Suspected Cases Research Articles

Effectiveness of typhoid conjugate vaccine in Zimbabwe used in response to an outbreak among children and young adults: A matched case control study

BackgroundZimbabwe suffers from regular outbreaks of typhoid fever (TF), worse since 2017. Most cases were in Harare and a vaccination campaign with Typhoid Conjugate Vaccine (TCV) was conducted in March 2019. The vaccine effectiveness (VE) was assessed against culture-confirmed S. Typhi in children six months to 15 years and in individuals six months to 45 years in Harare. MethodsA matched case-control study was conducted in three urban suburbs of Harare targeted by the TCV vaccination campaign. Suspected TF cases were enrolled prospectively in four health facilities and were matched to facility (1:1) and community (1:5) controls. FindingsOf 504 suspected cases from July 2019 to March 2020, 148 laboratory-confirmed TF cases and 153 controls confirmed-negative were identified. One hundred and five (47 aged six months to 15 years) cases were age, sex, and residence matched with 105 facility-based controls while 96 cases were matched 1:5 by age, sex, and immediate-neighbour with 229 community controls.The adjusted VE against confirmed TF was 75% (95%CI: 1–94, p = 0.049) compared to facility controls, and 84% (95%CI: 57–94, p < 0.001) compared to community controls in individuals six months to 15 years. The adjusted VE against confirmed TF was 46% (95%CI: 26–77, p = 0.153) compared to facility controls, and 67% (95%CI: 35–83, p = 0.002) compared to community controls six months to 45 years old. InterpretationThis study confirms that one vaccine dose of TCV is effective to control TF in children between six months and 15 years old in an African setting.

Clostridioides difficile infection (CDI) epidemiology and patient characteristics in Switzerland

ObjectivesClostridioides difficile infection (CDI) is a disease with high morbidity and mortality rates. The objective of this study was to describe CDI epidemiology and patient characteristics over a 5-year period in Switzerland and assess risk factors for mortality, recurrence and severe CDI. Patients and methodsWe retrospectively included all consecutive CDI cases having occurred in adult patients hospitalized in two tertiary centers: the Lausanne University Hospital (1000 beds) and the University Hospital of Zurich (900 beds), between 2014 and 2018. Suspected cases of CDI were identified from the microbiology laboratory database on the basis of a positive test and confirmed by records review. ResultsDuring first CDI episodes, the median age was 67 years and the median Charlson comorbidity index (CCI) score was 5. All in all, 299 out of 826 patients (36.2%) had severe infection based on the Infectious Diseases Society of America criteria. In the multivariable analysis, CCI was associated with increased risk of mortality. None of the factors recorded on admission were significantly associated with increased risk of recurrence. In the multivariable analysis, male sex and CCI were associated with severity, while immunosuppression was associated with less severe presentation. ConclusionsIf we did not identify any criteria on admission that could be predictive of recurrences, this could be explained the retrospective nature of the study. A higher comorbidity index is a key driver for severe CDI and mortality. Reporting of CDI is not mandatory in Switzerland; structuration of CDI reporting should be a short-term priority.

The Epidemiological Situation and Clinical Characteristic Aspect Cause by COVID-19 in Suspected Cases in Albania

BACKGROUND: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has forcefully entered our lives and profoundly changed the perception and habits of the world population since the December 2019. AIM: The aims of this study were to presents the epidemiology data and clinical characteristic aspect of patients suspected with COVID-19 and analyzed in the American laboratory in Tirana, Albania from August 2020 to March 2021. METHODS: This study includes 1205 suspected cases for SARS COVID-19. Professionally trained health workers collected the samples from suspected patients by using synthetic fiber swabs. Double specimens from nasopharyngeal and pharyngeal swabs were collected from each of person. A standard questionnaire about the demographic and clinical data was filled for each person. The software SPSS version 22.0 was used for analyzing all data and also the examination findings. RESULTS: The prevalence of SARS COVID-19 resulted to be 31.1%. The average age resulted 42.17 ± 18.6. The most predominant positive age resulted the age groups 31–40 years old and 41–50 years old with positivity 17.3% and 16.3%, respectively, with significant association p = 0.01. Male were the most analyzed and affected persons (61.6%) in this study with a strong significant association p = 0.0004. It turned out that more than half of patients refereed at least two symptoms in the same time of analyze and about 1/3 refereed more than three symptoms. We found an association for presence of all typical symptoms with positivity except the temperature. We identified that for all of these symptoms, the p value resulted less than 0.05. CONCLUSION: SARS COVID-19 in the early stages of the disease is highly contagious. For this reason, the screening of people with symptoms is recommended to determine who should be quarantined and be tested. In this manner, we can decrease the rate of infection and protect healthy people from infection.

Keratoconus. Its prevalence and severity in spring catarrh patients. A Perspective study.

Objectives: To find out the prevalence and severity of keratoconus in spring catarrh patients. Study Design: Descriptive and Perspective study. Setting: OPD K.D.A Teaching Hospital Kohat. Period: March 2017 to October 2019. Material &amp; Methods: All patients suffering from spring catarrh were included in the study after consent. Proper proforma was designed for record. Detail history was taken and for diagnosis all the patients were properly examined with slit lamp. Visual acuity was checked. Radioscopy for irregular scissor reflex and fundoscopy for oil droplet sign for keratoconus was carried out. Keratometry was done to determine the astigmatism and severity of keratoconus Grading of keratoconus was done by the highest axis of corneal power on keratometry as mild (&lt; 48 D), moderate (48-54 D) and severe (&gt; 54 D). Suspected cases were advised corneal topography. Total 480 patients were included in the study. Out of these 480 patients 295 (61.45%) were male and 185 (38.54%) female. The age range of patients was 9 to 37 years. Results: Out of 480 patients, 47(9.79%) patients had keratoconus in which 36(76.59%) were male and 11(23.40%) were female. Out of 47 patients 19 (40.42%) had mild, 22(46.80%) had moderate and 6(12.76%) patients had severe keratoconus. Conclusion: Keratoconus has strong association with spring catarrh.

Sinusoidal obstruction syndrome after liver transplantation: A multicenter observational study.

Sinusoidal obstruction syndrome after liver transplantation: A multicenter observational study.

A survey on the correlation between PM2.5 concentration and the incidence of suspected and positive cases of COVID-19 referred to medical centers: A case study of Tehran

COVID-19, one of the greatest health challenges of the present century, has infected millions of people and caused more than 6 million deaths worldwide. The causative agent of this disease is the new virus SARS-CoV-2; which continues to spread globally and sometimes with new and more complex aspects than before. The present study is an observational study aimed to investigate the role of AQI; PM2.5 and its relationship with the incidence of suspected cases (SC) and positive cases (PC) of COVID-19 at different levels of the air quality index (AQI) in Tehran, the capital of Iran in the period from Feb 20th, 2020 to Feb 22nd, 2021. Data on AQI were collected online from the air monitoring website of Air Quality Control Company under the supervision of Tehran Municipality. The data on suspected and positive cases were obtained from the Iranian Ministry of Health. The results and statistical analysis (Pearson correlation test) showed that with the increase of AQI level, the number of suspected cases (SC) and positive cases (PC), also increased (P-value<0.01). The average daily number of suspected and positive COVID-19 cases referred to medical centers, at different levels of the AQI was as follows: level II: yellow, moderate (SC: Nave = 466; PC: Nave = 223), level III: orange, unhealthy for sensitive groups (SC: Nave = 564; PC: Nave = 275), and Level IV: red, unhealthy (SC: Nave = 558; PC: Nave = 294). The results of the GEE for seasonal comparison (winter as reference season), showed that there is an epidemiological pattern in autumn with colder weather compared to other seasons in both suspected (Cl: %95, B = 408.94) and positive (Cl: %95, B = 83.42) cases of COVID-19. The results of this study will serve policymakers as an informative tool for guidance on the importance of the role of air pollution in viral epidemics.

Successful Thrombolytic Therapy in a Suspected Case of HeartMate 3 LVAD Thrombosis

IntroductionAlthough less common with the HeartMate 3 (HM3), pump thrombosis remains a life-threatening complication of durable left ventricular assist devices (LVAD). We present what we believe is the first case of suspected pump thrombosis in a patient with a HM3 LVAD that was successfully managed with tissue plasminogen activator (tPA).Case ReportA 22-year-old man who underwent HM3 implantation for end stage heart failure due to left ventricular non-compaction presented after experiencing two low flow alarms. His physical examination was notable for tachycardia at 125 beats per minute and an elevated Doppler mean blood pressure of 92 mm Hg. LVAD interrogation revealed low flows without power spikes (Figure 1A). Within 24 hours, he developed persistent hypotension requiring vasopressor support and multiple low flow alarms. Serial laboratory results were notable for rising LDH, peaking at 4,741 U/L and acute liver injury with AST 2,712 U/L, ALT 798 U/L and INR 5.2. Transthoracic echocardiography and computed tomography (CT) angiography did not reveal any obvious thrombus. Given this constellation of findings, pump thrombosis was suspected. Following multidisciplinary discussion, unfractionated heparin bolus and infusion were started. After an unremarkable head CT, heparin was stopped and systemic tPA was given at a dose of 5 mg over one minute followed by 10 mg over 10 minutes due to ongoing liver dysfunction. Heparin was resumed after PTT returned to therapeutic range. Immediately post tPA infusion, his LVAD flows improved from 2.3 L/min to 4.1 L/min (Figure 1B). Vasopressor support was quickly weaned. LDH, creatinine, and liver enzymes improved over the following days. Warfarin was resumed on day 14 of admission. He was discharged on aspirin, clopidogrel and warfarin.SummaryThrombolytics may be a potential therapeutic option in select cases of HM 3 pump thrombosis. Further research is warranted to delineate LVAD parameters that facilitate early recognition of pump thrombosis and successful medical management. Although less common with the HeartMate 3 (HM3), pump thrombosis remains a life-threatening complication of durable left ventricular assist devices (LVAD). We present what we believe is the first case of suspected pump thrombosis in a patient with a HM3 LVAD that was successfully managed with tissue plasminogen activator (tPA). A 22-year-old man who underwent HM3 implantation for end stage heart failure due to left ventricular non-compaction presented after experiencing two low flow alarms. His physical examination was notable for tachycardia at 125 beats per minute and an elevated Doppler mean blood pressure of 92 mm Hg. LVAD interrogation revealed low flows without power spikes (Figure 1A). Within 24 hours, he developed persistent hypotension requiring vasopressor support and multiple low flow alarms. Serial laboratory results were notable for rising LDH, peaking at 4,741 U/L and acute liver injury with AST 2,712 U/L, ALT 798 U/L and INR 5.2. Transthoracic echocardiography and computed tomography (CT) angiography did not reveal any obvious thrombus. Given this constellation of findings, pump thrombosis was suspected. Following multidisciplinary discussion, unfractionated heparin bolus and infusion were started. After an unremarkable head CT, heparin was stopped and systemic tPA was given at a dose of 5 mg over one minute followed by 10 mg over 10 minutes due to ongoing liver dysfunction. Heparin was resumed after PTT returned to therapeutic range. Immediately post tPA infusion, his LVAD flows improved from 2.3 L/min to 4.1 L/min (Figure 1B). Vasopressor support was quickly weaned. LDH, creatinine, and liver enzymes improved over the following days. Warfarin was resumed on day 14 of admission. He was discharged on aspirin, clopidogrel and warfarin. Thrombolytics may be a potential therapeutic option in select cases of HM 3 pump thrombosis. Further research is warranted to delineate LVAD parameters that facilitate early recognition of pump thrombosis and successful medical management.

Cord blood 25(OH)D3, cord blood total immunoglobulin E levels, and food allergies in infancy: A birth cohort study in Chongqing, China

BackgroundFood allergy (FA) in infants has become a common disease worldwide. There are many controversies surrounding the relationships among levels of cord blood 25-hydroxy vitamin D3 [25(OH)D3], total immunoglobulin E (IgE), and FA. MethodsIn this study, we recruited pregnant women in the third trimester undergoing obstetric examination in Chongqing City, Western China. Healthy full-term singleton births between May to August 2018 and November 2018 to January 2019 were included in the summer-birth and winter-birth cohorts, respectively. Questionnaires on vitamin D status in pregnancy and family allergies were used to investigate the pregnant women. The levels of <12 ng/mL, 12～20 ng/mL, and >20 ng/mL 25(OH)D3 in cord blood detected by liquid chromatography tandem mass spectrometry were considered deficient, insufficient, and sufficient, respectively. The electrochemiluminescence method was used to detect the total lgE levels in cord blood, classified into low-IgE (<0.35IU/mL) and high-IgE (≥0.35IU/mL) levels, respectively. Within postnatal 6 months, allergic symptoms in infants were investigated using questionnaire during the infants’ monthly physical examinations. Suspected cases of FA underwent a history inquiry, skin prick test, food elimination test, and open-food challenge for diagnosis of FA. Multivariate logistic regression was used to analyze the risk factors of FA in infants. ResultsIn this study, we recruited 741 pairs of pregnant women and infants, including 343 infants in the summer-birth cohort and 398 infants in the winter-birth cohort. The incidence of FA within postnatal 6 months was 6.88%, showing significantly higher incidence of FA in the winter-birth cohorts than in the summer-birth cohorts (10.3% vs. 2.9%, χ2 = 15.682, P = 0.000). Among the 741 infants, 47.1%, 27.5%, and 13.8% of infants had deficient, insufficient, and sufficient 25(OH)D3, respectively, in the cord blood; 81.5% and 18.5% of infants had total low-IgE and total high-IgE levels, respectively, in the cord blood. No significant correlation was found between the 25(OH)D3 and IgE levels (r = −0.038, P = 0.300). Logistic regression analysis showed that winter birth [odds ratio (OR) 95% confidence interval (CI): 4.292 (2.003～8.359)] compared with infants in summer birth group, and sufficient (>20 ng/mL) 25(OH)D3 levels in cord blood [OR (95% CI): 2.355 (1.129～4.911) compared with infants in the deficient group (<12 ng/mL) and 3.782 (1.680～8.514) compared with infants in the insufficient group (12～20 ng/mL)] were independent risk factors for FA in infants within postnatal 6 months. ConclusionsWinter birth and sufficient 25(OH)D3 levels in infant cord blood were independent risk factors for FA in infants. 25(OH)D3 and total IgE levels in cord blood cannot be used as predictors of FA in early infancy.

Internet of Healthcare Things (IoHTs) Technology to Strengthen Nigeria Health Systems: A predictive technique for Syndromic Surveillance of Suspected cases of Filovirus Diseases in Africa.

Infectious disease should be early recognised, treated timely and adequately, otherwise it spreads and leads to many other complications that is capable of causing health hazards, which can relatively become a cause of multiple cases of death. The emergence and re-emerging of Filovirus diseases especially in African continent are alarmingly threatening the healthcare workers and poses greater fatality rate. Ebola Virus Disease (EVD) and Marburg Virus Disease (MVD) are in the family of Filovirus infectious disease, that is predicted to continue emerging especially in regions where the reservoir host species are known. The upsurge of Internet of Things (IoTs) in Healthcare has provision very many technological advancement and positive solutions to healthcare challenges across the globe especially in many developed countries of the world. Internet of Healthcare Things (IoHTS) is a pool of innovative technological medical related devices that are connected together to provide seemingly control management, monitoring and surveillance, predictive detection and information sharing, etc that is capable of improving quality of healthcare delivery. Thus, early recognition, and timely detection and response to highly contagious and deadly virus is critically important in this modern era. This research study employs the Case-Study methodology to present an investigative framework of the use of Internet of Healthcare Things (IoHTs) technique to detect, predict and real-time report of -re-emerging Filovirus diseases in order to provide early recognition, quick response and intervention management with improved contact tracing tool of Geographical Information System (GIS) for active surveillance for informed decision-making on emergency healthcare delivery while minimizing the spread of the viruses. The study proposes to apply the emerging IoTs innovations to symptomatically detect and predict particular Filovirus (MVD or EVD) based on the defined physiological condition systematically presented. The objectives of the study are not limited to properly review the existing frameworks suitable for the research study, and design the propose architectural framework for the performance improvement of the system. The outcome is to provide a scientific way of detecting and predicting re-emerging Filovirus Diseases, and reporting such data in real-time for improve rapid response to emergency health intervention. The system structure is logically abreast with the technique to provide Suspected individuals with opportunity to early, easily and speedily detect and predict (know) their health condition during any Filovirus (EVD and MVD) outbreaks, and significantly minimize the spread of the diseases. Keywords : Ebola Virus Disease, Marburg Virus Disease, Internet of Healthcare Things, Smart Health Care, Filovirus, Predictive Detection, Syndromic Surveillance and Real-Time Reporting. DOI: 10.7176/CEIS/13-2-05 Publication date: April 30 th 2022

Detection of Brucella Infections from Clinically Suspected Cases of Brucellosis in Garmain City- Sulaimani Province Kurdistan- Iraq

Brucellosis is a zoonotic disease transmitted between animals and humans by contaminated food, direct contact with an affected animal, or inhalation of aerosols. The research was for the period October 2019 to March 2020, 67vein blood samples of clinically suspected brucellosis (Malta fever) and 20 from healthy persons as control were tested. Control samples showed negative for brucellosis infection when serological testing was performed. while out of 67 suspected patients, 14 were significantly positive for Rose Bengal at titer (160), 39 positive for ELISA (37 for IgG and 2 for IgM). Out of 37 positive samples for IgG by ELISA, only seven samples were positive for Rose Bengal while two positive samples for IgM was negative for Rose Bengal.

Post surgery mucor recurrence in COVID-19 associated mucormycosis patients of a tertiary care centre

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; Together with COVID-19 infection, we saw an outbreak of COVID associated mucormycosis (CAM). These patients were treated with antifungals, aggressive surgery, control of diabetes and other predisposing factors. But as demand increased, there was shortage of antifungals. So patients underwent relapses. The aim of study was to evaluate the causes and relevant factors predisposing to recurrence and tools used to evaluate recurrence and extent of disease in relation to primary disease.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; Prospective study of 160 CAM patients who were discharged successfully after surgery and kept under regular follow up by endoscopy, CRP, blood sugar monitoring.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; Our study of 160 follow up cases of CAM in whom 21 patients had recurrence. There were 18 males and 3 females. The most common affected was between 50-60 years. 67% of recurrent cases had poor diabetic control, 81% suspicious of recurrence in endoscopy, 86% showed rising trend in CRP (&amp;gt;5 mg/dl). These patients were further evaluated with radiological investigations like MRI and CBCT (cone beam CT). MRI detected recurrence in 38% whereas CBCT detected 62%. Most common site of recurrence was maxilla. All recurrent cases underwent surgical debridement and were given 5 gm of liposomal amphotericin.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; Mucormycosis is an invasive fungal disease. COVID patients in whom immunological status are altered, diabetic or immunocompromised should be kept under surveillence by endoscopy, CRP and blood sugar monitoring. Though CAM patients are treated with surgery and antifungals, they should be under regular follow up for more than 6 months. Diabetic control helps in curbing the rapid spread of CAM. Suspected cases should undergo radiological investigations like MRI and CBCT. Recurrent/residual disease of mucormycosis can be tackled and treated successfully.&lt;/p&gt;

Suspected COVID-19 Cases Admitted in a Tertiary Care Hospital. Correlation of Demographic and Clinical Characteristics with Viral Load Results and Hospitalization

Background: The current pandemic outbreak of COVID-19 due to the SARS-CoV-2 virus affected the health care systems, health services and economy globally. It also affected the health of the population worldwide, with high mortality and morbidity rates. The present study aimed to study the patients that were admitted to a tertiary care hospital and to investigate the potential correlation between hospitalization and RT-PCR for SARS-CoV-2 results with demographic characteristics and clinical characteristics. Moreover, it aimed to examine a mathematical formula that might describe the correlation of the aforementioned parameters.&#x0D; Methods: The study population included 1244 patients admitted to the Nikea General Hospital "Agios Panteleimon", Piraeus, Greece. Patient age, gender, underlying diseases, travel history, symptoms, etiology for hospital admission and contact with confirmed cases were recorded. Potential correlation of hospitalization and RT-PCR for SARS-CoV-2 results with the aforementioned characteristics were identified by chi-square test of independence and logistic regression analysis.&#x0D; Results: We observed significant correlation of hospitalization with fever, cough, dyspnea, pneumonia, travel history and etiology for hospital admission. We observed significant correlation of RT-PCR for SARS-CoV-2 results with rapid antigen test result, hospitalization etiology for hospital admission and contact with confirmed COVI-19 case.&#x0D; Conclusions: According to the logistic regression model, RT-PCR for SARS-CoV-2 result, fever, dyspnea, pneumonia, and underlying disease are the most important predictors for hospitalization in the population under study. Contact with confirmed COVID-19 case is the most important predictor for RT-PCR for SARS-CoV-2 result.

Non Traumatic and Non Hypertensive Intracerebral Bleed: Causes and Imaging Evaluation

Background: Cross-sectional observational study was done in patients with non-traumatic, non-hypertensive intracerebral bleed undergoing cerebral angiography to study its different causes.Material &amp; Methods:Patients with all age groups presenting to the emergency with acute non-traumatic intra-cerebral bleed undergoing cerebral angiography in our institution for a time period of 6 months with a total of 200 patients were included in the study. Data collected were analyzed with respect to causes, distribution of aneurysms. Suspected cases of hypertensive bleed were excluded from the study population.Results:Non-contrast computed tomographic images showed positive findings in the form of either intra-axial/extra-axial bleed or infarct in 95% of patients. However angiographic findings were positive in 52% of patients. Aneurysms were the most common positive angiographic findings (43% cases) with 95% of aneurysms were located in the circle of Willis. Majority of patients had solitary aneurysm while 6% had multiple aneurysms.Conclusions:Among all non-traumatic, non-hpertensive intracerebral bleed aneurysms accounts for majority of the causes. Other causes include intraparenchymal arterio-venous malformations, cerebral venous thrombosis with hemorrhagic infarct and dural arteriovenous malformations (AVM).

Toxicological Analysis of Fluorofentanyl Isomers in Postmortem Blood.

The opioid epidemic continues to evolve in the USA, with fentanyl the most prevalent synthetic opioid in fatal drug overdoses. Following the scheduling of fentanyl's core structure in 2018, there was a notable decline in the prevalence of fentanyl analogs in decedents; however, fluorofentanyl began being reported in casework in the winter of 2020. Fluorofentanyl has three positional isomers (para-fluorofentanyl (p-FF), ortho-fluorofentanyl (o-FF) and meta-fluorofentanyl (m-FF)), with the most predominant isomer that has recently emerged in the USA being p-FF. The goal of this study was to identify p-FF in postmortem cases between October 2020 and April 2021. Urine and blood were extracted using UCT Clean Screen® extraction columns and then screened using an Agilent 1290 Infinity liquid chromatograph (LC) coupled to an Agilent 6545 accurate mass time-of-flight mass spectrometer (TOF-MS) and quantified using an Agilent 6890N GC system coupled with an Agilent 5973 MS. The limit of quantitation (LOQ) for fentanyl, acetyl fentanyl, butyryl fentanyl, p-FF, o-FF and m-FF was 2.5 ng/mL. The screening method could not differentiate the three positional isomers of fluorofentanyl. Suspected overdose cases (n = 370) received from October 2020 through April 2021 from four Medical Examiner Districts in the state of Florida were analyzed for the presence of fluorofentanyl. The LC-QTOF-MS screen yielded 27 decedents positive for fluorofentanyl, with a majority being Caucasian (93%) and male (70%) with ages ranging from 27 to 63 years. Analysis of the blood and urine by GC-MS yielded 14 decedents positive for p-FF, nine of which were positive in the blood. The blood concentrations (n = 9) for p-FF ranged from <LOQ to 30 ng/mL, with an average and median of 9.9 ng/mL and 5.5 ng/mL, respectively. p-FF was identified in the blood of 33% of the cases, and the concentration of p-FF was generally higher than previously reported.

Utility of Lymphocyte Transformation Test for Assisting Updated Roussel Uclaf Causality Assessment Method in Drug-Induced Liver Injury: A Case-Control Study.

Background: The Roussel Uclaf Causality Assessment Method (RUCAM) is a validated tool for assessing causality in cases of suspected drug-induced liver injury (DILI). However, RUCAM cannot discriminate between concomitant hepatotoxic drugs with the same temporal sequence. Objective: To analyse the utility of the lymphocyte transformation test (LTT) for assisting updated RUCAM in 45 patients and 40 controls with a clinical diagnosis of DILI. Methods: Suspected DILI cases were detected through the Prospective Pharmacovigilance Program from Laboratory Signals in Hospital (PPLSH) or by consultations. The controls completed the drug therapy with no adverse reactions during the study period. A receiver operating characteristics (ROC) curve analysis was performed to calculate the optimal cut-off value for the stimulation index (SI), corresponding to the largest sum for the specificity and sensitivity values of LTT for true DILI cases. Results: Out of 45 patients diagnosed with DILI, 42 cases were detected by the PPLSH, two cases by consultation and one case by both methods. Most DILI cases (64.4%) arose during hospitalization. According to the biochemical parameters, 24 cases (53.3%) had the hepatocellular phenotype, 14 (31.1%) had the cholestatic phenotype, and 7 cases (15.6%) had the mixed phenotype. Considering the severity criteria, 7 (15.5%) cases were classified as moderate DILI, and 4 (8.9%) were severe DILI; there were no fatal cases. A total of 149 drugs (median/case, 3; IQR, 2–5) were suspected to be involved in the DILI cases (RUCAM score ≥3). In 8 cases, only one drug was suspected, and polypharmacy (≥5 drugs) was identified in 29% of the cases. Of all DILI cases, 46 (30.9%) of the 149 suspected drugs produced positive LTT results, and the LTT was positive in 34 (75.5%) of the 45 patients. No exposed controls produced positive LTT results. The optimal cut-off of 1.95 for the SI was obtained with a sensitivity of 77% and specificity of 100% (area under the curve, 0.91; 95% asymptotic confidence interval 0.84–0.97; p < 0.001). The sensitivity of the hepatocellular phenotype was 92%. Conclusion: Our results demonstrate that LTT is an add on strengthening causality in cases of suspected idiosyncratic DILI, especially for patients with several suspected drugs and a hepatocellular phenotype.

GeneXpert Based Confirmed Cases among Suspected Cases of Tuberculosis in a Tertiary Care Centre: A Descriptive Cross-sectional Study.

Tuberculosis is an infectious disease caused by Mycobacterium tuberculosis mostly affecting the lungs. Due to the low sensitivity of conventional microscopy and time-consuming culture method, Nucleic acid Amplification Assay Technique is preferred because of its rapidity and sensitivity. This test also helps in finding drug resistance to Rifampicin and also curtails the transmission of disease. The study is aimed to find the prevalence of GeneXpert confirmed cases among suspected cases of tuberculosis in a tertiary care centre. A descriptive cross-sectional study in 104 patients was conducted in a tertiary care centre from 30th Dec 2021 to 3rd Feb 2022. Ethical clearance was taken from the Institutional Review Committee (Reference number: 464/078/079). Sputum samples were collected from patients and were processed for GeneXpert under biological safety standards. GeneXpert Mycobacterium tuberculosis/rifampicin assay, sample processing, deoxyribonucleic acid extraction, and deoxyribonucleic acid amplification occurred in a fully automated cartridge-based real-time Polymerase chain reaction. A convenience sampling method was done. Collected data were coded as per variables and entered in Statistical Package for the Social Sciences version 25. Point estimate at 95% Confidence Interval was calculated along with frequency and percentage for binary data. In all 104 patients, GeneXpert detected 10 (9.62%) (3.94-15.26 at 95% Confidence Interval) positive tuberculosis cases. Out of total positive cases, there were 6 (60%) males and 4 (40%) females and there was 1 (10%) rifampicin-resistant case. The prevalence of pulmonary tuberculosis among presumptive cases in our study was found to be similar to reported literature. multidrug-resistant; nucleic acid amplification test; pulmonary tuberculosis.

First PCR Confirmed anthrax outbreaks in Ethiopia-Amhara region, 2018-2019.

BackgroundAnthrax is a disease that affects humans and animals. In Ethiopia, anthrax is a reportable disease and assumed to be endemic, although laboratory confirmation has not been routinely performed until recently. We describe the findings from the investigation of two outbreaks in Amhara region.MethodsFollowing reports of suspected outbreaks in Wag Hamra zone (Outbreak 1) and South Gondar zone (Outbreak 2), multi-sectoral teams involving both animal and public health officials were deployed to investigate and establish control programs. A suspect case was defined as: sudden death with rapid bloating or bleeding from orifice(s) with unclotted blood (animals); and signs compatible with cutaneous, ingestion, or inhalation anthrax ≤7 days after exposure to a suspect animal (humans). Suspect human cases were interviewed using a standard questionnaire. Samples were collected from humans with suspected anthrax (Outbreak 1 and Outbreak 2) as well as dried meat of suspect animal cases (Outbreak 2). A case was confirmed if a positive test was returned using real-time polymerase chain reaction (qPCR).ResultsIn Outbreak 1, a total of 49 cows died due to suspected anthrax and 22 humans developed symptoms consistent with cutaneous anthrax (40% attack rate), two of whom died due to suspected ingestion anthrax. Three people were confirmed to have anthrax by qPCR. In Outbreak 2, anthrax was suspected to have caused the deaths of two livestock animals and one human. Subsequent investigation revealed 18 suspected cases of cutaneous anthrax in humans (27% attack rate). None of the 12 human samples collected tested positive, however, a swab taken from the dried meat of one animal case (goat) was positive by qPCR.ConclusionWe report the first qPCR-confirmed outbreaks of anthrax in Ethiopia. Both outbreaks were controlled through active case finding, carcass management, ring vaccination of livestock, training of health professionals and outreach with livestock owners. Human and animal health authorities should work together using a One Health approach to improve case reporting and vaccine coverage.

The Distribution of Dengue Virus Serotype in Quang Nam Province (Vietnam) during the Outbreak in 2018.

Objectives: Quang Nam province in the Centre of Vietnam has faced an outbreak of dengue hemorrhagic fever (DHF) in 2018. Although DHF is a recurrent disease in this area, no epidemiological and microbiological reports on dengue virus serotypes have been conducted mainly due to lack of facilities for such a kind of advanced surveillance. The aim of this study was to detect different dengue virus serotypes in patients’ blood samples. Design and Methods: Suspected cases living in Quang Nam province (Vietnam) and presenting clinical and hematological signs of dengue hemorrhagic fever were included in the study. The screening was performed, and the results were compared by using two methodologies: RT real-time PCR (RT-rPCR) and the Dengue NS1 rapid test. Results: From December 2018 to February 2019, looking both at RT-rPCR [+] and NS1 [+] methodologies, a total of 488 patients were screened and 336 were positive for dengue virus detection (74 children and 262 adults); 273 of these patients (81.3%) underwent viral serotype identification as follows: 12.82% (35/273) D1 serotype, 17.95% (49/273) D2, 0.37% (1/273) D3, 68.50 (187/283) D4, and 0.37% (1/273) D2+D4 serotypes. The RT-rPCR outcomes showed higher sensitivity during the first three days of infection compared to NS1 (92.3% vs. 89.7%). The NS1 increased sensitivity after the first 3 days whilst the RT-rPCR decreased. Conclusions: Advanced surveillance with dengue virus serotypes identification, if performed routinely, may help to predict and prevent further DHF epidemics based on the exposure of the different serotypes during different periods that lead to the intensification of disease severity as a consequence of antibody-dependent enhancement (ADE).

Work absences among hospital cleaning staff during the SARS-CoV-2 (COVID-19) pandemic.

Introduction:Absenteeism justified by sick leaves are valuable indicators of workers’ health conditions.Objectives:To analyze hospital cleaning staff sick leaves during the COVID-19 pandemic.Methods:This retrospective cohort study included employees who presented a medical sick leave certificate justifying at least 1 missed day of work during the first wave of the COVID-19 pandemic. Data were collected from March 24 to December 31, 2020 at a teaching hospital.Results:A total of 199 workers who presented 689 medical certificates were included in the sample. The sample was 88.4% women. The mean ages for suspected COVID-19 cases and all other cases were 39.7 years and 40.9 years, respectively. Suspected COVID-19 cases involved longer leaves (mean 5.82 [SD, 3.35] days missed) and more medical sick leave certificates (mean 4.25 [SD, 3.13] certificates per worker) than other causes. Among suspected cases, 32.1% worked in critical areas of the hospital. Of the 83 RT-PCR tests performed, 24.1% were positive, with 80% of these employees working in semi-critical or administrative areas; 15% of workers who tested positive developed the severe form of the disease.Conclusions:Among workers who underwent RT-PCR testing, the rate of positive results was low. Most positive cases occurred in younger women who worked in non-critical units (ie, units involving no direct patient contact or without aerosol-generating procedures). The mean number of missed days was higher among suspected COVID-19 cases (7.85 days [SD, 4.05]). The use of individual protective equipment was common among these employees, and they were continuously trained.

Rheumatoid arthritis and spondyloarthritis prevalence in four European countries - a comparative study

Introduction/Objective. The objective was to compare rheumatoid arthritis (RA), spondyloarthritis (SpA) and subtypes of SpA prevalence in four European countries. Methods. A 33-items detection questionnaire, containing self-reported diagnosis, classification criteria for RA and SpA, personal and family history, was translated using cross-cultural adaptation and validated in France, Turkey, Lithuania and Serbia, where it was used on a population sample. Suspected cases were evaluated and confirmed by a rheumatologist. Prevalence estimates were age- and sex-standardized to European standard population. Results. In total, 33,454 people older than 18 years were screened and 31,454 interviewed: France 14,671, Lithuania 6,558, Serbia 6,213, Turkey 4,012. Standardized RA prevalence varied from 0.29% (95% CI: 0.17?0.40) in France to 0.57% (0.31?0.84) in Turkey; this inequality was mostly caused by differences in women prevalence (from 0.42% in France to 1.02% in Turkey) SpA prevalence was similar in France (0.30%), Serbia (0.35%) and Turkey (0.37%), but in Lithuania it was 0.89%, which could be caused by geographic and genetic differences, as SpA prevalence was higher in North and East Europe, as well as the human leukocyte antigen B27 presence. SpA prevalence was equally presented by gender for France and Serbia. Regarding SpA subtypes, ankylosing spondylitis prevalence varied from 0.07?0.30% (Serbia?Lithuania), PsA 0.10?0.26% (France?Lithuania), reactive arthritis was 0.09?0.18% (Serbia?Lithuania). Previously nondiagnosed SpA cases were found in 6.9% in France, 25.9% in Lithuania and 31.2% in Serbia. Conclusion. East?West decreasing tendency for the female RA prevalence was noted. SpA was higher in North-Eastern Europe than in its Western and Southern part. One quarter of the SpA patients in Lithuania and one third in Serbia were not previously diagnosed. The SpA population prevalence was higher than expected and similar to RA.