Treatment Of Cholera Research Articles

Mathematical modeling of cholera dynamics in the presence of antimicrobial utilization strategy

Antimicrobial resistance poses a significant threat to public health, particularly in cholera treatment. The emergence of antibiotic resistance, coupled with the sharp decline in pharmaceutical companies developing new cholera antibiotics, is a cause for concern. We formulate a multidrug-resistant (MDR) cholera epidemic model that incorporates a stage-switching strategy between two antibiotics to reduce the magnitude of resistance. The model is analyzed mathematically, and sensitivity analysis of the reproduction number is performed using sub-reproduction numbers. Stability analysis of the cholera-sensitive-only and cholera-resistant-only equilibria is investigated using Centre Manifold Theory. The model is calibrated through Markov Chain Monte Carlo simulations in Stan, showing stability at equilibrium points, which is further verified through numerical simulations. The simulations demonstrate an inverse relationship between the number of MDR cholera cases and the number of individuals receiving second-line treatment for cholera. This study suggests that the correct use of antibiotics can effectively manage the emergence of antimicrobial resistance. From a public health policy perspective, these findings emphasize the importance of antibiotic stewardship programs and the need for policies that promote the responsible use of existing antibiotics while encouraging the development of new treatment options. Such measures could help mitigate the global burden of MDR cholera and prevent further escalation of resistance.

Economic cost of a case of diarrhoea in Uvira, Democratic Republic of the Congo: A cost of illness study.

Diarrhoea is one of the leading causes of disability-adjusted life years (DALYs) among children below five years, though the proportion of the burden occurring amongst those aged over 70 is increasing. The cost of treating and managing diarrhoea can place a burden on individuals, their households, and society in general. The cost can be high but is often undocumented, and many studies focus on children or hospitalised patients only. This study aimed to estimate the economic cost per case of diarrhoea amongst individuals of any age in Uvira, Democratic Republic of the Congo. The study was cross-sectional and retrospective, and based on a household survey approximately representative of the city undertaken in September 2021. Data on quantities and prices of resources were collected in the survey, as well as from interviews with staff at the Cholera Treatment Centre in the Uvira general hospital and their records on resource use and patient numbers. Direct and indirect costs were measured from the societal perspective, and generalised linear regression used to identify factors associated with higher costs. Of 2,820 members of the 528 households surveyed, 175 people (6.2%) were reported to have had diarrhoea in the previous seven days. The majority sought care (91%) of which most (64%) visited a pharmacy. The average economic cost of illness (COI) for an episode of diarrhoea was 33,816 Congolese Francs (CDF) (US$ 17.0) in 2021 prices. The median was CDF 14,000 (US$ 7.0). The average out of pocket COI to patients was CDF 15,579 (US$ 7.8), representing 9% of the estimated average monthly income of households. On average caregivers and patients lost 4 days per episode. A concentration index suggested a lower economic COI among poorer households (p=0.099). A regression analysis identified that being older than 5 years (p=0.001) or being water insecure (p=0.032) were associated with higher COI. Households in Uvira experience many diarrhoeal episodes per year, and the COI is an important burden for them and society. These costs could be avoided if diarrhoea were prevented through public health interventions to reduce prevalence and care-seeking was better managed to avert this public health burden.

Surveillance of travel-associated isolates elucidates the diversity of non-pandemic Vibrio cholerae.

Vibrio cholerae is a Gram-negative bacterium found in aquatic environments and is the aetiological agent of cholera, characterized by acute watery diarrhoea and severe dehydration. Cholera presents a significant global health burden of an estimated 1.3-5 million annual cases, with the current pandemic caused by a toxigenic lineage of the O1 El Tor biotype called seventh pandemic El Tor (7PET) that is still ongoing. Whilst it is known that non-7PET lineages can cause sporadic disease, little is known about the transmission of these non-epidemic lineages. Thirty-four V. cholerae isolates were obtained from travellers returning from Indonesia to Australia between 2005 and 2017. These were whole genome sequenced, placed into a global phylogenetic context with 883 isolates, and screened for known genes associated with antimicrobial resistance and virulence. This analysis revealed that 30 isolates fell within non-7PET lineages and four within the 7PET lineage. Both 7PET and non-7PET isolates carried genes for resistance to antibiotics that are commonly used in cholera treatment such as tetracyclines and fluoroquinolones. Diverse virulence factors were also present in non-7PET isolates, with two isolates notably carrying toxin-coregulated pilus genes, which are primarily responsible for intestinal colonization in 7PET V. cholerae. This study demonstrates the role of travel in long-range carriage of epidemic and non-epidemic lineages of V. cholerae, and how sentinel travel surveillance can enrich our knowledge of V. cholerae diversity, reveal new biology about the spread of diverse lineages with differing disease potential and illuminate disease presence in endemic regions with limited surveillance data.

Vibrio cholerae virulence is blocked by chitosan oligosaccharide-mediated inhibition of ChsR activity.

Vibrio cholerae causes cholera, an important cause of death worldwide. A fuller understanding of how virulence is regulated offers the potential for developing virulence inhibitors, regarded as efficient therapeutic alternatives for cholera treatment. Here we show using competitive infections of wild-type and mutant bacteria that the regulator of chitosan utilization, ChsR, increases V. cholerae virulence in vivo. Mechanistically, RNA sequencing, chromatin immunoprecipitation with sequencing and molecular biology approaches revealed that ChsR directly upregulated the expression of the virulence regulator, TcpP, which promoted expression of the cholera toxin and the toxin co-regulated pilus, in response to low O2 levels in the small intestine. We also found that chitosan degradation products inhibit the ChsR-tcpP promoter interaction. Consistently, administration of chitosan oligosaccharide, particularly when delivered via sodium alginate microsphere carriers, reduced V. cholerae intestinal colonization and disease severity in mice by blocking the chsR-mediated pathway. These data reveal the potential of chitosan oligosaccharide as supplemental therapy for cholera treatment and prevention.

Determinants of recovery time from severe acute malnutrition among cholera-exposed and unexposed children in Ethiopia: a prospective cohort study.

There is a vicious interplay between severe acute malnutrition (SAM) and diarrheal diseases including cholera. The lack of sufficient evidence on the time to recovery and its determinants among children with cholera prompted this investigation. The study aimed to evaluate the time to recovery and determinants among children with severe acute malnutrition, comparing cholera-exposed and unexposed children. A prospective cohort study was carried out from September 10, 2022, to February 21, 2023, among 224 children below 15 years. The study was conducted at cholera treatment centers and nearby communities in the Bale and Guji Zones of Oromia Regional state in Ethiopia. A structured questionnaire was used to obtain information and anthropometric measurements were conducted weekly. After checking all assumptions, a multivariable Cox Proportional Hazards model was used to identify independent determinants of time to recovery using an adjusted hazard ratio (AHR) with a 95% confidence interval (CI). Statistical significance was declared at p < 0.05. Nearly 80% of participants recovered from SAM with a recovery rate of 40/1000 person-week observation and a median time to recovery of 21 days [Inter Quartile Range14-28]. The recovery time from SAM for cholera-exposed children was delayed by 54% [ARR: 0.46, 95% CI: 0.30-0.69] compared to unexposed children. Similarly, the recovery time from SAM for food-insecured families was delayed by 39% [ARR: 0.61, 95% CI: 0.38-0.96] compared to food-secured families. Moreover, children with more than three meal frequencies per day had 1.61 times [ARR: 1.61, 95% CI: 1.04-2.50] higher probability of fast recovery from SAM, compared to children with less than three meals. Children from families with good attitudes toward nutrition had more than two times [ARR: 2.23, 95% CI: 1.45-3.41] higher probability of faster recovery from SAM than families with poor attitudes. The study revealed that cholera exposure is one of the main determinants of prolonged recovery time for children with SAM. Food insecurity, meal frequency, and the attitude of parents toward children's dietary habits were determinants for the recovery of children from SAM. The findings imply the need for designing interventions to enhance child feeding during cholera illness, focusing on key determinants.

ANTIBACTERIAL EFFICACY OF BACTERIOPHAGES AGAINST VIBRIO CHOLERAE

This study investigates the use of bacteriophages as an alternative antibacterial approach to combat antibiotic-resistant Vibrio cholerae, a major public health concern. Vibrio cholerae strains were identified through culture on TCBS agar, microscopy, and biochemical tests (catalase, oxidase, indole, and citrate). Antibiotic susceptibility was assessed using the Kirby-Bauer disk diffusion method across five antibiotics: tetracycline, norfloxacin, ampicillin, ciprofloxacin, and erythromycin. Results showed resistance to ampicillin, tetracycline, and erythromycin, while strains remained susceptible to norfloxacin and ciprofloxacin Five bacteriophages against Vibrio cholerae were isolated from 50 wastewater samples, and only two (F1 and F2) showed lytic activity, forming clear plaques. These two lytic phages were further purified and characterized for stability across different temperatures, pH levels, and host range. The isolated phages were tested for host range against six Vibrio cholerae strains, with F1 lysing five strains and F2 lysing three, and demonstrated stability across temperatures (20°C to 55°C) and pH levels (4 to 9). They remained active across a wider temperature and pH range demonstrating their potential for therapeutic use. The study shows that these phages are highly specific, targeting only Vibrio cholerae strains from various sources without affecting other bacterial species. This specificity makes them safer for therapeutic use, as they are less likely to disrupt the body’s natural bacterial flora. Further genomic studies are recommended to characterize the genetic makeup of these phages, optimizing their application in cholera treatment. This study provides critical insights into the potential of bacteriophages as an alternative treatment for antibiotic-resistant Vibrio cholerae.

Comparing Doxycycline and Azithromycin in treating cholera

Cholera is a famous bacterial infection that was found in the Indian Ganges Delata during the 19th century. People who were infected suffered a lot from the symptoms like diarrhea and dehydration, which impacted peoples living standards. Doxycycline and Azithromycin are the most common drug treatments used for cholera patients. Doxycycline can inhibit the synthesis of bacterial protein by combining with the 30s ribosome and shorten the duration of this disease. Doxycycline is used over a wide range of age groups. Azithromycin can combine with the 50s ribosome to inhibit the synthesis of protein. However, using antibiotics over the given time period will cause the bacteria to grow resistant to them. This essay will discuss the two antibiotics that are used nowadays for Cholera treatment.

Genetic Stability and Public Health Implications of Plasmid-Free Vibrio cholerae

Background: Cholera, caused by Vibrio cholerae, is a significant global health concern, particularly in regions with poor sanitation. Specific Background: This study focuses on V. cholerae strains isolated from cholera patients in Al-Nasiriyah city, Iraq, where limited genetic studies have been conducted. Knowledge Gap: Despite extensive research on V. cholerae, little is known about the genetic makeup of strains from Al-Nasiriyah city and their plasmid content, which traditionally correlates with antibiotic resistance and virulence. Aims: This research aimed to characterize the genetic and antibiotic resistance traits of V. cholerae strains from cholera patients in Al-Nasiriyah city and to determine the presence of plasmids using advanced molecular techniques. Results: Contrary to expectations, our study identified V. cholerae strains devoid of plasmids and exhibiting a stable genetic profile across two chromosomes, with sizes ranging from 1 to 3 million base pairs. Novelty: Our findings challenge conventional wisdom by demonstrating the absence of plasmids in local V. cholerae strains and highlighting their unique genetic architecture. Implications: This study underscores the importance of genomic diversity studies in understanding V. cholerae epidemiology and guiding public health strategies. Future research should explore larger strain cohorts and conduct comparative genomic analyses to elucidate the broader implications of genetic variability on cholera outbreaks and treatment strategies. Highlights: Genetic Stability: V. cholerae strains exhibit stable genetic profiles. Plasmid Absence: No plasmids found, challenging antibiotic resistance assumptions. Public Health Impact: Crucial for effective cholera management and prevention strategies. Keywords: Vibrio cholerae, genetic diversity, antibiotic resistance, plasmid absence, public health implications

Cost of Cholera for Households and Health Facilities, Somalia

IntroductionCholera remains a substantial public health challenge in Somalia. Ongoing droughts in the country have caused significant outbreaks which have negatively affected the lives of many individuals and overwhelmed health facilities. We aimed to estimate the costs associated with cholera cases for households and health facilities in Somalia.MethodsThis cost-of-illness study was conducted in five cholera treatment centres in Somalia and 400 patients treated in these facilities. Data collection took place during October and November 2023. Given that a significant portion of the patients were children, we interviewed their caregivers to gather cost data. We interviewed staff at the centres and the patients. The data obtained from the household questionnaire covered direct (medical and non-medical) and indirect (lost wages) costs, while direct costs were estimated for the health facility (personnel salaries, drugs and consumables used to treat a patient, and utility expenses). All costs were calculated in US dollars (USD), using 2023 as the base year for the estimation.ResultsThe average total cost of a cholera episode for a household was US$ 33.94 (2023 USD), with 50.4% (US$ 17.12) being direct costs and 49.6% (US$ 16.82) indirect costs. The average total cost for a health facility to treat an episode of cholera was US$ 82.65. The overall average cost to households and health facilities was US$ 116.59. The average length of stay for a patient was 3.08 days. In the households, patients aged 41 years and older incurred the highest mean total cost (US$ 73.90) while patients younger than 5 years had the lowest cost (US$ 21.02). Additionally, 61.8% of households had to use family savings to cover the cost of the cholera episode, while 14.5% had to borrow money. Most patients (71.8%) were younger than 16 years– 45.3% were 5 years or younger– and 94.0% had never received a cholera vaccine.ConclusionOur study suggests that preventing one cholera episode in Somalia could avert substantial losses for both the households and cholera treatment centres. The findings shed light on the expenses associated with cholera that extend beyond healthcare, including substantial direct and indirect costs borne by households. Preventing cholera cases could lead to a decrease in this economic burden, consequently our study supports the need for preventive measures.

Detection of Vibrio cholerae as a Potential Microbiological Hazard from Water Samples Used for Cleaning Purpose of Pani-puri Serving Plates in Dhaka City, Bangladesh

Abstract BACKGROUND: Cholera remains a significant public health concern, particularly in endemic regions like Bangladesh. This study aimed to assess the prevalence and characteristics of Vibrio cholerae contamination in pani-puri plate wash water in Dhaka city, employing biochemical, microscopic, and antibiotic resistance analyses. METHODS: A total of 20 pani-puri plate wash water samples were collected from various locations in Dhaka between August 2023 and October 2023. The samples were analyzed at the Department of Microbiology, Stamford University Bangladesh. RESULTS: V. cholerae was found to be highly prevalent, especially in crowded urban areas. Biochemical tests confirmed the identity of the isolates as V. cholerae. Antibiotic susceptibility testing revealed concerning resistance patterns, with 100% resistance to commonly used drugs such as meropenem and ampicillin. In addition, resistance to cefixime, nalidixic acid, and chloramphenicol was observed, emphasizing the need for alternative treatment options. CONCLUSION: These findings highlight the significance of ongoing monitoring of V. cholerae populations for virulence factors and changes in antibiotic resistance to inform public health interventions and cholera control measures. The study underscores the importance of strict hygienic standards in the preparation of street food, particularly in endemic locations such as Dhaka, Bangladesh, to reduce the risk of waterborne diseases. Continuous surveillance for drug resistance and microbiological contamination is crucial for effective cholera treatment and prevention.

Existence of cholera outbreak, challenges, and way forward on public health interventions to control cholera outbreak in Guraghe Zones, southern Ethiopia, 2023.

In Ethiopia, despite major improvements seen in health service delivery system, the country continues to be significantly affected by cholera outbreaks. Cholera remains a significant public health problem among the vulnerable populations living in many resource-limited settings with poor access to safe and clean water and hygiene practices. Recurring cholera outbreaks are an indication of deprived water and sanitation conditions as well as weak health systems, contributing to the transmission and spread of the cholera infection. To assess the cholera outbreak, its challenges, and the way forward on public health interventions to solve the knowledge and health service delivery gaps related to cholera control in Guraghe Zone, Ethiopia, 2023. Active surveillance of the cholera outbreak was conducted in all kebeles and town administrative of Guraghe zone from 7/8/2023 to 30/10/2023. A total of 224 cholera cases were detected during the active surveillance method. Data obtained from Guraghe zone offices were exported to SPSS version 25 for additional analysis. The case fatality rate, incidence of the cases, and other descriptive variables were presented and described using figures and tables. A total of 224 cholera cases were detected through an active surveillance system. In this study, the case fatality rate of cholera outbreak was 2.6%. To tackle the cholera outbreak, the Guraghe zone health office collaborated with other stakeholders to prepare four cholera treatment centers. The absence of OCV, inaccessible safe water, low latrine coverage, inappropriate utilization of latrines, and absence of cholera laboratory rapid diagnostics test in Guraghe Zone are barriers to tackling the outbreak. Ethiopia National Cholera Plan targeted eradicating cholera by 2030, 222 cholera outbreak occurred in Guraghe Zone, Ethiopia. To minimize and control cholera mortality rate oral cholera vaccinations should be employed in all areas of the region. Sustainable WASH measures should be guaranteed for the use of safe water and good hygiene practices. Early diagnosis and treatment should be initiated appropriately for those who are infected.

Case-area targeted interventions during a large-scale cholera epidemic: A prospective cohort study in Northeast Nigeria.

Cholera outbreaks are on the rise globally, with conflict-affected settings particularly at risk. Case-area targeted interventions (CATIs), a strategy whereby teams provide a package of interventions to case and neighboring households within a predefined "ring," are increasingly employed in cholera responses. However, evidence on their ability to attenuate incidence is limited. We conducted a prospective observational cohort study in 3 conflict-affected states in Nigeria in 2021. Enumerators within rapid response teams observed CATI implementation during a cholera outbreak and collected data on household demographics; existing water, sanitation, and hygiene (WASH) infrastructure; and CATI interventions. Descriptive statistics showed that CATIs were delivered to 46,864 case and neighbor households, with 80.0% of cases and 33.5% of neighbors receiving all intended supplies and activities, in a context with operational challenges of population density, supply stock outs, and security constraints. We then applied prospective Poisson space-time scan statistics (STSS) across 3 models for each state: (1) an unadjusted model with case and population data; (2) an environmentally adjusted model adjusting for distance to cholera treatment centers and existing WASH infrastructure (improved water source, improved latrine, and handwashing station); and (3) a fully adjusted model adjusting for environmental and CATI variables (supply of Aquatabs and soap, hygiene promotion, bedding and latrine disinfection activities, ring coverage, and response timeliness). We ran the STSS each day of our study period to evaluate the space-time dynamics of the cholera outbreaks. Compared to the unadjusted model, significant cholera clustering was attenuated in the environmentally adjusted model (from 572 to 18 clusters) but there was still risk of cholera transmission. Two states still yielded significant clusters (range 8-10 total clusters, relative risk of 2.2-5.5, 16.6-19.9 day duration, including 11.1-56.8 cholera cases). Cholera clustering was completely attenuated in the fully adjusted model, with no significant anomalous clusters across time and space. Associated measures including quantity, relative risk, significance, likelihood of recurrence, size, and duration of clusters reinforced the results. Key limitations include selection bias, remote data monitoring, and the lack of a control group. CATIs were associated with significant reductions in cholera clustering in Northeast Nigeria despite operational challenges. Our results provide a strong justification for rapid implementation and scale-up CATIs in cholera-response, particularly in conflict settings where WASH access is often limited.

Perceptions and Controversies on Cholera in the Traditional Chinese Medicine Field in the Late Qing Dynasty

Abstract At the beginning of the initial cholera outbreak in China, Wang Qingren (王清任), after years of clinical trials, became an early representative who discovered the infectious characteristics and observed the course of cholera in the field of traditional Chinesse medicine (TCM). Kou Langao (寇兰皋) and Xu Zimo (徐子默), both medical practitioners, constructed a diagnosis and treatment system for cholera with cold patterns under the theory of typhoid. They represented “School of Cholera with Cold Patterns” (SCCP). In the 1860s, with the influence of Wang Shixiong’s (王士雄) studies on the nature of cholera under the theory of epidemic febrile disease, the “School of Cholera with Heated Patterns” (SCHP) prevailed thereafter. The two schools complemented each other in theories and contributed to the integrity of TCM in cholera diagnosis and treatment. By reviewing previous literature, books, clinical cases, and historical materials in medical field, this article aims 1) to summarise the influence of TCM on the cognitive development towards cholera in the late Qing dynasty; 2) to explore the origin of the controversy between SCCP and SCHP from historical evidence; 3) to summarize the historical lessons from the debate over cholera in TCM based on the principle of treatment based on pattern identification, and offer suggestions for the current prevention and treatment of new diseases using TCM.

The surging cholera epidemic in Africa: a review of the current epidemiology, challenges and strategies for control

Africa, a known region with abundant warm coastal waters and a natural reservoir for Vibrio cholera, is known to bear the highest burden of cholera morbidity and mortality globally. Malawi is currently experiencing the deadliest cholera outbreak in two decades, and neighbouring countries, Mozambique and Zambia, have also reported significant numbers of cases. If the current trend of cholera transmission is sustained, the number of fatalities recorded in 2021, Africa’s deadliest year for cholera over the past decade, might be exceeded. This article aims to review the current epidemiology, prevention and control strategies, and treatment of cholera in Africa to highlight context-specific challenges and recommend possible solutions. The authors found out that cholera outbreaks in Africa are taking place in the midst of epidemics (measles, mumps, etc.) and natural disasters like cyclones and flooding (Mozambique, Malawi), drought (Kenya, and Ethiopia), and conflict (Cameroon, the DR Congo, Nigeria, and Ethiopia). The shortages of medical supplies like cholera kits and oral cholera vaccines in many countries due to constrained and limited resources and antibiotic resistance further make management and control difficult. The outbreak is spreading throughout the region because of poor sanitation, unsafe water supplies, and increased cross-border travel. Cholera in Africa follows a seasonal pattern, suggesting specific periods for heightened outbreak preparedness and response. The authors suggest a targeted multisectorial approach and a coordinated mechanism to respond to the epidemic through sustained political will, formidable partnerships, resource mobilisation, and the provision of technical support and advocacy at sub-national, national, and international levels.

Effectiveness of one dose of killed oral cholera vaccine in an endemic community in the Democratic Republic of the Congo: a matched case-control study

A global shortage of cholera vaccines has increased the use of single-dose regimens, rather than the standard two-dose regimen. There is sparse evidence on single-dose protection, particularly in children. In 2020, a mass vaccination campaign was conducted in Uvira, an endemic urban setting in eastern Democratic Republic of the Congo, resulting in largely single-dose coverage. We examined the effectiveness of a single-dose of the oral cholera vaccine Euvichol-Plus in this high-burden setting. In this matched case-control study, we recruited individuals with medically attended confirmed cholera in the two cholera treatment facilities in the city of Uvira. The control group consisted of age-matched, sex-matched, and neighbourhood-matched community individuals. We recruited across two distinct periods: Oct 14, 2021, to March 10, 2022 (12-17 months after vaccination), and Nov 21, 2022, to Oct 18, 2023 (24-36 months after vaccination). Study staff administered structured questionnaires to all participants to capture demographics, household conditions, potential confounding variables, and vaccination status. The odds of vaccination for the case and control groups were contrasted in conditional logistic regression models to estimate unadjusted and adjusted vaccine effectiveness. We enrolled 658 individuals with confirmed cholera and 2274 matched individuals for the control group. 99 (15·1%) individuals in the case group were younger than 5 years at the time of vaccination. The adjusted single-dose vaccine effectiveness was 52·7% (95% CI 31·4 to 67·4) 12-17 months after vaccination and 44·7% (24·8 to 59·4) 24-36 months after vaccination. Although protection in the first 12-17 months after vaccination was similar for children aged 1-4 years and older individuals, the estimate of protection in children aged 1-4 years appeared to wane during the third year after vaccination (adjusted vaccine effectiveness 32·9%, 95% CI -30·7 to 65·5), with CIs spanning the null. A single dose of Euvichol-Plus provided substantial protection against medically attended cholera for at least 36 months after vaccination in this cholera-endemic setting. Although the evidence provides support for similar levels of protection in young children and others in the short term, protection among children younger than 5 years might wane significantly during the third year after vaccination. Wellcome Trust and Gavi, the Vaccine Alliance.

Ślady ajurwedy w dziewiętnastowiecznej medycynie polskiej: kazus szpitali cholerycznych w Warszawie i Poznaniu w latach 1831 i 1866

Elements of Ayurveda in nineteenthcentury Polish medicine: the case of cholera hospitals in Warsaw and Poznań in 1831 and 1866 The article contributed to the history of translational medicine and presents the transfer of elements of the Ayurvedic treatment of cholera to the medical practice in Poland in the 19th century, carried out through Western European doctors. Special attention is paid to the role played in this process by foreign physicians and surgeons working in Warsaw hospitals during the November Uprising. Their education, medical experience and competence as regards cholera treatment were described, as well as the scientific research they carried out in Warsaw and their preferences for cholera treatment. It was demonstrated that the Hindu treatment regimen was accepted by colonial doctors and after some modifications disseminated in Europe. To assess the persistence of the treatment in Poland, the medications used in 1831 in Warsaw hospitals were compared with those administered to patients in the Poznan lazarette in 1866. The article is based on foreign doctors reports on the fight against cholera in 1831 in the Kingdom of Poland, as well as a unique report on the treatment of cholera at the Sisters of Charity Hospital in Poznan in 1866.

Phytochemical and thin layer chromatographic studies on a Spondias mangifera of Kamrup District of Assam

Spondias mangifera is a medicinal plant found in home gardens Kamrup. It is to be used for the treatment of dysentery, rheumatism, swollen joints, abscesses and cholera. Phytochemical investigation on ethanolic bark extract proves the presence of different important chemicals in this plant. TLC study also indicates the presence of multiple compounds in the bark of this plant.

Experience in the treatment and prevention of cholera in the XIX century (based on reports and publications of doctors of the Saratov province)

The article is devoted to the study of medical practice and treatment methods used by Saratov doctors in the fight against cholera epidemics in the XIX century. The relevance of the study is determined by the increased interest of the broad strata of Russian society and representatives of government structures in the search for effective practices in the treatment and counteraction to the spread of dangerous infectious diseases (including cholera). Epidemics and pandemics of infectious diseases pose a serious potential danger to human life and health, as well as create increased risk and socio-economic threats to modern humanity. These challenges actualize the appeal to the chosen topic. This article discusses a multidimensional problem concerning the methods of treatment that doctors used in the fight against the terrifying and deadliest disease of that time – cholera. This problem is considered on the example of the cholera epidemics of 1847 and 1892 and the fight against them on the territory of the Saratov Volga region. The main research perspective is focused on the analysis of archival sources identified by the author – the diaries of Saratov doctors, on the pages of which they not only presented an official report to the provincial medical board, but also shared their experience in treating cholera patients. The results of the study allow us to conclude that as a result of many years of medical practice of city and county doctors of the Saratov province, as well as generalization of empirical materials based on their diary entries, optimal solutions for the prevention and control of cholera epidemics were developed, and at the same time, general methods of treating cholera patients were gradually formed in the XIX century. not only on the territory of the Saratov Volga region, but also throughout the country.

Unraveling the mechanistic insights of sophorolipid-capped gold nanoparticle-induced cell death in Vibrio cholerae.

Cholera is one of the leading causes of mortality and morbidity worldwide. The treatment of cholera includes rehydration therapy, often combined with the administration of antibiotics (in severe cases). With the emergence and rapid spread of antimicrobial resistance, such microbial pathogens have become a compelling medical problem and a global threat. To combat the resistance to antibiotics, there is an urgent need for the discovery of novel and potent antimicrobial agents. The discovery of antimicrobial nanoparticles as an alternative to the existing antimicrobial regime has increased the hope for its use as one of the most promising tools against an array of microbial pathogens, including multidrug-resistant bacteria. Our recent report demonstrated that sophorolipid-capped gold nanoparticles (AuNPs-SL) exhibit potent antibacterial activity against Vibrio cholerae; however, the killing mechanism remained obscure. Metal nanoparticle-mediated killing of microbes occurs through non-specific mechanisms. To develop antimicrobial nanoparticles with better efficacy, knowledge of their specific mechanism of action is essential. In this work, we deduced the mechanistic insights of AuNPs-SL mediated cell death of V. cholerae. We observed that AuNPs-SL treatment evokes reactive oxygen species (ROS) formation. The surge in the ROS level triggers the overexpression of ROS-responsive genes, depolarization of the membrane, change in membrane permeability and leakage of intracellular proteins and DNA, depletion of ATP levels in the cell, DNA damage, and subsequent cell death. This study shows the possibility of use of AuNPs-SL as an alternative potential antimicrobial agent. IMPORTANCE Vibrio cholerae, a Gram-negative bacterium, is the causative agent of a fatal disease, "cholera." Prevention of cholera outbreak is possible by eliminating the bacteria from the environment. However, antimicrobial resistance developed in microorganisms has posed a threat and challenges to its treatment. Application of nanoparticles is a useful and effective option for the elimination of such microorganisms. Metal-based nanopaticles exhibit microbial toxicity through non-specific mechanisms. To prevent resistance development and increase antibacterial efficiency, rational designing of nanoparticles is required. Thus, knowledge on the exact mechanism of action of nanoparticles is highly essential. In this study, we explore the possible mechanisms of antibacterial activity of AuNPs-SL against V. cholerae. We show that the interaction of AuNPs-SL with V. cholerae enhances ROS production and membrane depolarization, change in permeability, and leakage of intracellular content. This action leads to the depletion of cellular ATP level, DNA damage, and subsequent cell death.

Geographical Origin, WASH Access, and Clinical Descriptions for Patients Admitted to a Cholera Treatment Center in Northwest Syria between October and December 2022.

Background On September 10, 2022, a cholera outbreak was declared in Syria for the first time in over a decade of protracted conflict. As of May 20, 2023, 132,782 suspected cases had been reported, primarily in northwest and northeast Syria. We aim to provide a detailed description of water sources and clinical status of a patient cohort seen at a cholera treatment center (CTC) in northwest Syria. Methods We retrospectively identified patients with confirmed cholera who presented to the CTC in Idlib governorate between October 8 and December 18, 2022. Data were obtained from clinical case records and analyzed in R v4.0.4. Results Ninety-four patients (55.3% men) were treated at the CTC. Thirty-five patients were severely dehydrated (Plan C treatment), 54 had some dehydration (Plan B), and 5 had no dehydration (Plan A). Most patients were between 11 and 20 years old ( n = 25, 26.6%) or 31 and 40 years old ( n = 19, 20.2%). Note that 70.2% ( n = 66) of patients were seen in November 2022 and most were from Harim district ( n = 44, 46.8%). Public wells ( n = 46, 48.9%) and water trucking ( n = 41, 43.6%) were the most commonly used water sources. Note that 76.6% ( n = 72) did not have access to chlorine-treated water. Forty-seven patients (50%) had more than five water, sanitation, and hygiene (WASH)-related cholera risk factors. Following treatment, six patients were transferred to another treatment center, three died (case fatality rate: 3.2%), and the remainder were discharged. Conclusion Most patients reported WASH-related risk factors for cholera, reflecting the poor state of WASH in northwest Syria after over a decade of conflict. This relates to the direct and indirect impacts of urban and periurban violence as well as the underfunded humanitarian response. Strengthening WASH and health promotion are important components to control the outbreak.