Search

Abstract Dengue virus (DENV) is a mosquito-borne virus that causes dengue fever, a significant public health concern in many tropical and subtropical regions. Dengue is endemic in more than 100 countries, primarily in tropical and subtropical regions of the world. Each year, up to 400 million people get infected with dengue. Approximately 100 million people get sick from infection, and 40,000 die from severe dengue. Unfortunately, dengue vaccine development is also marred with various complicating factors, as the forefront candidate vaccine performed unsatisfactorily. Moreover, the only licensed vaccine (Dengvaxia) for children 9 through 16 years of age is available in just a few countries. The treatment difficulties are compounded by the absence of an effective antiviral agent. Exploring plant-based therapeutics for dengue from the laboratory to clinical application involves a multi-stage process, encompassing various scientific disciplines. Individual investigators have screened a wide range of plant extracts or compounds for potential antiviral activity against DENV. In vitro studies help identify candidates that exhibit inhibitory effects on viral replication. Some of the most promising medicinal plants showing in vitro activity against DENV include Andrographis paniculate , Acorus calamus, and Cladogynos orientalis. Further laboratory studies, both in vitro and in animal models (in vivo), elucidate the mechanisms of action by which the identified compounds exert antiviral effects. Medicinal plants such as Carica papaya, Cissampelos pareira, and Ipomea batata exhibited potent platelet-enhancing activities while Azadirachta indica and Curcuma longa showed promising effects in both in vitro and in vivo studies. Based on positive preclinical results, researchers design clinical trials. This involves careful planning of trial phases, patient recruitment criteria, ethical considerations, and endpoints. The most important medicinal plants showing efficacy and safety in clinical trials include Carica papaya and Cissampelos pareira. This review suggests that several promising medicinal plants exist that have the potential to be turned into clinical drugs to treat dengue infection. However, in addition to developing synthetic and plant-based therapies against dengue infection, vector management strategies should be made robust, emphasizing the need to focus on reducing disease incidence.

Abstract Background Essential oils of Cymbopogon citratus and Hyptis suaveolens are known for their insecticidal properties, but remain ineffective against mosquitoes resistant to synthetic insecticides. In order to improve insecticidal properties of these plants, this study aimed to investigate the chemical composition and insecticidal activity against Anopheles gambiae mosquitoes of essential oil obtained by co-distillation of dry leaves of C. citratus and H. suaveolens. Methods Essential oils were extracted by hydrodistillation from dry leaves of C. citratus and H. suaveolens, separately, then from the mixture of the dry leaves of the two plants in mass ratio 50/50. Each pure essential oil and the mixture obtained either by co-distillation or by combining pure essential oils in volume ratio 50/50 were then analysed by GC/MS. All essential oils and Deltamethrin 0.05% (positive control) were tested on two species of mosquitoes of the genus Anopheles gambiae according to the World Health Organization standard methods. Results Essential oil obtained by co-distillation mainly contained piperitone (40.80%), 1,8-cineole (24.64%), p-menth-4(8)-ene (13.20%), limonene (6.09%) and α-pinene (4.73%). However, the mixture of pure essential oils of these two plants mostly contained geranial (20.74%), neral (16.42%), 1,8-cineole (19.79%), sabinene (6.03%) and β-pinene (3.87%). The essential oil of C. citratus mainly contained geranial (41.49%), neral (32.83%), β-myrcene (13.66%) and geraniol (3.49%) while the major constituents of essential oil of H. suaveolens were 1,8-cineole (39.58%), sabinene (12.06%), β-pinene (7.73%), α-terpinolene (6.72%) and (E)-caryophyllene (7.49%). At the dose of 1%, all essential oils, except that of H. suaveolens, induced about 100% of mortality on the sensitive species of An. gambiae. However, on the resistant species at the same dose, the essential oil obtained by co-distillation induced the highest mortality (53.44%). The essential oils of C. citratus, H. suaveolens and the mixture of the two pure essential oils caused respectively 2.47, 15.28 and 18.33% of mortality. The synthetic insecticide caused 100 and 14.84% of mortality respectively on the sensitive and resistant species of An. gambiae. Conclusion Essential oil obtained by co-distillation showed good insecticidal efficacy against a resistant species of An. gambiae and might constitute a new solution to fight against mosquitoes resistant to synthetic insecticides.

Abstract Background Malaria remains a significant public health burden, necessitating evidence-based strategies to reduce prevalence and associated morbidity. This study explores the potential of integrated healthcare, encompassing both modern and traditional herbal medicine (THM), for malaria control in Ghana. Methods Employing a qualitative approach, semi-structured interviews were conducted with medical doctors, pharmacists, and THM providers. Thematic analysis approach was utilized to inductively analyse interview data and integrate participants’ lived experiences and suggestions. Results Six themes emerged: Standardization of THM practice; Training on THM broadened; Research on THM expanded; Increasing awareness of THM integration hospitals and inclusion of THM in national health insurance scheme; Constant supply of certified herbal medications; and Tax relief provision. These recommendations form the ‘STRICT’ framework for developing functional health system for promoting an effective malaria control through integrated healthcare in Ghana. Conclusion It was evident that the ‘STRICT’ framework can potentially transform healthcare delivery and improve service quality for malaria patients. Policymakers, healthcare providers, and managers can utilize these insights to advocate for and implement integrated healthcare strategies, ultimately enhancing service delivery for all Ghanaians, particularly those suffering from malaria.

Abstract Background Borneo, the third largest island in the world, is facing a significant burden of emerging and re-emerging vector-borne diseases due to rapid changes in primary tropical rainforests and urban landscapes. These vector-borne diseases include the endemic epidemic cycles that occur in the more populated and urbanized areas, as well as the possible transmission through enzootic and sylvatic transmission cycles that occur mainly in the overlapping landscapes or among the indigenous population in the forest. The island will be changed significantly in the future due to the increase in human activities, especially mega events such as the relocation of the Indonesian capital to Nusantara in East Kalimantan Borneo, increasing urbanization, agriculture, hydropower projects, ecotourism activities in Sabah, North Borneo, and Sarawak, Central and South Borneo. Therefore, an overview of the current situation of vector-borne diseases is crucial for the next possible epidemic preparedness. Methods This study conducted the PRISMA-ScR scoping review and formulated a set of research questions to identify current trends in vector-borne diseases in Borneo. These questions aim to identify which diseases have been studied, what geographical areas have been covered by the research, how the One Health approach—encompassing human, animal and environmental factors—is integrated, and what gaps and challenges exist in addressing these diseases. Results A total of 2241 references were screened for eligibility and 117 articles were selected for review. The majority of the materials focused on mosquitoes and malaria, and the One Health elements focused mainly on humans. Conclusions This review has identified the most and least studied vector-borne diseases and highlighted some of the gaps in knowledge and research on vector-borne diseases on the island of Borneo. Future studies should particularly focus on other neglected diseases such as Zika, chikungunya, Japanese encephalitis, filariasis and tick-borne diseases. In addition, advanced surveillance systems will be developed to improve early detection and response specifically for remote regions where vector-borne diseases are endemic or emerging.

Abstract Background Larval source management (LSM) is re-emerging as a critical malaria intervention to address challenges associated with core vector control tools, such as insecticide-treated nets (ITNs), and to accelerate progress towards elimination. Presently, LSM is not widely used in rural settings and is instead more commonly applied in urban and arid settings. A systematic entomological assessment was conducted in rural communities of southeastern Tanzania, where insecticide-treated nets (ITNs) are widely used, to explore opportunities for deploying LSM to improve malaria control. Methods Aquatic habitat surveys were conducted in 2022 and 2023 to understand habitat usage by different mosquito vectors, covering five villages during the rainy season and seven villages during the dry season. Additionally, samples of adult mosquitoes were collected to assess the role of various Anopheles species in malaria transmission in the area, and to explore opportunities for species sanitation using targeted LSM. Results Adult mosquito surveys showed that in this area, the total entomological inoculation rates (EIR) for indoor collections were 20.1 and 6.5 infectious bites per person per year for outdoors. Anopheles funestus and Anopheles arabiensis were the only Anopheles vectors identified. Anopheles funestus was responsible for over 97.6% of the malaria transmission indoors and 95.4% outdoors. The concurrent larval surveys found that habitats with late instar An. arabiensis and An. funestus comprised only a small subset of 11.2%–16.5% of all water bodies in the rainy season, and 9.7%–15.2% in the dry season. In terms of size, these habitats covered 66.4%–68.2% of the total habitat areas in the wet season, reducing to 33.9%–40.6% in the dry season. From the rainy season to the dry season, the surface area of habitats occupied by An. arabiensis and An. funestus decreased by 92.0% to 97.5%, while the number of habitats occupied by An. arabiensis and An. funestus decreased by 38.0% to 57.3%. Anopheles funestus preferred large, permanent habitats with clear water and vegetation year-round, while An. arabiensis showed contrasting seasonal preferences, favouring sunlit still waters in the rainy season and larger, opaque habitats in the dry season. Conclusion These findings suggest that An. funestus, which is the dominant malaria vector in the area, mediating over 95% of malaria transmission, preferentially occupies only a small subset of uniquely identifiable aquatic habitats in both wet and dry seasons. This presents an opportunity to expand LSM in rural settings by carefully targeting An. funestus habitats, which might be effective and logistically feasible as a complementary approach alongside existing interventions. Further research should assess the impact of targeted LSM for species sanitation compared to blanket LSM.

Abstract Background Recent reports from Thailand reveal a substantial surge in Plasmodium knowlesi cases over the past decades, with a more than eightfold increase in incidence by 2023 compared to 2018. This study investigates temporal changes in genetic polymorphism associated with the escalating transmission of P. knowlesi malaria in Thailand over time using the prominent vaccine candidate, pkmsp1 as a marker. Methods Twenty-five P. knowlesi samples collected in 2018–2023 were sequenced for the 42-kDa region of pkmsp1 and compared with 24 retrieved sequences in 2000–2009, focusing on nucleotide diversity, natural selection, recombination rate, and population differentiation. Results Seven unique haplotypes were identified in recent samples, compared to 15 in earlier samples. Nucleotide and haplotype diversity were lower in recent samples (π = 0.016, Hd = 0.817) than in earlier samples (π = 0.018, Hd = 0.942). Significantly higher synonymous substitution rates were observed in both sample sets (dS–dN = 2.77 and 2.43, p

Abstract Background In 2020, Malawi had 6.9 million malaria cases and 2551 deaths, mainly in children under five years of age. The 2017–2022 Malawi malaria control strategic plan promoted the consistent use of insecticide-treated nets through free distribution and mass campaigns. Despite widespread availability of the control strategy plan, Chikwawa District continues to suffer from high malaria burden especially among under five children, due to inconsistent insecticide-treated (ITN) net usage. For this reason, this study aimed at exploring caregivers’ perceptions on insecticide-treated net utilisation and also find out about its effectiveness among those who consistently use them. Methods This study used a sequential exploratory mixed methods design. The data used for quantitative analysis was drawn from the population of under-five children’s caregivers within the catchment area of Chikwawa district hospital. The sample size was 96 participants, as determined by Cochran’s formula. The data collection lasted from December 2023 to April 2024 and included four in-depth interviews and three focus group discussions to address the objectives qualitatively. Results The study revealed that 91.67% of households used ITNs, with 87.50% using them daily. The significant factors influencing ITN utilisation included the number of nets, user satisfaction, perceived impact, user habits, acquisition method, and usage frequency (all p values

Abstract Background Attractive targeted sugar bait (ATSB) stations containing bait (to attract) and ingestion toxicant (to kill) sugar-foraging mosquitoes are hypothesized to reduce malaria transmission by shortening the lifespan of Anopheles vectors. Methods A two-arm cluster-randomized controlled trial (cRCT) was conducted in Western Province Zambia. Seventy clusters of 250–350 households were assigned (1:1) by restricted randomization to an intervention arm (ATSB) or control arm (no ATSB) in the context of standard of care vector control (insecticide-treated nets and/or indoor residual spraying). Two ATSB stations (Westham Sarabi, 0.11% dinotefuran w/w) were maintained on exterior walls of eligible household structures for a 7-month deployment period (December-June) during the high malaria transmission season. The primary outcome was clinical malaria incidence among two consecutive seasonal cohorts of children aged 1–14 years, followed-up monthly from January-June in 2022 and 2023. Secondary outcome was Plasmodium falciparum prevalence among individuals aged over six months. Analysis compared clinical malaria incidence and prevalence between arms among the intention-to-treat population. Results ATSB coverage, assessed by cross-sectional survey, was 98.3% in March–April 2022 and 89.5% in March–April 2023. 4494 children contributed any follow-up time to the cohort, with 2313 incident malaria cases in the intervention arm (1.28 per child per six-month transmission season), and 2449 in the control arm (1.38 per child-season). The incidence rate ratio between the two arms was 0.91 (95% CI 0.72–1.15, p = 0.42). 2536 individuals participated in cross-sectional surveys, with prevalence of P. falciparum 50.7% in the intervention arm and 53.5% in the control arm. The odds ratio between the two arms was 0.89 (95% CI 0.66–1.18, p = 0.42). Secondary covariable-adjusted and subgroup analyses did not substantially alter the findings. No serious adverse events associated with the intervention were reported. Conclusions Two ATSB stations deployed per eligible structure for two consecutive transmission seasons did not result in a statistically significant reduction in clinical malaria incidence among children aged 1–14 years or in P. falciparum prevalence in rural western Zambia. Further studies are needed to assess the efficacy of ATSB stations in different settings and with different deployment strategies. Trial registration The trial is registered with Clinicaltrials.gov (NCT04800055).

Abstract Background Malaria remains a significant concern for children under five in malaria-endemic regions. Rwanda’s successful efforts in malaria treatment reduced nationwide cases, but high mortality persists in the Eastern and Southern provinces. This study aimed to investigate the clinical features of severe malaria and to identify the death risk factors among under-five children in Eastern province Hospitals. Methods This cross-sectional study assessed severe malaria-related mortality and associated factors among children aged under five years in hospitals of Eastern Province, Rwanda, from 2017 to 2021. Data were collected from hospital records, and descriptive statistics and logistic regression were used for data analysis. Results Factors associated with severe malaria-related mortality included coma (aOR: 10, 95% CI: 1.2–82.5, p = 0.03), Vomiting (aOR: 5.2, 95% CI: 1.0–26.0, p = 0.04), four or more days of illness before consultation (aOR: 30.9, 95% CI: 8.7–109.9, p

Abstract Background The primary strategy for achieving the second goal of the Global Program to Eliminate Lymphatic Filariasis (GPELF) is morbidity management and disability prevention (MMDP), aimed at alleviating the suffering of affected populations. A significant challenge in many LF-endemic areas is the effective registration and identification of individuals with LF, which is crucial for planning and ensuring access to MMDP services. This study seeks to map the geographical distribution of LF-related morbidities across 24 endemic districts in Ethiopia. Methods A community-based cross-sectional study was conducted to identify individuals affected by LF in 24 endemic districts using primary health care units (PHCUs). The study involved 946 trained health extension workers (HEWs) conducting house-to-house visits to identify and register cases of lymphedema and hydrocele, with support from 77 trained supervisors and 87 team leaders coordinating the morbidity mapping. Certified surgeons performed confirmatory evaluations through clinical assessments on a randomly selected sample of cases to validate HEW diagnoses, ensuring accurate identification of lymphedema and hydrocele. Statistical analysis of the data, including the severity of lymphedema and acute attacks, was conducted using STATA 17. Results This study involved 300,000 households with nearly 1.2 million individuals, leading to the identification of 15,527 LF cases—14,946 (96.3%) with limb lymphedema and 581 (3.7%) with hydrocele. Among those with lymphedema, 8396 (54.1%) were women. Additionally, 13,731 (88.4%) patients resided in rural areas. Of the 14,591 cases whose acute attack information was recorded, 10,710 (73.4%) reported experiencing at least one acute attack related to their lymphedema in the past 6 months, with a notable percentage of males (74.5%; n = 4981/6686). Among the 12,680 recorded cases of leg lymphedema, the percentage of acute attacks increased with severity: 64% (n = 5618) mild cases, 68% (n = 5169) moderate cases and 70% (n = 1893) severe cases. Conclusion This study successfully mapped the geographical distribution of LF morbidities across 24 LF-endemic districts in Ethiopia, identifying a substantial number of lymphedema and hydrocele cases, particularly in rural areas where healthcare access is limited. The findings underscore the potential of Ethiopia’s health extension program to identify affected individuals and ensure they receive necessary care. The findings inform targeted interventions and access to MMDP services, contributing to Ethiopia’s goal of eliminating LF by 2027.

Abstract Background The emergence of multidrug resistant Candida species to available drugs has led to renewed interest in the use of herbal medicines globally. This study scientifically verified antifungal effectiveness of five commonly used plant species in Pader district, against selected pathogenic candida strains. Methods Powdered roots of Momordica foetida, Sansevieria dawei and Distimake dissectus; and stem barks of Khaya anthotheca and Mitragyna rubrostipulata were extracted sequentially using petroleum ether and methanol, respectively; and total water extraction at 24.4 °C (maceration), 60 °C (decoction) and boiling water at 87 °C (hot water infusion). Extracts and their combinations, positive controls (amphotericin B, and fluconazole) and negative control (80% dimethyl sulfoxide, verified to be tolerable concentration to the tested Candida species) were screened and verified for their antifungal activity against Candida albicans (ATCC: American Type Culture Collection reference strain 10231, ATCC 90028, 0770a and 0796), C. glabrata (VVc 004, ATCC 2950) and C. tropicalis (ATCC 750 and 0210) using agar well diffusion and broth micro-dilution, respectively. Results Aqueous extract (24.4 °C) of M. rubrostipulata (ZOI: 18.00 ± 1.00 to 38.33 ± 0.17; MIC: 3.13 ± 0.00 to 20.83 ± 4.17; MFC: 12.50 ± 0.00 to 200.00 ± 0.00), methanol extract of K. anthotheca (10.11 ± 0.31 to 15.11 ± 0.65; 1.04 ± 0.26 to 12.50 ± 0.00; 12.50 ± 0.00 to 100.00 ± 0.00), and combination of aqueous extract (60 °C) of D. dissectus + methanol extract of K. anthotheca (7.89 ± 0.26 to 19.67 ± 0.37; 0.78 ± 0.00 to 50.00 ± 0.00; 12.50 ± 0.00 to 200.00 ± 0.00) exhibited broad spectrum antifungal activities and were fungistatic against all tested Candida species, which comprised 8 clinical/control and susceptible/resistant strains. None of the conventional drugs used demonstrated broad spectrum antifungal activity across all tested Candida species/strains. Conclusion Methanol extract of K. anthotheca, aqueous extract (24.4 °C) of M. rubrostipulata, and combination of aqueous extract (60 °C) of D. dissectus + methanol extract of K. anthotheca could be effective in the treatment of candidiasis. They demonstrated potential broad spectrum antifungal activity against different species and strains of tested Candida than the fluconazole and amphotericin B drugs. Their fungistatic nature showed their ability to inhibit fungal growth. Hence, these extracts/extract combination can offer better treatment option for candidiasis if they are standardized and also their active curative compounds isolated and made into antifungal drugs.

Abstract Background Since 2012, the World Health Organization has recommended seasonal malaria chemoprevention (SMC) with sulfadoxine-pyrimethamine plus amodiaquine (SPAQ) for children aged 3–⁠59 months in regions where malaria transmission is seasonal. Full ingestion of SMC medicines without spitting or vomiting during a complete 3-day course is critical to ensure effectiveness of SMC medicines and to avoid development of antimalarial resistance. Although evidence suggests that spitting or vomiting is not rare, there is limited analytical evidence on potential factors associated with spitting or vomiting in SMC campaigns. Methods We utilized data from SMC coverage surveys conducted in Burkina Faso, Chad, Togo and Nigeria between 2020 and 2022. Episodes of spitting or vomiting were defined as SMC-eligible children spitting out most of the dose or vomiting the entire dose within 30 min of SPAQ administration as reported by primary caregivers. We conducted a cross-sectional study using mixed-effects logistic regression with variables including household socioeconomic variables and caregiver knowledge of SMC, to identify factors associated with spitting or vomiting. Results The proportion of SMC-eligible children spitting or vomiting SPAQ doses ranged from 1.81% in Nigeria to 4.36% in Chad. The odds of spitting or vomiting were lower among children administered medicines under community distributor (CD) supervision, and whose primary caregivers had a high degree of knowledge of SMC. Spitting or vomiting were negatively associated with caregiver adherence to AQ administration and caregiver reporting of children’s adverse reactions to SMC medicines. Over half of the children experiencing a spitting or vomiting episode did not receive a replacement dose from CDs. Redosing was positively associated with caregiver educational attainment, caregiver knowledge of SMC, and directly supervised medicine administration. Conclusions CD-supervised administration of SPAQ can strengthen community engagement strategies to enhance appropriate administration and full ingestion of SMC medicines according to the SMC delivery protocol.

Abstract Background Diagnosis and treatment initiation delays for tuberculosis (TB) are significant challenges in resource-limited settings. These delays can result in poor treatment outcomes, disease transmission, and increased costs. This study aimed to assess the effect of integrating traditional care with modern healthcare systems on reducing TB diagnosis delay. Methods A cluster randomized controlled trial was conducted among TB patients, with 510 participants, 255 individuals were assigned to the intervention group and 255 to the control group. Training in the intervention group was provided for both traditional and modern healthcare providers in three rounds to enhance their knowledge, attitudes, and skills in TB screening and referral. A non-parametric independent sample test was used to compare the baseline and end-line data. The effect size was determined using Cohen’s d. To account for individual and cluster-level variations, a mixed-effect parametric survival model was employed. Furthermore, conditional (fixed only) and marginal (random effects) graphs were used to compare between the intervention and control groups. Results A total of 510 participants were included in the baseline study, with a similar number of participants included in the endline study. In the intervention group, the delay in diagnosis was 4.185 per 1000 person-days post-intervention, compared to 4.608 per 1000 person-days pre-intervention. In the control group, the delay for diagnosis was 4.759 per 1000 person-days pre-intervention and 5.031 per 1000 person-days post-intervention. The median time to diagnosis was 135 days. The non-parametric comparison showed that the intervention significantly reduced patient delays in the intervention group compared to the control group (p = 0.006), with a Cohen's d effect size of 0.246. The intervention also significantly reduced diagnosis delay in the intervention group compared to the control group (p = 0.036), with a Cohen's d effect size of 0.187. The diagnosis of TB was accelerated by 1.076 times due to the integration of traditional care with the modern healthcare system in the intervention group compared to the control group (δ: 1.076; 95% CI 1.021, 1.134). Conclusions The involvement of traditional care providers in TB control programs significantly reduced diagnosis delays in Ethiopia. These findings suggest the need for integrating traditional care with modern healthcare systems for the effective prevention of TB in high-burden countries. Clinical trial registration ClinicalTrials.gov ID: NCT05236452.

Abstract Background Plasmodium falciparum (P. falciparum) remains a significant public health challenge globally, especially in sub-Saharan Africa (SSA), where it accounts for 99% of all malaria infections. The outcomes of P. falciparum infection vary, ranging from asymptomatic to severe, and are associated with factors such as host immunity, parasite genetic diversity, and multiplicity of infection (MOI). Using seven neutral microsatellite markers, the current study investigated P. falciparum genetic diversity and MOI in both asymptomatic and symptomatic malaria individuals in Uganda. Methods This cross-sectional study analyzed 225 P. falciparum isolates from both asymptomatic and symptomatic malaria patients, ranging in age from 6 months to ≥ 18 years. P. falciparum genetic diversity, MOI, and multi-locus linkage disequilibrium (LD) were assessed through genotyping of seven neutral microsatellite markers: Poly-α, TA1, TA109, PfPK2, 2490, C2M34–313, and C3M69–383. Genetic data analysis was performed using appropriate genetic analysis software. Results P. falciparum infections exhibited high genetic diversity in both asymptomatic and symptomatic individuals. The mean expected heterozygosity (He) ranged from 0.79 in symptomatic uncomplicated malaria cases to 0.81 in asymptomatic individuals. There was no significant difference (p = 0.33) in MOI between individuals with asymptomatic and symptomatic infections, with the mean MOI ranging from 1.92 in symptomatic complicated cases to 2.10 in asymptomatic individuals. Polyclonal infections were prevalent, varying from 58.5% in symptomatic complicated malaria to 63% in symptomatic uncomplicated malaria cases. A significant linkage disequilibrium (LD) was observed between asymptomatic and symptomatic uncomplicated/complicated infections (p

Samuel J Martin,1 Phaibun Chiraphatthakun,2 Anan Samson Keereemalee,2 Wirachat Chiraphatthakun,2 Robert W Arnold2– 4 1Loma Linda University School of Medicine, Loma Linda, CA, USA; 2Jungle School of Medicine Kawthoolei, the Free Burma Rangers, Kawthoolei, Karen State, Burma; 3Alaska Blind Child Discovery, Alaska Children’s EYE & Strabismus, Anchorage, AK, USA; 4Ophthalmology Department Consultant, Providence Alaska Medical Center (1989-2024), Anchorage, AK, USACorrespondence: Robert W Arnold, Alaska Children’s EYE & Strabismus, 3500 Latouche Street #280, Anchorage, AK, 99508, USA, Tel +1 (907)561-1917, Fax +1 (907)563-5373, Email eyedoc@alaska.netPurpose: The rate of moderate-to-severe hearing loss in Southeast Asia is 5.8%, among the world’s most prevalent. However, it is difficult to measure for people whose healthcare access is limited by the ongoing civil war. Therefore, a cross-sectional study of the impacts of hearing loss was incorporated with ongoing vision/cataract clinics along the Thai-Burma border.Patients and Methods: In this cross-sectional observational study, culturally sensitive informed consent was obtained from patients presenting to a regionally promoted hearing clinic in Karen State, Burma (Myanmar) with a chief complaint of hearing loss. They were then administered a standardized survey derived from the Hearing Handicap Inventory for Adults/Elderly (HHI), then assessed based on history, otoscopy, Weber and Rinne testing, and portable audiometry.Results: Twenty-two adults and children presented with a chief complaint of hearing loss, and 26 others came seeking vision care needing cataract surgery. HHI survey showed 41% had mild-to-moderate, and 34% had moderate-to-severe hearing impairment. On a 0– 4 Likert scale, prominent complaints due to hearing loss were feeling upset (2.4 ± 1.8), limited social life (2.2 ± 1.6), using the phone less (2.1 ± 1.8) and needing to be warned of the danger by others (2.1 ± 1.9). Seventy-three percent had no prior hearing care. Access was limited due to financial (59%), limited travel (50%), and military conflict (41%). Pure-tone averages were 55.3 + 22.1 dB and 67.9 + 14.5 dB for the right and left ears, respectively. Pure tone averages are negatively correlated with HHI survey score (R = − 0.53). Chicken feathers were a common mechanism of ear drum trauma. Twenty patients received Solar Ear hearing aids.Conclusion: Ongoing military conflict in the Karen State leaves the internally displaced people with high prevalence of hearing loss and fear of additional injury due to inability to hear danger. Surveys such as this appear more useful to assess the individual impact of hearing loss rather than severity. Efforts by regional medics to provide hearing care should be supported.Plain Language Summary: Residents in a war zone in Karen State, Burma, had survey, ear exam and audiometry showing high prevalence of hearing loss including tympanic membrane perforation by chicken feathers.Keywords: internally displaced persons, hearing loss, audiometry, chicken feather injury, tympanic membrane perforation, health care access

Introducción. Aedes aegypti es un vector importante de enfermedades arbovirales como el dengue, entre otras. Las estrategias tradicionales de control, como el uso de insecticidas, han perdido eficacia debido a la aparición de resistencia en las poblaciones de mosquitos. El control biológico y el uso de hongos biocontroladores se presentan como alternativas viables y amigables con el medio ambiente. Objetivo. Evaluar la patogenicidad in vitro de aislamientos del género Trichoderma –obtenidos del Urabá antioqueño– sobre larvas de Ae. aegypti, y determinar la concentración letal media (CL50) y el tiempo letal medio (TL50) del más patógeno. Materiales y métodos. Mediante el método de larvas centinelas con especímenes de Ae. aegypti, se logró aislar hongos de cuerpos de agua de la región del Urabá (Antioquia). Los aislamientos se caracterizaron a nivel morfológico y molecular, para determinar su identidad taxonómica. Se llevaron a cabo pruebas de patogenicidad in vitro utilizando larvas de Ae. aegypti en los estadios L2 y L3. Posteriormente, se seleccionó una cepa para determinar su concentración letal media y tiempo letal medio. Resultados. La cepa AP-91 de Trichoderma sp. causó porcentajes altos de mortalidad en poblaciones de larvas de Ae. aegypti. Se obtuvo una concentración letal media de 1,8 × 107 conidios/ml y un tiempo letal medio de 20,67 horas. Conclusión. La cepa AP-91 tiene potencial para el control biológico de Ae. aegypti y puede ser una candidata idónea para usar en el manejo integrado de vectores mediante su cultivo escalado. La investigación sugiere explorar los compuestos y enzimas producidos por esta cepa para comprender mejor su patogenicidad.

La displasia septo-óptica es una afección neurológica congénita de etiología multifactorial caracterizada por agenesia del septum pellucidum, disgenesia del cuerpo calloso o ambas, hipoplasia del quiasma o nervios ópticos y disfunción hormonal con alteraciones hipofisiarias o hipotalámicas. Para hacer el diagnóstico se requieren dos de estos criterios y la resonancia magnética es el examen de elección. La mayoría de los casos se presentan con anomalías del desarrollo cortical en la forma conocida como displasia septo-óptica plus. Si bien las convulsiones y los trastornos del neurodesarrollo son las manifestaciones neurológicas dominantes, es una entidad muy heterogénea con múltiples hallazgos clínicos y radiológicos que se deben considerar. Se presenta el caso de un hombre de 35 años con antecedentes de traumatismo craneoencefálico en la infancia y remisión por epilepsia focal resistente al tratamiento asociada con déficit cognitivo. En la evaluación inicial, la tomografía computarizada de cráneo simple se apreció agenesia del septum pellucidum y disgenesia del cuerpo calloso. Se practicó una resonancia magnética cerebral que confirmó la agenesia del septum pellucidum y, también, reveló irregularidad y engrosamiento anómalo de la corteza cerebral en los lóbulos frontales y la región perisilviana; además, se encontró sustancia gris heterotópica en los lóbulos frontales y la región frontoinsular izquierda, leve ventriculomegalia supratentorial, apariencia atípica del rostrum del cuerpo calloso e hipoplasia del quiasma y los nervios ópticos. Aunque la agenesia del septum pellucidum fue la clave en este caso, no es un hallazgo presente en todos los pacientes.

Introducción. La relación entre la obesidad y el consumo de alcohol es un tema de gran interés para la salud pública. Las bebidas alcohólicas aportan calorías adicionales a la dieta, lo que podría ser un factor relevante en el riesgo de sobrepeso. Sin embargo, su asociación con la ganancia de peso es controversial y está influenciada por múltiples factores. Objetivo. Analizar la relación entre la ingestión moderada de alcohol y el índice de masa corporal, y las variables que pueden influir en dicha relación. Materiales y métodos. La muestra estuvo constituida por 155 personas de Puerto Madryn (Argentina). Cada participante contestó un cuestionario sobre salud, estilo de vida, factores demográficos y socioeconómicos. Se tomaron medidas antropométricas y se tipificaron los polimorfismos de 18 genes relacionados con el metabolismo del alcohol. Resultados. Se encontró que el consumo moderado de alcohol está asociado con un índice de masa corporal más bajo, particularmente en el sexo femenino. Un aumento de 14 gramos de alcohol estuvo asociado con un riesgo de 0,68 para la obesidad y 0,71 para el sobrepeso. La variante T del marcador rs4646543 (ALDH1A1), un gen involucrado en el metabolismo del alcohol y en la adipogénesis, se asoció con una mayor frecuencia de consumo de bebidas alcohólicas. Conclusión. Los hallazgos del presente trabajo sugieren que el consumo moderado de alcohol no contribuye significativamente al peso corporal en la muestra estudiada. Además, la asociación con ciertas variantes genéticas, como las del gen ALDH1A1, podría explicar biológicamente la relación inversa observada entre el peso y el consumo de alcohol.

Se presenta el primer caso documentado en Colombia del síndrome PURA, una enfermedad neurológica rara. Esta afección resulta de mutaciones del gen PURA, localizado en el cromosoma 5, que producen haploinsuficiencia de la proteína PUR-α. Esta proteína es esencial para el desarrollo temprano del cerebro y la función neuronal. El paciente, un niño de siete años, comenzó a presentar movimientos distónicos de las manos a los 14 días de vida. A los seis años, se le diagnosticó retraso en el neurodesarrollo, hipotonía generalizada, episodios frecuentes de apnea y dificultad para la deglución. Aunque inicialmente se consideraron otras condiciones, como la distrofia muscular de Duchenne y la lipofuscinosis ceroidea neuronal, la secuenciación completa del exoma reveló la variante patógena c.692T>C (p.Phe231Ser) en el exón 1 del gen PURA, no registrada previamente en otros pacientes. Este hallazgo permitió un enfoque de manejo integral, con el cual se abordaron las características y alteraciones clínicas del paciente. Dado que el síndrome PURA no figura en la lista de enfermedades huérfanas o raras reconocidas por el Ministerio de Salud y Protección Social de Colombia, este reporte podría influir en su reconocimiento oficial. El caso demuestra la importancia de considerar diagnósticos raros en pacientes con síntomas neurológicos poco comunes y subraya la utilidad de la secuenciación genómica para el diagnóstico. Además, enfatiza la necesidad de colaboración en el área de la salud para optimizar el cuidado de los pacientes con síndrome PURA y otras enfermedades semejantes.

Introducción. La toxoplasmosis congénita es una enfermedad parasitaria de importante prevalencia a nivel mundial, con gran morbilidad y afectación del neurodesarrollo en pacientes pediátricos. Objetivo. Describir las secuelas y valorar el neurodesarrollo de pacientes pediátricos con toxoplasmosis congénita en el Hospital Militar Central del 2013 al 2020. Materiales y métodos. Se trata de un estudio observacional, descriptivo y de corte transversal, con componente analítico, que incluyó los pacientes pediátricos con diagnóstico de toxoplasmosis congénita que consultaron al Hospital Militar Central durante el periodo de enero de 2013 a diciembre de 2020. En los niños menores de seis años, se utilizó la escala de neurodesarrollo Ages and Stages Questionnaires 3. Resultados. Se incluyeron 45 pacientes con toxoplasmosis congénita confirmada, con una media de edad de 5,9 años; 60 % eran de sexo masculino. El 11,2 % estaban sintomáticos al nacer y el 33 % presentó coriorretinitis. Durante el seguimiento, el 73 % presentó secuelas oftalmológicas; el 64 %, tenía calcificaciones en la tomografía computarizada; el 4,4 %, hidrocefalia; el 11,2 %, parálisis cerebral, y el 13,4 %, epilepsia focal. El 58 % de los menores de seis años presentó compromiso del neurodesarrollo y el 62 % de los mayores de seis años tenía déficit cognitivo. En esta cohorte, el 68 % de los pacientes recibió tratamiento posnatal. Se obtuvo una asociación estadísticamente significativa entre no recibir tratamiento y las secuelas oftalmológicas (OR = 5,2; p < 0,001). Conclusiones. La toxoplasmosis congénita se asoció con secuelas a largo plazo, similares a las descritas en otras series de casos latinoamericanos. Es de suma importancia hacer un diagnóstico temprano, con evaluación, tratamiento y seguimiento interdisciplinario oportunos en los pacientes colombianos para mejorar su pronóstico.

Creutzfeldt-Jakob disease is a rare neurodegenerative disease caused by prions. We present the case of a woman in the seventh decade of life with rapidly progressive dementia and myoclonus. Her brain magnetic resonance imaging revealed lesions in the basal nuclei, and the electroencephalogram showed periodic bilateral epileptiform discharges. In the cerebrospinal fluid, the prion protein was detected using the real-time quaking-induced conversion test (RT-QuIC), and elevated levels of tau and 14-3-3 proteins. We emphasize the significance of determining the prion protein in the definitive diagnosis of this disease.

Introducción. Los cambios del envejecimiento son multidimensionales y multifactoriales, y el síndrome geriátrico de fragilidad es su expresión más problemática y compleja. Este lleva a vulnerabilidad, cambio desproporcionado del estado de salud y declinación funcional, haciéndose necesaria su identificación efectiva y un abordaje integral. Objetivo. Describir las características sociodemográficas, clínicas, funcionales y relacionales de la fragilidad en adultos mayores con riesgo cardiovascular en el suroccidente colombiano. Materiales y métodos. Se desarrolló un estudio observacional, de tipo transversal, analítico. La población seleccionada fueron adultos mayores inscritos en un programa de riesgo cardiovascular y metabólico en Popayán, Cauca. Mediante un análisis multivariado, se exploró la relación entre fragilidad y algunas variables sociodemográficas, clínicas y funcionales. Resultados. Participaron 293 adultos mayores, principalmente mujeres (69,6 %), con edad promedio de 71,23 ± 7,38 años. El 77,1 % se clasificó como independientes en actividades básicas y, el 56,3 %, en actividades instrumentales de la vida diaria; predominó la autonomía en hombres. El 71,1 % de las mujeres y el 43,8 % de los hombres se clasificaron como prefrágiles. En el análisis bivariado, se encontró una relación entre la fragilidad, y las variables sexo, edad, estado civil, nivel educativo, ocupación, perímetro de pantorrilla, capacidad funcional, capacidad instrumental y funcionalidad familiar. El análisis multivariado demostró mayor prevalencia (55 %) de fragilidad o prefragilidad en las mujeres. Conclusiones. La mayoría de los participantes se clasificaron como prefrágiles; prevaleció la dependencia y fragilidad en las mujeres, lo que sugiere la necesidad de implementar estrategias de prevención y un abordaje diferencial según el sexo.

Introduction. Intestinal parasitic infections represent a public health problem, especially among vulnerable populations. There are few studies on the prevalence and determinants of intestinal parasites infections in street dwellers, who may experience significant health and socioeconomic implications. Understanding the prevalence and associated factors of intestinal parasites in this population is crucial for targeted interventions to mitigate the spread of these infections. Objective. To determine the prevalence of intestinal parasites in street dwellers attending a shelter in Cali, Colombia. Materials and methods. We selected 66 participants who met the inclusion criteria. We collected serial stool samples for laboratory evaluation and sociodemographic data, and information on their hygiene habits and addictions. Results. Seventy-six percent of the participants had intestinal parasites or commensals, with 30% presenting monoparasitism, 46% polyparasitism, and 20% eosinophilia. Blastocystis spp. was the most common organism (68.18%), followed by Endolimax nana (34.85%) and Entamoeba coli (18.18%). The most common pathogens were the Entamoeba histolytica/E. dispar/E. moshkovskii complex (10.61%) and hookworms (9.09%). We evaluated prevalence-related determinants. Conclusions. Intestinal parasitism is a health problem among street dwellers in Cali. A serial examination is recommended for diagnosing intestinal parasitic infection, especially in cases of low parasite loads. Campaigns should be established to reduce the prevalence of these parasites in populations at risk of complications.

Introduction. Rabies virus infection can cause fatal brain disease in mammals. Any species is susceptible to infection. Any effort aimed at recognizing infected animals and performing first actions in the event of transmission is mandatory. Objective. To determine knowledge, attitudes, and practice profiles regarding rabies, or hydrophobia, in a municipality of Colombia, using a multiple correspondence analysis. Materials and methods. A descriptive observational study involving 71 pet owners was carried out in the municipality of Ibagué (Tolima). A questionnaire-based survey collected data on rabies knowledge, attitudes, practices, and demographic information. The survey was conducted between October and November 2021, and the data analysis involved descriptive statistics and multiple correspondence analysis. Results. The study revealed a commendable level of rabies awareness among the urban residents in the study municipality. However, there are causes of concern as they allow stray animals to enter their homes and are not aware of the importance of notifying dead animals. The respondents demonstrated a humane approach to bite management and emphasized the importance of wound cleaning. Additionally, they expressed a strong desire for more information to enhance their knowledge and awareness of the disease. Conclusion. The findings of this study provide valuable insights for improving rabies prevention efforts and promoting public health. Health education, evidence-based strategies, and community participation are essential for successful disease control and educational gaps addressing related to sociocultural factors.

Introduction. Pintomyia (Pifanomyia) longiflocosa is an endemic species from Colombia, found between the central and eastern Andes, and reported as one of the primary vectors of cutaneous leishmaniasis in coffee-growing zones of the country. This species is classified in the Townsendi series and can only be identified by the morphology of the male adults. Objective. To determine the potential use of the fourth larval stage of the vector Pi. longiflocosa in morphological taxonomy based on the description of its chaetotaxy. Materials and methods. Pintomyia longiflocosa adults were captured in Campoalegre, Huila, and reared in the Entomology Laboratory at the Colombian Instituto Nacional de Salud. To identify the setae found in each corporal segment, 15 fourth-instar larvae were mounted on microscope slides using Canadian balm after being cleared with 10 % potassium hydroxide and saturated phenol. Additionally, five specimens were prepared for their observation by scanning electron microscopy. Results. Based on the description of Pi. longiflocosa, we established that all species of the subgenus Pifanomyia so far described have the same antennal morphology and clavate setae along their body. However, various setae present in Pi. longiflocosa are absent in Pi. youngi, suggesting differences among the larvae of the Townsendi series. Conclusions. These results support the potential importance of morphological characters from the fourth larval instar, such as antennal morphology and chaetotaxy, specifically in closely related species that are cryptic in their adult stages.

Los virus herpes simple (Herpes Simplex Virus, HSV) de tipo 1 y 2 producen la infección de transmisión sexual más común en mujeres, con mayor incidencia en los países en desarrollo. Además de generar secuelas principalmente neurológicas en el recién nacido, cuando la primoinfección ocurre durante el periodo perinatal, puede diseminarse y producir gran morbimortalidad de la madre y el neonato. A pesar de contarse con pruebas de laboratorio confiables, el diagnóstico de la infección por HSV durante el periodo perinatal es complejo, pues sus manifestaciones clínicas varían desde la forma diseminada hasta la asintomática o se pueden producir síntomas inespecíficos sin lesiones en piel o mucosas, por lo que es fundamental tener la sospecha clínica. Se presenta el caso de una madre con infección diseminada por HSV de tipo 2 que presentó hepatitis viral y cuyo neonato falleció, resaltándose la importancia de sospechar la infección por HSV en una mujer gestante febril con compromiso sistémico durante el periodo perinatal, aun en ausencia de brote.

Introduction. A clinical autopsy is a fundamental diagnostic tool for confirming the diagnosis of diseases of public health interest. However, the clinical-pathological concordance has not been evaluated. Objective. To determine the concordance between clinical diagnoses and anatomopathological findings from autopsies conducted at a tertiary-level hospital institution. Materials and methods. A descriptive, observational, cross-sectional, and retrospective study where we analyzed autopsy cases performed between 2015 and 2019. The variables studied were age, gender, origin, and clinical and anatomopathological diagnoses. Results. The concordance degree was slight (κ = 0.30; 95% CI: 0.21-0.42), which coincides with internationally reported findings in healthcare institutions with a similar patient population and availability of diagnostic resources. The clinical-pathological discrepancy, as evidenced according to the Goldman et al. classification, then modified by Battle et al., was 57.3% (47/82), corresponding to major discrepancies, a value within the expected limits. Conclusions. The concordance between clinical diagnoses and anatomopathological findings in autopsies is slight, and the discrepancies are within the expected range. This study highlights the importance of improving clinical and syndromic diagnosis of public health interest.

Objective. To examine maternal mortality in Panama, analyzing its direct obstetric deaths, indirect obstetric deaths, and contributory conditions. Methods. This cohort study used publicly available data from the National Institute of Statistics and Census to present a 25-year retrospective analysis of maternal deaths in the Republic of Panama from 1998 to 2022. Public data were sourced from the National Institute of Statistics and Census website of Panama. Relevant codes from the International Statistical Classification of Diseases and Related Health Problems, Tenth Revision (ICD) were used. The maternal mortality ratio (MMR) was defined as the number of maternal deaths per 100 000 live births. Trendline reliability with R2 was performed to analyze the data. Results. A total of 1 026 maternal deaths occurred in Panama from 1998 through 2022, of which 61.2% were attributed to direct obstetric causes; 23.9%, indirect obstetric causes; 13.6%, contributory conditions; and 1.4% were unknown or undetermined. The average MMR was 60.1. The trendline reliability resulted in R2 = 0.1 (y = –0.5147x + 1094.7), which is not statistically significant but meets the 2030 Sustainable Development Goals. The specific primary causes of direct obstetric deaths were: 12.9% due to postpartum hemorrhage (ICD O72); 9.2%, eclampsia (ICD O15); 6.7%, puerperal sepsis (ICD O85); and 6.3%, pre-eclampsia (ICD O14). For indirect obstetric deaths, the primary causes were: 14.9% due to other maternal diseases classifiable elsewhere but complicating pregnancy, childbirth, and the puerperium (ICD O99); and 7.3%, maternal infectious and parasitic diseases classifiable elsewhere but complicating pregnancy, childbirth, and the puerperium (ICD O98). Conclusions. The findings of this study confirmed that there were substantially more direct obstetric causes (61.2%) than indirect obstetric causes (23.9%), contributory causes (13.6%), or unknown/undetermined causes (1.4%) of maternal mortality, despite being highly preventable. Although Panama is right on track to fulfill the target of 70 MMR by 2030, these results highlight the lack of health care access due to the absence of obstetrician-gynecologists per 100 000 population in indigenous comarcas, where 30.8% of the maternal mortalities occur. Furthermore, the health system in Panama is not immune to pandemics and crises. From 1998 to 2022, there were 5 years when the MMR in Panama exceeded 70: 2001, 2002, 2006, 2011, and 2020. These findings also underscore the dichotomy between statistics and health policy. While the trendline reliability was insignificant (R2 = 0.1), the MMR satisfies requirements for the 2030 Sustainable Development Goals. Future studies should consider factors related to indirect obstetrics and contributory causes of deaths, health care access, COVID-19, cesarean section and natural birth, age, economic income, prenatal and postpartum care, as well as the quality of private and public health facilities in the Americas.

La educación continua de los equipos de salud es imprescindible para garantizar resultados que tengan un efecto positivo en la salud de la comunidad. En el 2019, a través del Ministerio de Salud Pública y Asistencia Social (MISPAS), República Dominicana inició la implementación de la iniciativa HEARTS de la Organización Panamericana de la Salud (OPS). De esta manera, se alineó con las mejores prácticas mundiales para la prevención y el manejo de la hipertensión y las enfermedades cardiovasculares (ECV), y así reducir las tasas de mortalidad debida a esta enfermedad no transmisible (ENT). De hecho, la hipertensión es la principal causa de ECV, y la ECV es la ENT responsable de más muertes en el mundo. El personal médico pasante de República Dominicana tiene la enorme labor de diagnosticar y tratar de manera oportuna a las personas con presión arterial alta y diversos factores de riesgo cardiovascular. Por lo tanto, la capacitación y formación de los estudiantes de pregrado previo a ejercer funciones como médicos pasantes, representa una prioridad en el sistema de salud del país. La iniciativa HEARTS ha producido una serie de cursos virtuales de alta calidad, gratuitos y disponibles todo el año en la plataforma del Campus Virtual de Salud Pública de la OPS. Estos cursos constituyen una oportunidad singular para que las escuelas de medicina adheridas a la Asociación Dominicana de Facultades y Escuelas de Medicina (ADOFEM), a través de un acuerdo con el MISPAS, utilicen el e-learning como herramienta innovadora y poderosa de entrenamiento de los miembros del equipo de salud.

Objective. To determine the prevalence of HIV in women with (pre)cancerous cervical lesions in Suriname and their retention in care. Methods. A retrospective population study including all women diagnosed with (pre)invasive cervical intraepithelial neoplasia (CIN I to III or cervical cancer) in the only pathology department, during 2010–2020. The HIV test coverage and the HIV positivity ratio were determined through matching pathology data with the national HIV test database. The relation between retention in HIV care up to 2022 and different covariates was determined through Kaplan–Meier survival analysis and log-rank tests. Results. There were 2 901 (1 395 CIN I, 396 CIN II, 444 CIN III, and 666 cervical cancer) diagnoses of (pre)invasive cervical neoplasia. An overall HIV test coverage of 57.5% and a positivity ratio of 5.8% were found, with no difference among the (pre)cancer stages. The undiagnosed prevalence (women not previously known HIV-positive at cervical diagnosis) was 1.6% and 2.9% among precancer and cancer diagnoses, respectively. The median time in care of women with cervical cancer was 8 months for those not on antiretroviral therapy (ART) and 4 years for those starting ART. Among women with precancer stages this was 5 and 10 years, respectively (p < 0.05). Conclusions. HIV testing, followed by treatment initiation when found HIV-positive, should be prioritized in women diagnosed with cervical neoplasia. This will enhance the individual clinical outcomes and facilitate the control of the HIV epidemic in Suriname.

Objetivo. Sistematizar evidências sobre o efeito de intervenções mundiais para a redução do consumo e/ou venda de bebidas alcoólicas. Método. Mapa de evidências que, a partir de buscas em nove bases bibliográficas, incluiu 182 estudos de revisões sistemáticas com ou sem metanálises, revisões de intervenções e revisões de revisões. Os estudos avaliaram o efeito de intervenções - agrupadas em conjuntos abrangentes de ações: comunicação para mudança de comportamento; ambientes promotores da saúde e mudanças dos sistemas - sobre dois desfechos de interesse: redução de consumo e redução da compra e/ou venda de álcool. Resultados. Foram registradas 207 associações entre diferentes intervenções e desfechos, com destaque para intervenções de comunicação para mudança de comportamento (81,64%) e para o desfecho de redução de consumo (98,55%). A maioria das associações apresentou efeito positivo (40,58%), inconclusivo (28,99%) ou potencialmente positivo (26,57%). Das intervenções com resultado positivo ou potencialmente positivo, destacam-se o monopólio de vendas de bebidas alcoólicas pelo governo, controle de densidade de pontos de venda, cobrança de preço mínimo por unidade, advertências sanitárias em rótulo de bebidas alcoólicas e múltiplas intervenções integradas. Conclusão. Espera-se que o presente mapa auxilie formuladores de políticas públicas e profissionais de saúde na adaptação de experiências para seus contextos de atuação, estimulando ações intersetoriais para reduzir o consumo de álcool.

Abstract Background Malaria during pregnancy leads to many deaths in Africa. COVID-19 contributed to more malaria cases due to interruptions in prevention efforts. Intermittent presumptive treatment (IPTP) is an effective malaria prevention strategy for pregnant women, but adoption barriers still exist. The study aim was to explore barriers to the adoption of IPTP at Kawempe National Referral Hospital (KNRH) Uganda. Methods In a qualitative study design, data was collected using focus group discussions. A total of 37 postpartum mothers were interviewed in six focus group discussions. The interviews were conducted using a structured guide to explore barriers to IPTP implementation at KNRH. The data was transcribed, coded, and analysed using NVivo 10. Results The study found that mothers lacked adequate knowledge about IPTP, faced socioeconomic and cultural constraints, fear of side effects, a high pill burden, and experience of health system challenges as major themes of barriers to optimal IPTP use. Conclusions and recommendations Challenges in the service delivery and inadequate information in regard to importance and expected side effects were identified by the users as the major barriers to IPTP delivery in public health care setting. Improving delivery of focused health education talks and health work attitude and delivery chain for IPTP in the health facilities are recommended to increase its uptake.

Abstract Background Artemisinin-based combination therapy (ACT) is currently recommended for treatment of uncomplicated malaria. However, the emergence and spread of partial artemisinin resistance threatens their effectiveness for malaria treatment in sub-Saharan Africa where the burden of malaria is highest. Early detection and reporting of validated molecular markers (pfk13 mutations) in Plasmodium falciparum is useful for tracking the emergence and spread of partial artemisinin resistance to inform containment efforts. Methods Genomic surveillance was conducted at 50 surveillance sites across four regions of Uganda in Karamoja, Lango, Acholi and West Nile from June 2021 to August 2023. Symptomatic malaria suspected patients were recruited and screened for presence of parasites. In addition, dried blood spots (DBS) were collected for parasite genomic analysis with PCR and sequencing. Out of 563 available dried blood spots (DBS), a random subset of 240 P. falciparum mono-infections, confirmed by a multiplex PCR were selected and used for detecting the pfk13 mutations by Sanger sequencing using Big Dye Terminator method. Regional variations in the proportions of pfk13 mutations were assessed using the chi square or Fisher’s exact tests while Kruskal–Wallis test was used to compare absolute parasite DNA levels between wild type and mutant parasites. Results Overall, 238/240 samples (99.2%) contained sufficient DNA and were successfully sequenced. Three mutations were identified within the sequenced samples; pfk13 C469Y in 32/238 (13.5%) samples, pfk13 A675V in 14/238 (5.9%) and pfk13 S522C in (1/238 (0.42%) samples across the four surveyed regions. The prevalence of pfk13 C469Y mutation was significantly higher in Karamoja region (23.3%) compared to other regions, P = 0.007. The majority of parasite isolates circulating in West Nile are of wild type (98.3), P = 0.002. Relative parasite DNA quantity did not differ in samples carrying the wild type, C469Y and A675V alleles (Kruskal–Wallis test, P = 0.6373). Conclusion Detection of validated molecular markers of artemisinin partial resistance in multiple geographical locations in this setting provides additional evidence of emerging threat of artemisinin partial resistance in Uganda. In view of these findings, periodic genomic surveillance is recommended to detect and monitor levels of pfk13 mutations in other regions in parallel with TES to assess potential implication on delayed parasite clearance and associated treatment failure in this setting. Future studies should consider identification of potential drivers of artemisinin partial resistance in the different malaria transmission settings in Uganda.

Abstract Background In 2021, an estimated 750,000 people died from malaria. Despite this significant burden, globally, malaria incidence and mortality rates have substantially dropped over the last 30 years. However, growth in spending on malaria and improved outcomes have recently stagnated. This development has made it more important than ever to understand what constitutes efficient spending on malaria. Methods Data from various sources, including disaggregated data on malaria spending from the WHO Global Malaria Programme, National Health Accounts, and the Global Burden of Disease 2021 study was used in this study. The National Health Account report is produced at the end of a national accounting exercise that aims to map the flow of financial resources from all perspectives—incl. sources, agencies—in the health sector. Malaria spending estimates for all malaria-endemic countries from 2000 to 2020, with government and donor spending disaggregated into 11 key programme areas were generated in this study. Then, these spending estimates were combined with outcome data and estimated country efficiency using robust non-parametric stochastic frontier analysis and linear regression to examine the types of malaria spending associated with better malaria outcomes. Results Across malaria-endemic countries, there is wide variation in malaria spending, with spending associated with the malaria burden within the country. Argentina, Paraguay, and Turkmenistan stood out as examples of low spending relative to their respective malaria incident per person at risk rates, while the Philippines, Guatemala, and Sri Lanka stood out as countries with case fatality ratios that were low relative to their malaria spending. Having a greater proportion of malaria spending sourced from donors or on prevention was associated with increases in incidence efficiency, while having a greater proportion of spending on anti-malarial medicines was associated with increases in case fatality efficiency. Conclusions Prioritization of spending on prevention, anti-malarial medicines, and health systems strengthening can fight incident cases and fatalities simultaneously, especially in resource-scarce, malaria-endemic countries. Furthermore, improving the availability, frequency of collection, and quality of detailed disaggregated spending data is essential to support work that strengthens the evidence base on spending efficiency and work that improves understanding of how spending on malaria could be leveraged to bridge gaps in equity across population groups.

Abstract Background Larval source management (LSM) effectively reduces mosquito populations at their breeding sites, addressing issues like insecticide resistance that limit the effectiveness of primary interventions such as insecticide-treated nets (ITNs). Although traditionally used in urban and dry areas, recent research suggests it might also be effective in rural settings in eastern and southern Africa, where Anopheles funestus thrives in permanent water bodies that sustain year-round transmission. Targeting these habitats could enhance LSM, but it requires understanding local community practices, as mosquito breeding sites often overlap with community water resources. This study examined how communities use aquatic habitats and how these practices may impact LSM strategies, with a focus on habitats used by An. funestus. Methods This study was conducted in three villages in the Ulanga and Malinyi districts of southeastern Tanzania using a mixed-methods approach. Quantitative data were collected through cross-sectional surveillance, and qualitative data through unstructured interviews, focus group discussions, and field observations. Data analysis integrated both quantitative and qualitative findings to develop a comprehensive understanding of community perspectives. Results A survey of 931 aquatic habitats found mosquito larvae in 73% of them, with late instar An. funestus present in 23%. River streams made up 41% of the habitats, while ground pools accounted for 4%. Most habitats (90%) were used by communities, including 95% of those with An. funestus larvae, for activities such as domestic chores, agriculture, livestock rearing, brickmaking, and fishing. Focus group discussions revealed a willingness to adopt LSM, with a preference for larviciding and habitat modification over habitat removal, as the water sources were vital for daily use. Community concerns centered on the safety of larvicides for humans and animals, the environmental impact, and the need for better awareness of how LSM affects health and livelihoods. Conclusion This study highlights community perspectives on LSM, focusing on the dual function of aquatic habitats as mosquito breeding sites and essential community water sources. This dual role presents both challenges and opportunities, suggesting that LSM strategies must balance public health needs with socio-economic realities. There was a clear preference for larviciding and habitat modification over removal, with a strong emphasis on health and environmental safety. The study emphasizes the importance of educating communities on the safety and effectiveness of LSM, and tailoring LSM strategies to fit the needs and preferences of local communities.

Abstract Background Malaria continues to be a significant global health concern, and developing effective therapeutic strategies requires an understanding of the immune response to the disease. This systematic review synthesized the current body of research on the role of regulated on activation, normal T cell expressed and secreted (RANTES)—in the pathogenesis and disease severity of malaria. Methods A systematic review protocol was registered with PROSPERO under the registration number CRD42024535822. The systematic review was conducted following PRISMA guidelines to identify studies examining RANTES levels in individuals infected with Plasmodium species. Searches were performed across multiple databases, including ProQuest, Journals@Ovid, Embase, Scopus, PubMed, and MEDLINE. Further searches were performed in Google Scholar. Quality assessment was done using the Joanna Briggs Institute (JBI) critical appraisal tools. Alterations in RANTES levels in patients with malaria were synthesized narratively. Results A comprehensive search of major databases identified 22 studies meeting inclusion criteria, predominantly focusing on Plasmodium falciparum and Plasmodium vivax infections. RANTES levels were found to vary significantly across different severities of malaria, with several studies reporting lower levels in severe cases compared to non-malarial controls. However, inconsistencies were observed in the alterations of RANTES levels between severe and non-severe malaria cases. Conclusion Taken together, the finding of this systematic review underscore the complex regulation of RANTES in malaria pathophysiology. Future research should focus on longitudinal assessments to elucidate the dynamic role of RANTES throughout the course of malaria and recovery, to potentially inform the design of novel therapeutic strategies.

Abstract Background Malaria continues to be a critical public health concern in India, predominantly driven by complex interplays of ecological, climatic, and socioeconomic factors. Methods This study aimed to assess the association between climatic variables (temperature and precipitation) and malaria incidence across India from 2010 to 2019, utilizing data from the Global Historical Weather and Climate Data for climate metrics and the Global Burden of Disease Study for malaria incidence rates. Generalized Linear Mixed Models (GLMMs) with a Poisson distribution were employed to analyze the data, adjusting for socio-economic status, as indexed by the Human Development Index (HDI). Results The results indicated a declining trend in both the number of malaria cases and age-specific incidence rates (ASIR) over the study period. In 2010, India reported approximately 20.7 million cases with an ASIR of 1688.86 per 100,000 population, which significantly reduced to 9.8 million cases and an ASIR of 700.80 by 2019. High malaria incidence was consistently observed in the states of Jharkhand and Odisha, whereas Sikkim reported the lowest numbers. Statistical analysis identified significant associations between malaria incidence and both temperature deviations and precipitation levels, with variations also linked to HDI, suggesting better detection and reporting capabilities in more developed areas. Conclusion The study underscores the critical interactions between climatic variables and socio-economic factors in shaping the trends of malaria incidence across India. These findings highlight the necessity for adaptive, localized public health strategies that integrate environmental monitoring with socio-economic data to efficiently predict and manage malaria outbreaks.

Abstract Background The most widely used anti-malarial drug artemisinin (ART) is metabolized extensively, but the therapeutic capacity of its major metabolite remains unknown. Whether the major metabolite of ART (ART-M) contributes to its antiplasmodial potency was investigated in this study. Methods The metabolite identification and enzyme phenotyping of ART were performed using human liver microsomes (HLMs). The stereostructure of the major metabolite ART-M was elucidated by spectroscopic and X-ray crystallographic analysis. The anti-malarial activity of ART-M against two reference Plasmodium strains (Pf3D7 and PfDd2) was evaluated. The pharmacokinetic profiles of ART and its metabolite ART-M were investigated in healthy Chinese subjects after a recommended two-day oral dose of ART plus piperaquine. Pharmacodynamic parameters based on minimum inhibitory concentration (MIC50) and free plasma concentration were employed to evaluate the therapeutic potency of ART-M, including fAUC0-t/MIC50, fCmax/MIC50 and T > MIC50. Results A major metabolite 10β-hydroxyartemisinin (ART-M) was found for ART in human, and CYP3A4/3A5 was the major enzymes responsible for ART 10β-hydroxylation. Compared with ART (MIC50, 10.1 nM against Pf3D7), weaker antiplasmodial activity was found for ART-M (MIC50, 61.4 nM against Pf3D7). However, a 3.5-fold higher maximal free plasma concentration was achieved for ART-M (fCmax, 180.0 nM vs. 51.8 nM for ART). ART-M displayed comparable antiplasmodial potency to ART, in terms of fAUC0-t/MIC50 (12.5 h), fCmax/MIC50 (2.8) and T > MIC50 (5 h). Conclusions The major metabolite 10β-hydroxyartemisinin contributes to the antiplasmodial efficacy of ART, which should be considered when evaluation of ART dosing regimens and/or clinical outcomes.

Abstract Background Malaria remains a significant public health challenge in Africa where it is the most important vector-borne disease. Nigeria bears the largest burden, with pregnant women and children under 5 years being more affected. Although, long lasting insecticidal nets (LLINs) remain effective for control, its use has been suboptimal. Hence this study assessed, household ownership, physical integrity and use of LLINs among children. Methods A community-based, cross-sectional study was carried out among 1642 households using a multistage sampling technique in Osun State, Nigeria. A pretested, interviewer-administered questionnaire was used to obtain information on socio-demographic characteristics and use among under-fives. LLINs were inspected for physical integrity and cleanliness. A binary logistic regression analysis was conducted to identify factors influencing LLIN use by under-fives. Results The mean age of children was 32.2 ± 16.5 months. Most households, 1586 (96.6%) had an LLIN while 165 (10.4%) did not hang their net. Holes were present in LLINs in 360 (22.7%) households and 196 (12.4%) had dusty or stained nets. Most households, (1259; 79.4%), had at least one LLIN for every 2 household members and survey participants reported that 1331 (83.9%) under-fives slept under an LLIN the night before the survey. Factors associated with reported LLIN use were; older parents/guardians aged 50–59 years (AOR: 3.02; 95% CI 1.50–6.09), having a post-secondary education (AOR: 2.56; 95% CI 1.31–5.00), having LLIN obtained

Abstract Background Malaria is a major cause of ill health and death in children in Africa. The disease also imposes a severe social and economic burden on households and health systems and is strongly associated with poverty. This study summarizes the most up-to-date cost of treating severe malaria in children in Africa. Methods A systematic search was conducted in PubMed, Embase, Cinahl, and Web of Science databases. Google and Google Scholar were searched for grey literature followed by scanning of the reference lists of the previous systematic reviews. The search was limited to children

Abstract Background In light of the existing body of scientific data, many substances are now recognized or reasonably assumed to be human carcinogens. Public knowledge about modifiable environmental carcinogens is regarded as a crucial first step in primary prevention. This study aimed to assess Jordanians' awareness of some of the recognized environmental human carcinogens and general cancer information. Methods This study was conducted using a cross-sectional descriptive survey based on a questionnaire completed by Jordanian participants aged 18 or above. The questions consisted of the following sections: socio-demographic characteristics, questions about the prevalent and non-prevalent cancer types in Jordan and general causes of cancer, closed-ended questions to evaluate knowledge about environmental carcinogens as well as factors that influence the development of cancer, source of knowledge about carcinogens and interest in learning about human carcinogens, and the best way for prevention of cancer. Results A total of 579 questionnaires were completed. Among respondents, 55.6% (n = 322) had a knowledge score ≥ 8 indicating good knowledge. However, low awareness was demonstrated regarding cancer-causing substances such as wood dust, Nitrosamines, Aflatoxins, Formaldehyde, Naphthalene, Asbestos, Benzene, and Arsenic. A significant portion of the participants failed to categorize infectious pathogens linked to cancer as variables that either cause cancer or raise the risk of developing cancer. Conclusion This study demonstrated a good level of awareness regarding some environmental carcinogens but also highlighted the lack of knowledge about other environmental carcinogens. These findings may provide a guide for future awareness programs by health authorities.

Abstract Background Intestinal worm infections are a significant public health concern for pregnant women in low- and middle-income countries. These infections can lead to anaemia, malnutrition, and adverse pregnancy outcomes, including premature birth and low birth weight. Deworming medication during pregnancy is a safe and effective strategy to prevent these complications and improve maternal and child health. This study aims to investigate the trends and inequalities in the use of deworming medication during pregnancy among women in Sierra Leone between 2008 and 2019. Methods The study utilised data from the Sierra Leone Demographic Health Surveys conducted in 2008, 2013, and 2019. We used the Health Equity Assessment Toolkit developed by the World Health Organisation to calculate various measures of inequality, including difference, ratio, population attributable risk, and population attributable fraction. An inequality assessment was conducted for five stratifiers: age, economic status, level of education, place of residence, and sub-national province. Results The prevalence of deworming medication during pregnancy was 43.8% in 2008, 72.4% in 2013, and 83.5% in 2019 in Sierra Leone. There was a decrease in age-related inequality from a difference of 3.7% in 2008 to −0.8% in 2019. Economic-related inequality increased from a difference of −8.5% in 2008 to −8.2% in 2019. Both population attributable fraction and population attributable risk were zero in all survey years for economic status, indicating no improvement in the setting average without economic-related inequality. Inequality in education increased from a difference of -8.9% in 2008 to −8.4% in 2019 and decreased from a difference of −2.6% in 2008 to –5.5% in 2019 for place of residence. Provincial inequality decreased from a difference of 29.5% in 2008 to 11.8% in 2019. The population attributable risk for province reveals that the setting average could have been 10.5 percentage points lower in 2008, 8.2 percentage points lower in 2013, and 5.9 percentage points lower in 2019 without provincial inequality. Conclusion The prevalence of deworming medication use during pregnancy substantially increased from 2008 to 2019 (43.8% to 83.5%) in Sierra Leone. This suggests a positive public health trend in maternal healthcare access and education. Inequalities related to economic status and education increased slightly while age-related, place of residence and provincial inequalities decreased. This indicates an inequitable distribution of this essential healthcare intervention across these stratifiers. The government and policymakers should continue efforts to raise awareness and promote the use of deworming medication during pregnancy.

Abstract Background After three years with no local transmission of malaria, an outbreak occurred in Iran in 2022. Key malaria control methods in Iran are including indoor residual spraying (IRS), long-lasting insecticide-treated nets (LLINs), and prompt diagnosis and treatment of malaria cases. Anopheles sacharovi is one of the main malaria vectors in Iran. This study aimed to determine the insecticides resistance status of An. sacharovi in northwestern Iran, to inform effective vector control programs in this region. Methods Larval stages of An. sacharovi were collected from various larval habitats located in the villages along the Aras River. Adult susceptibility tests were performed on An. sacharovi using diagnostic doses of insecticides accordance to World Health Organization (WHO) guidelines. The study also evaluated agricultural insecticide and fertilizer usage alongside the presence of natural mosquito predators in breeding sites in the study area. Results Alongside various chemicals such as silica, humic acid, superphosphate, sulfur, urea, and solupotasse at different dose levels, organophosphorus and pyrethroid insecticides are commonly used in rice fields and orchards. Anopheles sacharovi displayed diverse reactions to insecticides, demonstrating resistance to DDT but sensitivity to malathion, and showing similar reactions to carbamate and pyrethroid insecticides. Conclusions These results provide significant insights into agricultural practices and the presence of mosquito larvae in the study area. The extensive use of a specific herbicide illustrates its popularity among farmers for weed control, while other agricultural products focus on enhancing soil fertility and productivity. The absence of mosquito larvae in habitats with predators indicates the usefulness of these predators in controlling the population of mosquitoes. The resistance of mosquitoes to certain insecticides highlights the need for careful selection and intermittent use of insecticides in vector control programs. These findings can inform the development of targeted strategies to reduce malaria transmission risks. Further research is essential for assessing the effectiveness of these interventions.

Abstract Dengue is the most rapidly spreading vector-borne disease worldwide, with over half the global population at risk for an infection. Antibody-dependent enhancement (ADE) is associated with increased disease severity and may also be attributable to the deterioration of disease in vaccinated people. Two dengue vaccines are approved momentarily, with more in development. The increasing use of vaccines against dengue, combined with the development of more, makes a thorough understanding of the processes behind ADE more important than ever. Above that, due to the lack of treatment options, this method of prevention is of great importance. This review aims to explore the impact of ADE in dengue vaccinations, with the goal of enhancing potential vaccination strategies in the fight against dengue.

Abstract Malaria remains a significant global health challenge, with millions of cases and high mortality rates annually, especially in low-income countries. Africa bears a substantial burden, with direct costs of malaria among children under five reaching millions of dollars in countries like Ghana, Tanzania, and Kenya. In 2021, over 610,000 malaria-related deaths were reported, 96% of which occurred in sub-Saharan Africa. Despite existing interventions, such as long-lasting insecticidal nets, indoor residual spraying, and intermittent preventive treatment, the re-emergence of malaria underscores the need for innovative preventive strategies. This study explores the potential of utilizing mobile phone caller tunes to raise awareness and promote the uptake of the RTS,S malaria vaccine. The technology acceptance model (TAM) provides a framework for understanding how users perceive and adopt new technologies. Caller tunes, a mobile phone feature that plays audio for callers waiting to be connected, have been effective in health communication campaigns in Asia and Africa. This approach could be leveraged to enhance malaria vaccine awareness, particularly in low-income countries where vaccine hesitancy is prevalent and malaria endemic. Overall, mobile technologies have significantly improved healthcare delivery in Africa, facilitating communication, monitoring, and treatment adherence in remote areas. Integrating caller tunes with health messages about the malaria vaccine could address vaccine hesitancy and improve uptake. This would require collaboration with telecommunication companies, healthcare providers, and policymakers to design culturally and linguistically appropriate messages. However, the cost of caller tune services, the need for internet access, and cultural differences are the expected challenge that may occur in this approach. Therefore, strategic partnerships and intersectoral approaches can mitigate these issues, making caller tunes a viable tool for public health communication. Raising awareness through this innovative method could enhance the adoption of the RTS,S vaccine and support ongoing malaria control efforts in Africa.

Abstract Background Pyrethroid-chlorfenapyr nets have shown significant epidemiological impact over pyrethroid-only and pyrethroid plus piperonyl-butoxide (PBO) in Africa. A non-inferiority evaluation of PermaNet® Dual, a new chlorfenapyr plus deltamethrin net, compared to Interceptor® G2, was conducted in experimental huts in Siaya, Kenya against free-flying pyrethroid-resistant Anopheles funestus. Methods This study was an experimental hut trial, following a 7 by 7 Latin Square design. Seven treatments and seven sleepers were deployed in the experimental huts daily and rotated weekly and daily, respectively. Mosquitoes were collected every morning between 06:30 h and 08:30 h and were assessed for blood feeding and then monitored for immediate knockdown 1-h post collection and delayed mortality after 72 h. Differences in proportional outcomes were analysed using the blocked logistic regression model, while differences in numerical outcomes were analysed using the negative binomial regression model. Non-inferiority determination was performed based on World Health Organization (WHO) protocol. Results Mortality at 72 h was 30.2% for PermaNet 3.0, 44.4% for the Interceptor® G2 and 49.2% for the PermaNet® Dual. Blood feeding was highest with PermaNet® Dual at 15%, and least with PermaNet® 3.0 at 10%. PermaNet® Dual and Interceptor® G2 had no significant differences in mortality (OR = 1.10, 95% CI 1.00–1.20) or blood feeding (OR = 1.18, 95% CI 1.04–1.33) and the lower confidence bounds were within the non-inferiority margins but for blood feeding, non-inferiority was relatively high to the upper 95% confidence bound. PermaNet® Dual was non-inferior to the Interceptor® G2 and superior to the PermaNet® 3.0 nets in causing mortality but inferior to PermaNet ®3.0 in blood feeding inhibition of the vectors. Conclusion PermaNet® Dual met the WHO criteria for non-inferiority to Interceptor® G2 and may be considered for deployment for public health use against pyrethroid-resistant Anopheles vectors of malaria.

Abstract Background Glucose-6-Phosphate Dehydrogenase deficiency (G6PDd) is a common genetic enzymopathy that can induce haemolysis triggered by various factors, including some anti-malarial drugs. Although many Point-of-Care (PoC) tests, such as Standard G6PD™ are available to detect G6PDd, its pooled diagnostic test accuracy (DTA) remains unknown. Methods To estimate the DTA of StandG6PD-BS at various thresholds of G6PDd, a systematic review with a DTA meta-analysis were conducted, searching EMBASE, MEDLINE, and SciELO databases up to April 4, 2024.The included studies were those that measured G6PD activity using StandG6PD-BS (reference test) and spectrophotometry (gold standard) in patients suspected of having G6PDd. The risk of bias (RoB) of the studies was assessed using the QUADAS-2 tool and the certainty of evidence (CoE) with the GRADE approach. For the estimation of within-study DTA, a random-effect bivariate meta-analysis was performed to determine the pooled sensitivity and specificity for 30%, 70%, and 80% enzyme levels’ thresholds, and a graphical analysis of the heterogeneity using crosshair and Confidence Regions on receiver operating characteristic (ROC) space plots. Results After screening 2496 reports, four studies were included with 7864 participants covering all thresholds. Two studies had high RoB in QUADAS-2 domains 2 and 3, and the others had low RoB, with low, moderate, and high heterogeneity at the 30%, 70%, and 80% thresholds, respectively. The pooled sensitivity was 99.1%, 95.7%, and 90% for 30%, 70%, and 80% thresholds, respectively. The pooled specificity was 97.4%; 92.9%; and 89.0% for 30%, 70%, and 80% thresholds, respectively. Conclusion StandG6PD-BS is a PoC test with high sensitivity and specificity to detect G6PDd at different thresholds.

Rationale: American tegumentary leishmaniasis comprises cutaneous and mucocutaneous manifestations caused by parasitic infections by various Leishmania species. This report details the clinical interventions for a patient with American tegumentary leishmaniasis in Mendoza, Argentina, a non-endemic region. Patient concerns: A 43-year-old male was admitted to a tertiary care hospital in Mendoza, Argentina Republic with a history of progressive nasal discharge, septal perforation, facial pain, and pruritus. Despite treatment for presumed nasal myiasis and vasculitis with granulomatosis, symptoms persisted. Diagnosis: American tegumentary leishmaniasis. Interventions: Intravenous liposomal amphotericin B. Outcomes: Follow-up at 30 days showed no recurrence of symptoms with a remarkable clinical improvement of the nasal lesion. Lessons: This case sheds light on the necessity of accurate identification for timely intervention and the need to recognize the diverse manifestations of American tegumentary leishmaniasis to avoid misdiagnosis.