patients (13%) were operated for extratemporal epilepsy, among them, 4 had lesionectomy, 7 functional hemispherotomy, and 5 patients had Gamma Knife Stereotactic Radiosurgery. Our postoperative outcomes 3 months after surgery found 113 patients (85.6%), seizure-free (Engel I), 16 Engel II (12.1%), and 3 Engel III (2.3 %) in temporal lobe epilepsy. In extratemporal lobe epilepsy, 12 (70.5%) were Engel I, seizure-free, 4 Engel II (23.5%) and 1 Engel III (6%). These results confirm that a majority of patients with drug-resistant epilepsy may benefit from surgical treatment without submitting to preoperative invasive explorations. This should help develop epilepsy surgery widely in Africa.