Serological Tests Research Articles

A Case Report on Anti-N-Methyl-D-Aspartate Encephalitis

Aim: The case study aims to describe and evaluate the initial neuropsychiatric symptoms, therapeutic methods, and diagnostic criteria, of a 3-year-old girl who had been diagnosed with anti-N-Methyl-D-Aspartate Receptor (NMDAR) encephalitis. This case study implies the importance of early detection and treatment in pediatric autoimmune encephalitis, highlighting its diagnostic challenges and the successive use of immunotherapy and outcomes. Presentation of Case: A 3-year-old developmentally normal girl child was brought to the hospital with C/O fever for 2 days. Following this she had seizures lasting for around 2 minutes and followed by shivering movements in the right leg for 15 minutes and then she regained consciousness after 25 minutes. CSF analysis showed pleocytosis. Serological tests (Typhoid IgM, Rapid Malaria, Scrub IgM, Dengue IgM, Japanese Encephalitis, and Herpes Simplex Virus IgM) were negative. MRI indicated diffuse encephalopathy, and EEG detected epileptic activity. Further antibody testing in serum and CSF revealed positive Anti-NMDAR antibodies. The patient was treated with amoxicillin-clavulanate(400mg), ceftriaxone(750mg), and acyclovir(130mg) intravenously initially. Once the definitive diagnosis was made, she was treated with IVIG(26g), methylprednisolone(390mg), and levetiracetam(280mg). Discussion: Anti-N-Methyl-D-Aspartate Receptor Encephalitis is an autoimmune encephalitis characterized by complicated neuropsychiatric symptoms and immunoglobulin G (IgG) antibodies against the NR1 subunit of the NMDA receptors in the central nervous system. Conclusion: The appropriate diagnosis and treatment of autoimmune encephalitis necessitate an organized approach. A wide range of autoantibody tests can be performed to identify or rule-out specific autoimmune causes. Patients may relapse and require appropriate follow-up care.

PARACOCCIDIOIDOMICOSE NA ODONTOLOGIA

Paracoccidioidomycosis is a fungal disease caused by the fungus Paracoccidioides brasiliensis, which prefers humid and warm places. Male individuals between 30 and 60 years of age are generally the most affected by this disease, especially those who work in rural areas or gardening. The objective of this study was to conduct a literature review addressing the topic of paracoccidioidomycosis in dentistry, highlighting its oral clinical aspects, increasing the knowledge of dentists so that they can help in the early recognition and diagnosis of the lesion. Diagnosis can be made through fungal culture, incisional biopsy, serological tests, histopathological analysis of the skin and mucous membranes, and chest X-rays to check for possible lung involvement. The most frequent clinical signs appear in the alveolar mucosa, gums, palate, and tongue, but other areas of the body can also be affected by the condition. In most cases, the disease is identified through oral clinical characteristics, and the dentist is the first professional to treat these patients. Treatment for paracoccidioidomycosis is prolonged and varies according to the severity of the lesions, involving the use of various antifungals such as itraconazole and cotrimoxazole. To increase the patient's life expectancy and prevent the spread of the disease, it is essential that the dentist recognizes the oral clinical manifestations, performs tests, and correctly refers the patient for appropriate medical treatment.

Prevalence of immunoglobulin E sensitisation to mites and pollens in 25,451 French dogs from 2016 to 2022.

Canine atopic dermatitis (cAD) is a common skin disorder in dogs, wherein allergens are presumed to exert a significant influence. The prevalence of allergen sensitisation in dogs with suspected cAD remains inadequately investigated in France. This study aimed to analyse allergen-specific immunoglobulin (Ig)E test results from French dogs with suspected cAD, exploring potential risk factors influencing sensitisation. The study included 25,451 client-owned dogs presented with clinical signs of cAD between January 2016 and December 2022. The study population consisted of 226 pure breeds and 915 cross-bred dogs of both sexes, with a mean age of 4.4 (±2.8) years. Data collection involved the compilation of results from canine serological allergen-specific IgE ELISA tests, using a 23 allergen composite panel. The influence of breed, sex, age, geographical area and sampling season on IgE test outcomes subsequently was analysed. Of the 25,451 analysed samples, 75.6% exhibited significant serum IgE concentrations in response to at least one of the tested allergens, with 67.9% testing positive for mites and 39.8% for pollens. Breed, sex, age, geographical area and sampling season were identified as significant risk factors influencing sensitisation patterns. This study provides insights into the prevalence and risk factors associated with allergen sensitisation in dogs with suspected cAD. Understanding these factors is crucial for effective diagnosis and tailored management strategies in veterinary practice. The findings underscore the need for personalised approaches in addressing cAD, considering individual patient characteristics.

CMV Retinitis in the Context of SARS-CoV-2 Infection: A Case Study and Comprehensive Review of Viral Interactions

Purpose: Cytomegalovirus (CMV) retinitis is a sight-threatening condition predominantly affecting immunocompromised individuals, such as those with Human Immunodeficiency Virus (HIV)/Acquired Immunodeficiency Syndrome (AIDS). We aimed to present an observational case report on CMV retinitis following Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) infection and to review the literature on the molecular and cellular changes in CMV and SARS-CoV-2 infections and how they may influence each other. Case Description: A 32-year-old man with a history of AIDS presented with decreased vision and ocular pain exacerbated by movement, beginning a day prior. Ocular examination revealed anterior uveitis, corneal endothelial edema, and retinal necrosis in the left eye. CMV retinitis was diagnosed based on positive serologic testing and a low cluster of differentiation 4 (CD4) count, with concurrent SARS-CoV-2 infection detected. Treatment included valganciclovir and topical agents, with a focus on managing CMV complications. This case highlights the potential role of SARS-CoV-2 in reactivating dormant CMV in severely immunocompromised individuals. We also discuss the implications of this interaction for immunocompromised patients, emphasizing the need for vigilant monitoring and personalized treatment strategies. Conclusions: Our case suggests that SARS-CoV-2 may trigger reactivation of CMV infection, leading to bilateral involvement in patients with low CD4 lymphocyte counts, which can result in severe visual impairment. The review discusses the molecular and cellular interactions between CMV and SARS-CoV-2, as well as risk factors, pathophysiology, and diagnostic methods for CMV retinitis, providing recommendations based on the literature findings.

Seronegative and Low Seropositive Treatment-Naive Secondary Syphilis in India: A Cross Sectional Study

Abstract The non-treponemal tests like VDRL and RPR hold an important place in the diagnosis of syphilis. In many countries, these tests are used for screening, with positive results being subsequently confirmed by treponemal or specific tests like TPHA or FTA-ABS. Recent observations of low-titer VDRL or RPR positivity (<1:8) or negative results in patients with clinically active syphilis are becoming a cause for concern especially in the backdrop of a resurgence of the disease. Such a scenario might undermine the usefulness of VDRL or RPR as effective screening test and for treatment monitoring. We studied the titers of non-treponemal serological test (VDRL) in non-HIV-positive, untreated cases of secondary syphilis (diagnosed clinically and confirmed serologically with specific treponemal tests like TPHA or FTA-ABS). It was an OPD-based cross-sectional study, which included patients presenting with muco-cutaneous lesions suggestive of secondary syphilis, confirmed serologically with positive specific treponemal tests, who were seronegative for HIV1 and 2 and had not received treatment with injectable benzathine penicillin. Their VDRL titers were noted. Information regarding duration of lesions and any previous genital ulcer was obtained, and additional information was sought regarding any medications taken during the last two months. Nineteen patients (12 males, 4 females, and 3 transgender individuals) between the ages of 18 and 46 years were included in the study. Ten of these cases (52.63%) had a VDRL titer of less than 1:8 (non-reactive in 5 patients, titer of 1:4 in 5 patients). Among the remaining nine cases, a titer of 1:8 was observed in six, 1: 16 in two, and 1:32 in one case. Our observations raise concerns regarding the possibility that a significant number of patients with active syphilis and potential to transmit the disease are being left untreated because of low or negative titers in the screening tests. This may account for the slow resurgence of syphilis as documented by increase in case rates and incidence of congenital syphilis in different parts of the world.

Analysis of Clinical and Laboratory Profiles of Patients Hospitalized with Hemorrhagic Fever with Renal Syndrome in Southwestern South Korea.

Hemorrhagic fever with renal syndrome (HFRS) is caused by hantaviruses. Data of 34 patients with HFRS hospitalized at Chosun University Hospital, South Korea, between 2010 and 2021 were retrospectively analyzed. Nested reverse transcription polymerase chain reaction (RT-nPCR) targeting the L segment of hantavirus and sequencing were used for diagnosis. Most cases occurred in men and during the months of October through December. Common symptoms were fever, chills, gastrointestinal symptoms, and myalgia. The common laboratory abnormalities were thrombocytopenia, proteinuria, and elevated levels of serum creatinine, aspartate transaminase, alanine transaminase, and lactate dehydrogenase. Approximately 91.2% of patients had the Hantaan virus with a new genotype cluster, whereas 8.8% had the Seoul virus. Seropositivity based on IgM titer >1:32 on admission was noted in 20.6%, and a 4-fold increase in IgG titer of 1:512 was observed in 11.8%. This study demonstrated that RT-nPCR targeting the L segment of hantaviruses is a more reliable diagnostic method compared to serological testing.

A Machine Learning Approach to Identifying Risk Factors for Long COVID-19

Long-term sequelae of coronavirus disease 2019 (COVID-19) infection are common and can have debilitating consequences. There is a need to understand risk factors for Long COVID-19 to give impetus to the development of targeted yet holistic clinical and public health interventions to reduce its associated healthcare and economic burden. Given the large number and variety of predictors implicated spanning health-related and sociodemographic factors, machine learning becomes a valuable tool. As such, this study aims to employ machine learning to produce an algorithm to predict Long COVID-19 risk, and thereby identify key predisposing factors. Longitudinal cohort data were sourced from the UK’s “Understanding Society: COVID-19 Study” (n = 601 participants with past symptomatic COVID-19 infection confirmed by serology testing). The random forest classification algorithm demonstrated good overall performance with 97.4% sensitivity and modest specificity (65.4%). Significant risk factors included early timing of acute COVID-19 infection in the pandemic, greater number of hours worked per week, older age and financial insecurity. Loneliness and having uncommon health conditions were associated with lower risk. Sensitivity analysis suggested that COVID-19 vaccination is also associated with lower risk, and asthma with an increased risk. The results are discussed with emphasis on evaluating the value of machine learning; potential clinical utility; and some benefits and limitations of machine learning for health science researchers given its availability in commonly used statistical software.

Hydatid cyst in the tail of the pancreas: a rare case report

Hydatid cysts, caused by Echinococcus granulosus, are rare but significant when found in the pancreas, particularly in endemic regions. This case report discusses a 32-year-old female with a pancreatic tail cyst presenting with epigastric pain and intermittent fever. Diagnostic imaging, contrast enhanced computed tomography (CECT) and magnetic resonance cholangiopancreatography (MRCP), and serological tests were inconclusive, making preoperative diagnosis challenging. Differential diagnoses included pancreatic pseudocysts, benign neoplasms, abscesses, and other cystic lesions. The patient underwent surgical exploration, where a hydatid cyst was identified and treated with cyst removal, partial pericystectomy, and marsupialization. Postoperative management included albendazole therapy. Pancreatic hydatid cysts, though rare, should be considered in differential diagnoses for pancreatic cystic lesions, especially in endemic areas. Accurate diagnosis typically requires a combination of imaging, serology, and histopathological examination, with surgery often necessary for definitive diagnosis and treatment.

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.

Epidemiological characteristics of the 2019 Measles outbreak in central Tunisia

Abstract Background Measles is still an important public health problem worldwide causing significant morbidity and mortality. Measles represents a vaccine-preventable disease. In Tunisia, vaccination against measles was launched in 1983. In spite of the progress made towards measles elimination, Tunisia experienced an outbreak in 2019. We aimed to describe the measles outbreak in the central region of Tunisia in 2019. Methods We carried out a descriptive study using surveillance data from January to December 2019 in four governorates in Tunisia (Monastir, Mahdia, Kairouan, and Kasserine). All suspected measles cases and declared to regional directorate of primary health care were included. A suspected measles case was defined as any person with fever and generalized maculo-papular rash plus one of the following symptoms: cough or coryza or conjunctivitis. A laboratory confirmed measles case is a suspected case of measles that has been confirmed positive by testing (IgM+). Results A total of 2,688 suspected cases were recorded, of which 369 cases were (14.7%) were confirmed measles through serological testing. The sex ratio was 1.06 for suspected cases and 1.12 for measles cases. Infants under one year old accounted 42.2% of suspected cases. The majority of suspected cases (67.3%) were not vaccinated. Among confirmed measles cases, positivity rates were 81.8% for unvaccinated, 70.0% for those with one dose and 27.2% for those with two doses. The hospitalization rate was 61.5 %; highest rates were observed in infants under one year of age (65.7%) and in the age group over 38 years (69.0%). In total, 27 deaths were reported. The highest lethality rate was observed in the age group under 12 months (2%). Conclusions The 2019 measles outbreak in Tunisia highlighted that this disease remains a serious viral infection. Unvaccinated populations could be a potential source for new outbreaks, imposing substantial public health burdens. Key messages • The country needs to establish a national review committee to monitor measles elimination status. • To address future challenges, immunity gaps in the population should be closed.

Bartonella endocarditis: lessons learnt from an African cohort

Abstract Background Bartonella (B) quintana endocarditis is a preventable, vector-borne, and important cause of blood culture-negative endocarditis (BCNE). The ESC guideline for the management of endocarditis recommends blood serology (IgG titer ≥800) and polymerase chain reaction (PCR) testing on both blood and valvular tissue for diagnosis. Access to these molecular technologies is limited in Africa and there is a paucity of B. quintana endocarditis research on the continent. Purpose Record the clinical picture and explore the risk factors for disease and the diagnostic utility of immunofluorescence (IFA) in PCR-proven cases with B. quintana endocarditis. Methods Data were analysed from a prospective observational cohort study of patients with infective endocarditis managed at our institution. All BCNE cases from October 2019 to January 2024 were evaluated to identify patients with PCR-proven B. quintana on valvular tissue. A commercially available IFA was used for blood serology testing. 16S rRNA PCR testing with sequencing was performed on valvular tissue. Results Thirty five of the 58 cases (60.3%) with BCNE were diagnosed with Bartonella endocarditis. A diagnosis of PCR-proven B. quintana endocarditis was made in 21 cases. Of these, seven patients (33.3%) were either homeless or lived in informal housing. Thirteen patients (61.9%) had an alcohol-use disorder. Four patients (19%) were Human Immunodeficiency (HIV) virus- positive. Eighteen patients (85.7%) reported the onset of symptoms more than two weeks before presentation. Common presenting symptoms were dyspnea (n=21;100%), loss of weight (n=10;47.6%) and fever (n=7;33.3%). Common clinical features were digital clubbing (n=17;80.9%), pallor (n=13; 61.9%), microscopic haematuria (n=12; 57.1%) and severe regurgitant lesions (n=21; 100%). Blood serology was available in 17 patients with an IgG titer (1≥256) in all patients apart from one (1:64). Only one case (5.8%) had an IgG titre ≥800. The most common isolated valve lesion on echocardiography was severe aortic regurgitation (n=10;47.6%). Surgical replacement and repair were performed in 17(80.9%) and 4(19%) patients respectively. The one-, three- and six-month mortality was 14%, 14 % and 14% respectively. No cases of relapse were reported. Discussion B.quintana is the most prevalent cause of BCNE in our centre. The typical clinical and echocardiographic profile was consistent with the reported literature of a destructive endocarditis in a patient with a low socioeconomic background. Despite this, the surgical outcome is fair and comparable to European data. The IFA used in this study is different to the assay referenced in the ESC guideline and may explain the relatively low serology titres observed (despite PCR-proven disease). Further study with the commercial IFA is needed to determine a cut-off titre that will give a comparable sensitivity to the referenced in-house IFA.Destructive aortic valve endocarditisResultant severe aortic regurgitation

The use of digital technologies to promote sexual health in young adults: a narrative review

Abstract Background New technologies have the potential to play an important role in promoting sexual health, especially among young people, who are the biggest users and those at greatest risk of contracting Sexually Transmitted Infections (STI). The risk behavior assumed by young people today highlights this vulnerability in several contexts, such as individual, social, economic, and family. In this sense, it becomes relevant to approach sex education in schools using digital technologies. Objectives To identify the evidence in the literature on the use of digital technologies to promote the sexual health of young adults. Methods Narrative literature review. Three independent reviewers extracted, analyzed and synthesized the articles and results. Results Through the selection process, four studies were included. The articles show that the use of digital technologies (mobile phones/applications) leads to increased knowledge, improved attitudes and sexual behavior among young adults. The interventions studied in the studies were based on Short Message Service, electronic mail interventions and the MyPEEPS mobile application, with the following main focuses: Increased knowledge, attitudes, and behaviors of young adults. Considering the results of the studies, all interventions proved to be effective as facilitators of sexual health promotion. Conclusions The use of digital technologies allowed an increase in the promotion of the sexual health of the participants, since there was an increase in the level of knowledge with the use of digital technologies such as SMS, emails and mobile applications when comparing the experimental and control groups. The use of these digital technologies also allowed for a change in attitudes and behaviors, such as a significant increase in serological testing for STIs and an increase in health care seeking. Key messages • The use of digital technology promotes the sexual health of young adults, so these strategies should be implemented by health professionals. • The dissemination of these digital strategies will have an impact on Public Health, specifically regarding the sexual health of young adults.

The European Mobile Laboratory: key insights from a decade of outbreak response

Abstract EMLab has responded to emergencies including the West Africa Ebola virus outbreak (2014-2016), the COVID-19 pandemic, and outbreaks of yellow fever, Marburg virus, and Lassa fever. It has deployed mobile labs and experts to many countries, including Guinea, Liberia, Sierra Leone, Nigeria, Uganda, the Democratic Republic of the Congo, Germany, and Greece. With accumulated experience from each deployment, EMLab’s diagnostic expertise has evolved beyond RT-PCR and serological testing to include basic point-of-care tests, haematology, and genomic surveillance capacities, also focusing on interoperability with other response capacities such as EMTs. Critical to mission success, the organization works closely with the WHO and GOARN, and was certified in 2023 as an official German response capacity within the European Civil Protection Pool. The two-year continuous deployment from 2014-2016 was pivotal in shaping EMLab’s evolution, also leading to significant capacity-building efforts in West Africa. In Guinea, for example, a surveillance network of three diagnostic laboratories has been established and successfully detected cases of viral haemorrhagic fevers, including the re-emergence of Ebola virus and the first reported case of Marburg virus in Guinea in 2021. Ultimately, EMLab’s extensive experience demonstrates that effective public health emergency response requires constant evolution, strategic partnerships, and a commitment to building local capacities, paving the way for a more resilient and prepared global health community.

Knowing the Antibody Status may influence compliance of health care workers to COVID-19 booster dose

Abstract Background Previous studies showed that the fourth SARS-CoV-2 vaccine dose has a protective effect against infection, as well as against severe disease and death. This study aimed to examine whether knowledge of a high level antibody after the 3rd dose may reduce compliance to the 4th booster dose among health care workers. Methods We conducted a prospective cohort study among health care workers vaccinated with the first three doses at Rambam Healthcare Campus, a tertiary hospital in northern Israel. Participants underwent a serological test before the 4th booster vaccine was offered to all of them, with results provided to participants. The population was divided into two groups: those with antibody below 955 AU/ml, and those with 955 AU/ml and higher, a cutoff found protective in a previous study. Multiple logistic regression was carried out to compare the compliance to the 4th booster between the two groups, adjusted for demographic and clinical variables. Results After adjusting for the confounding variables, the compliance was higher in those with antibody levels below 955 AU/ml (OR = 1.41, P = 0.05, 95% CI 1.10-1.96). In addition, male sex, and age of 60 years and above were also associated with higher vaccination rate (OR = 2.28, P < 0.001, 95% CI 1.64 - 3.17), (OR = 1.14, P = 0.043, 95% CI 1.06 - 1.75), respectively. Conclusions Knowledge of the antibody status may affect compliance with the booster dose. Considering waning immunity over time, reduced compliance may affect the protection of health care workers who declined the 4th dose. Key messages • Knowing the antibody status may affect compliance of health care workers with the booster dose. • Reduced compliance of health care workers may affect their protection.

Mother-to-child Transmission using the National HBV Perinatal Prevention Data in Korea, 2002-2021

Abstract Aims To define risk factors associated with mother-to-child transmission (MTCT) and to create supporting evidence for the National Hepatitis B Perinatal Prevention Program (HBPPP) in Korea. Methods We analyzed HBPPP mother-infant pair data enrolled from 2002 to 2021. The major outcome was the HBsAg status of the infant resulting from post-vaccination serological testing. Additionally, we used prescription records of antivirals against the hepatitis B virus (telbivudine, tenofovir disoproxil fumarate) from 2010 to 2021 by data linkage with the National Health Insurance claims data. To select significant risk factors by maternal HBeAg status based on the data from 34 to 42 weeks of pregnancy, multivariate logistic regression analysis was used. Results Data from 232,242 mother-infant pairs were analyzed. Among 154,331 (66.5%) infants with post-vaccination serological testing results, 3,620 (2.3%) were HBsAg-positive. The incidence of MTCT has shown a decreasing trend, from 4.1% in 2002 to 1.0% in 2021. However, the rate was high at 5.5% (1822/32986) for infants of HBeAg-positive mothers. Maternal antiviral prescription during the pregnancy period, old age, HBeAg negative, delivery type (C-section), and breastfeeding were significant factors in decreasing the risk of MTCT. Among the HBeAg-positive, there was a significant difference in the antiviral prescription 0.7% (11/1692) compared to the non-prescription 4.9% (789/16264) [aOR, 7.71; 95% CI, 4.24-14.02]. The result was similar for the HBeAg-negative group, 0.7% (302/44888). Conclusions To eradicate the hepatitis B virus on a national level, MTCT must be further reduced. To achieve this, it is necessary to introduce strong additional preventive measures, including quantitative HBV DNA testing for mothers with chronic hepatitis B and administering antiviral prophylaxis at the third trimester of pregnancy with HBV-DNA ≥200,000 IU/mL into the HBPPP. Key messages • The incidence of mother-to-child transmission has shown a decreasing trend, from 4.1% in 2002 to 1.0% in 2021. • Maternal antiviral prescription, old age, HBeAg negative, delivery type (C-section), and breastfeeding were significantly decrease the risk of mother-to-child transmission.

Long-term prognosis and predictors of death in chronic Chagas cardiomyopathy in women and men

Abstract Background Chronic Chagas cardiomyopathy (CCC) is one of the leading causes of heart failure (HF) in Latin America and carries high morbidity and mortality. Previous studies showed conflicting results in epidemiological and clinical evidence of a gender-associated risk of death in patients with HF due to CCC. Purpose This study analysed the long-term prognosis and the main predictors of death in women and men with HF due to CCC. Methods From March 2009 to January 2023, we followed a cohort of outpatients with HF due to CCC. Specific serological tests diagnosed Chagas disease. Baseline data included clinical characteristics and echocardiographic findings. Statistical analyses were performed using the Kaplan-Meier (K-M) method to analyse time-to-event data and Cox proportional hazards methods to search for predictors of death. Results We studied 739 patients, with a mean age of 57.0 ± 12.1 years, 387 (52%) male. Women had a higher mean age (58.4 ± 11.7 vs. 55.8 ± 12.3 years; p=0.001), had a higher mean baseline left ventricular ejection fraction (LVEF) (44.3±14.5 % vs. 37.0±14.5%; p<0.001) and a smaller left ventricular diastolic diameter (LVDD) (56.8±8.9 vs. 62.5±9.4 mm; p<0.001). Over a median follow-up period of 10 years, 213 (56%) men and 169 (44%) women died (K-M: log-rank p=0.043; Figure). Men received more beta-blocker therapy (52.4% vs. 47.6%; p=0.040) and had a higher prevalence of chronic kidney disease (CKD) (p=0.003) and stroke (p=0.007). HFpEF was more prevalent in women and HFrEF in men (p<0.001). Device implantation and transplant were similar between women and men. Cox regression analysis for death adjusted for age, sex, myocardial infarction, diabetes, CKD, stroke, atrial fibrillation (AF), and LVEF showed LVEF (HR= 0.98;95%CL:0.97-0.98), age (HR=1.03;95%CL1.02-1.04) and CKD (HR= 1.32;95%CL:1.10-1.64) as the main predictors of death. In men, the main predictors were age (HR=1.02;95%CL:1.01-1.04), CKD (HR=1.409;95%CL:1.07-1.86), and LVEF (HR=0.98;95%CL:0.97-0.99), and in women AF (HR=1.41;95%CL:1.03-1.91), age (HR=1.03;95%CL:1.01-1.04), and LVEF (HR=0.97;95%CL:0.96 -0.98). Conclusion women had a better prognosis than men, but gender was not an independent predictor of death. Prevention of comorbidities, especially CKD in men and AF in women, and higher beta-blocker therapy can significantly reduce the death rate in women and men with HF from CCC.

Lyme disease in UK primary care: a knowledge, attitude and practice survey.

Lyme disease (LD) cases in the UK most commonly present within the primary care setting. Despite an upward trend of incidence, little is known regarding general practitioner (GP) experience with diagnosis and treatment. This study aims to describe baseline primary care clinician Knowledge, Attitude and Practice (KAP) in Scotland and England. Online KAP survey on Lyme disease for UK based practising GPs. An online KAP questionnaire was developed for use in UK primary care. The survey was distributed through UK based research networks, professional societies and via social media. 191 complete responses were analysed (England n=130, Scotland n=61). The Scotland-based respondent group had more relevant consultations in the previous 3 years. Respondents from Scotland demonstrated a greater awareness that erythema migrans (EM) is pathognomonic for Lyme disease and that serological testing of this patient group is not indicated. Less common cardiac and neurological symptoms were not as well associated with Lyme disease by both respondent groups for the former and England-based respondents for the latter. Prescribing according to the National institute for Health and Care Excellence (NICE) guidance was identified in 70% of Scotland and 42% of England-based GP responses. Targeted resources may improve clinician confidence on exposure risk, symptom recognition, testing limitations and treatment dose and duration. Scotland-based respondents' better survey performance potentially reflects greater clinical exposure and public awareness of the disease, due to high endemicity within the nation.

Comment on Dutta Majumder et al.’s 2019 ‘Ocular Syphilis: An Update’

ABSTRACT The article ‘Ocular Syphilis: An Update (2019)’ provides a thorough review of the challenges in diagnosing ocular syphilis. However, our research on ‘Dermatological and Ocular Manifestations of Syphilis,’ identifies a significant gap in both literature and clinical practice: the lack of recognition of dermatological signs during ophthalmological assessments. Ocular syphilis often mimics other conditions and can remain undiagnosed for months or years. Detecting dermatological signs, such as the characteristic palmar rash of secondary syphilis and extragenital chancres, could prompt earlier investigation and serological testing, reducing unnecessary diagnostic workups and inappropriate management. Early recognition would facilitate timely administration of Penicillin G, helping prevent vision loss, which is often reversible with prompt treatment. We urge Ocular Immunology and Inflammation to highlight the importance of incorporating dermatological assessments in future ocular syphilis publications to improve diagnostic protocols and patient outcomes.

Detection of Brucella militensis in the Serum of Patients Suspected of Brucellosis by the Omp31 Gene Amplification, Compared to the Serological Diagnostic Tests

Background and Objectives: Brucellosis is one of the most common infectious diseases with a global spread. It has a high prevalence in Iran. This study aims to diagnose brucellosis caused by Brucella melitensis in the serum of patients by the amplification of omp31 gene, compared to the serological tests. Methods: Blood samples were collected from 200 people suspected of brucellosis. The samples were evaluated by serological tests including Rose Bengal test, Wright test, Coombs-Wright test, gel agglutination test, and 2-mercaptoethanol (2ME) test. DNA extraction was done by the phenol/chloroform extraction method. Molecular detection with polymerase chain reaction (PCR) method was done using the specific primers of the Omp31 gene. Data were analyzed in SPSS software, version 23 using the analysis of variance. Results: Of 200 patients, 122 were female and 78 were male with a mean age of 45.17±17.43 years. The results of PCR test for the omp31 gene were positive in 14.5% of cases, which was consistent with the results of serological tests (13.8%). The sensitivity of Wright, Coombs-Wright, 2ME, and gel agglutination tests, compared to PCR, was 89.7, 75.9, 55.2 and 55.2%, respectively. Most of the affected people were housekeepers (41.5%) and urban residents (75.5%). Muscle pain (68%) and leg pain (62.3%) were the most common symptoms. Consumption of non-pasteurized dairy products was the highest risk factor (17%). Conclusion: The diagnosis of brucellosis by the omp31 gene amplification has higher sensitivity and accuracy compared to the serological tests. Considering the importance of rapid and timely diagnosis of brucellosis to control its clinical complications, the molecular diagnosis method is recommended as a diagnostic method.

Advances in Plant Disease Diagnostics and Surveillance- A review

Plant diseases pose a significant threat to global food security, leading to substantial yield losses and economic impacts. Early detection and effective monitoring are crucial for managing plant diseases, yet traditional diagnostic methods such as visual inspections, serological tests, and molecular assays face limitations in sensitivity, specificity, and scalability. In recent years, advancements in diagnostic and surveillance technologies have revolutionized plant health management. Next-Generation Sequencing (NGS) enables comprehensive pathogen profiling, while CRISPR-based diagnostics offer rapid and highly specific detection. Similarly, biosensors and portable devices provide on-site diagnostics, and machine learning and AI applications enhance the analysis of complex datasets, supporting automated disease identification and predictive modeling. Concurrently, advances in disease surveillance through remote sensing technologies, including satellites and Unmanned Aerial Vehicles (UAVs), enable large-scale, real-time monitoring of crop health, detecting disease outbreaks and facilitating targeted interventions. Integrating these diverse technologies into multi-platform systems offers a holistic approach to plant disease management, combining molecular diagnostics, environmental monitoring, and digital platforms to support data-driven decision-making. Several challenges remain, including high costs, technical complexities, and the need for standardized data integration. Addressing these barriers is essential to ensure that these technologies are accessible and effective across various agricultural systems, particularly in resource-limited settings. Future research should focus on enhancing the robustness, affordability, and scalability of these tools while promoting interdisciplinary collaborations.