Hasil untuk "Arctic medicine. Tropical medicine"

Al-Bowri SS, Al-Mekhlafi AM, Abdul-Ghani R et al.

Saeed S Al-Bowri,1 Abdulsalam M Al-Mekhlafi,2 Rashad Abdul-Ghani,2,3 Ahmed A Azazy4 1Health Sciences Department, Faculty of Medicine and Health Sciences, Seiyun University, Seiyun, Yemen; 2Department of Medical Parasitology, Faculty of Medicine and Health Sciences, Sana’a University, Sana’a, Yemen; 3Tropical Disease Research Center, Faculty of Medicine and Health Sciences, University of Science and Technology, Sana’a, Yemen; 4Department of Laboratory Medicine, Faculty of Applied Medical Sciences, Al Baha University, Al Baha, Saudi ArabiaCorrespondence: Rashad Abdul-Ghani, Department of Medical Parasitology, Faculty of Medicine and Health Sciences, Sana’a University, P.O. Box 13078, Sana’a, Yemen, Tel +967 775005239, Email rashadqb@yahoo.comBackground: Schistosomiasis persists as a public health problem in Hadhramout, the largest governorate in the eastern part of Yemen. Despite its endemicity, epidemiological patterns in many districts remain unclear. Therefore, this study aimed to determine the prevalence and factors associated with schistosomiasis among schoolchildren in the Amd District of Hadhramout Valley.Methods: A cross-sectional study was conducted with 380 schoolchildren aged 6– 16 years. Data on the children’s sociodemographic characteristics, infection-related behaviors, and environmental factors were collected using a structured questionnaire. Urine filtration and Kato-Katz techniques were used to detect and count the eggs of Schistosoma haematobium and S. mansoni, respectively. Data were analyzed using appropriate statistical tests, and multivariable binary logistic regression analysis was performed to identify predictors of schistosomiasis.Results: In Amd District, 33.7% (95% CI: 28.9– 38.7) of schoolchildren had light-intensity infection with any Schistosoma species, indicating a moderate risk level, specifically S. haematobium among 31.6% (95% CI: 26.9– 36.3) and S. mansoni among 2.1% (95% CI: 0.7– 3.6) of children. Macrohematuria, microhematuria, and proteinuria were significantly associated with S. haematobium infection. However, neither hematochezia nor diarrhea was significantly associated with S. mansoni infection. Multivariable binary logistic regression analysis identified male gender (AOR = 4.2; 95% CI: 2.48– 7.12; P < 0.001), age ≥ 10 years (AOR = 3.1; 95% CI: 1.70– 5.56; P < 0.001), and contact with natural water sources (AOR = 2.0; 95% CI: 1.06– 3.58; P = 0.032) as independent predictors of schistosomiasis.Conclusion: The risk of schistosomiasis in Amd District is moderate and predominated by S. haematobium, with light-intensity infections affecting approximately one-third of schoolchildren. Therefore, biannual preventive chemotherapy with praziquantel is recommended for all enrolled and non-enrolled school-age children. Macrohematuria, microhematuria, and proteinuria are important indicators of S. haematobium infection. Meanwhile, male gender, older age, and water contact can independently predict infection.Keywords: schistosomiasis, schoolchildren, Yemen

Fazle Rabbi Chowdhury, Zazeba Hossain, Nahid Parvez et al.

Acute arboviral infections like dengue have a significant negative socioeconomic and health impact on many tropical and subtropical areas of the world. About 3.9 billion Individuals are at risk of contracting the dengue virus and Asia bears the brunt of that load. Bangladesh, like other south-east Asian countries faced a massive outbreak of dengue in 2019. This cross sectional study was done in three tertiary care centers in Dhaka, Bangladesh during this worst outbreak of dengue. The study was conducted from 1st July to 31st December, 2019 with an aim to describe the clinical and laboratory variations among severe dengue cases and to conduct a serotype survey. This might help to understand the future changes in the clinical or serological profile of the circulating dengue virus. The study enrolled 1978 participants who were grouped into group B (Patients with warning signs or risk factors who should be admitted for close observation as they approach critical phase) and C (Patients having severe plasma leakage leading to dengue shock and/or fluid accumulation with respiratory distress, severe organ impairment and severe metabolic abnormalities) according to national guidelines. Furthermore, 81 samples were serotyped using Qiagen One step RT-PCR kit (Cat. No: 210212). In addition sequencing (ABI sequencing platform) of partial C-prM gene of five DENV-3 isolates were done and analyzed (BLAST tool of NCBI) for phylogenetics (MEGA6 software package). Among the 1978 enrolled participants group B and C patients were 1580 (80%) and 398 (20%) respectively. The median (IQR) age of the patients were 26(11 to 41). Maximum proportion of the enrolled were male (72.3%) (p = 0.0002). Most common co- morbidities were hypertension (90; 4.5%) and DM (70; 3.5%). Group C patients more commonly presented with vomiting (p 0.133), diarrhea (p<0.0001) and abdominal pain (p 0.0203). The common mode of bleeding was melaena (12%). Thirteen (0.7%) patients succumbed to death, 12 of them belonged to group B who mostly presented with GI manifestations (99.9%) and melaena (12%). Only 5.6% of the cases were secondarily infected. In group C cases low hemoglobin and hematocrit was observed with high AST (p 0.004, 0.006 and 0.0016 respectively). Fluid requirement was also more in the same group (p<0.0001). Group B patients had a higher platelet requirement (p = 0.0070). Twelve patients (0.7%) required ICU. The management profile of these cases are showcased here which highlights minimal use of antibiotics and no application of steroids, which abides by the current national protocol. Furthermore, 81 samples from enrolled participants were serotyped and majority (79%) yielded DENV-3, followed by DENV 2 & 3 co-infection (13.6%) and DENV-2 alone (7.4%). Following phylogenetic analysis DENV-3 and DENV2 were deemed to be of genotype I and cosmopolitan variety respectively. This study presents the first instance of heterogeneous co-infection with several serotypes since 2000 in Bangladesh. It also gives an overview of serotype prevalence, management evaluation and clinical results that promises to navigate future control planning.

Abdullahi Ahmad, Nuredin Ibrahim Mohammed, Fatou Joof et al.

Abstract Background Carriers of persistent asymptomatic Plasmodium falciparum infections constitute an infectious reservoir that maintains malaria transmission. Understanding the extent of carriage and characteristics of carriers specific to endemic areas could guide use of interventions to reduce infectious reservoir. Methods In eastern Gambia, an all-age cohort from four villages was followed up from 2012 to 2016. Each year, cross-sectional surveys were conducted at the end of the malaria transmission season (January) and just before the start of the next one (June) to determine asymptomatic P. falciparum carriage. Passive case detection was conducted during each transmission season (August to January) to determine incidence of clinical malaria. Association between carriage at the end of the season and at start of the next one and the risk factors for this were assessed. Effect of carriage before start of the season on risk of clinical malaria during the season was also examined. Results A total of 1403 individuals—1154 from a semi-urban village and 249 from three rural villages were enrolled; median age was 12 years (interquartile range [IQR] 6, 30) and 12 years (IQR 7, 27) respectively. In adjusted analysis, asymptomatic P. falciparum carriage at the end of a transmission season and carriage just before start of the next one were strongly associated (adjusted odds ratio [aOR] = 19.99; 95% CI 12.57–31.77, p < 0.001). The odds of persistent carriage (i.e. infected both in January and in June) were higher in rural villages (aOR = 13.0; 95% CI 6.33–26.88, p < 0.001) and in children aged 5–15 years (aOR = 5.03; 95% CI 2.47–10.23, p =  < 0.001). In the rural villages, carriage before start of the season was associated with a lower risk of clinical malaria during the season (incidence risk ratio [IRR] 0.48, 95% CI 0.27–0.81, p = 0.007). Conclusions Asymptomatic P. falciparum carriage at the end of a transmission season strongly predicted carriage just before start of the next one. Interventions that clear persistent asymptomatic infections when targeted at the subpopulation with high risk of carriage may reduce the infectious reservoir responsible for launching seasonal transmission.

M. Fatahi Bafghi, S. Salary, F. Mirzaei et al.

Background Henna ( Lawsonia inermis ) with anti-bacterial properties has been widely used in traditional medicine especially Persian medicine. Henna oil is suggested for diseases of infectious origin, such as cervical ulcers. Group B Streptococcus agalactiae , Pseudomonas aeruginosa and, Trichomonas vaginalis are involved in the infection of women especially cervicitis. Henna grows in dry and tropical regions. The main important landraces of henna landraces are cultivated in Kerman, Sistan and Baluchestan, Hormozgan, and Bushehr provinces in Iran. Proper use of antimicrobial agents, use of new antimicrobial strategies, and alternative methods, such as herbal methods may help reduce drug resistance in the future. This study’s objective was to investigate the anti- Trichomonas vaginalis activity of three different henna landraces and antimicrobial effects against group B Streptococcus agalactiae and, Pseudomonas aeruginosa . Methods Total phenol content was measured by Folin ciocaltu method. Antibacterial effect of landraces of Henna against P. aeruginosa and S. agalactiae were assayed by well diffusion method and minimal inhibitory concentration assessments were done using the broth micro-dilution technique. Anti-Trichomonas effect of Henna landraces were assayed by Hemocytometery method. Results Total phenol content of Shahdad, Rudbar-e-Jonub, and Qaleh Ganj was 206.51, 201.96, and 254.85 μg/ml, respectively. Shahdad, Rudbar-e-Jonub, and Qaleh Ganj had MIC against GBS at 15, 15 and, 4 μg/ml. The growth inhibition diameter of the most effective henna (Shahdad landrace) at a concentration of 20 μg/ml on P. aeruginosa was 2.46 ± 0.15 cm and in the MIC method at a concentration of 5 μg/ml of Shahdad landrace, P. aeruginosa did not grow. IC50 of shahdad Henna after 24 h, 48 h, and 72 h was 7.54, 4.83 and 20.54 μg/ml, respectively. IC50 of Rudbar-e-Jonub extract was 5.76, 3.79 and 5.77 μg/ml in different days. IC50 of Qaleh Ganj extract was 6.09, 4.08 and 5.74 μg/ml in different days. Conclusions The amount of total phenol in Qaleh Ganj was higher than the other varieties. In the well diffusion method, Qaleh Ganj was more effective against group B Streptococcus (Gram-positive bacterium) than the other two landraces, and Shahdad landrace was more effective against P. aeruginosa (Gram-negative bacterium) than other. In the MIC method, the same result was obtained as in the well diffusion method, but at a lower concentration.

Z. Rezaei, B. Pourabbas, Vera Kühne et al.

To evaluate the diagnostic performance of five alternative serodiagnostic tests, serum samples from 100 confirmed visceral leishmaniasis (VL) patients, 197 healthy endemic individuals, and 58 non-VL patients living in southern Iran were compared. The VL patients were defined as individuals with a positive result of the immunofluorescent antibody test (IFAT), having clinical signs and symptoms and appropriate response to treatment. The index tests were two direct agglutination tests, DAT-ITM (Institute of Tropical Medicine, Antwerp, Belgium) and DAT-KIT (Royal Tropical Institute, Amsterdam, The Netherlands), and three rapid diagnostic tests (RDTs), Kalazar Detect (InBios International Inc., USA), IT Leish (Bio-Rad, catalog 710124), and Leishmania test (Cypress Diagnostic Company, Belgium). Sensitivities of DAT-ITM and DAT-KIT were low, respectively, 56% and 59%, while specificities were acceptable, respectively, 98% and 93%. Observed sensitivities and specificities of RDTs were higher (71%, 81%, 70% and 99%, 99%, 98% for Kalazar Detect, IT Leish, and Leishmania test, respectively). Even with a maximum sensitivity of 81%, RDTs missed almost one-fifth of VL patients that were positive in IFAT. We conclude that RDTs in VL patients do not possess adequate performance in southern Iran and require some improvement, but they can still be helpful in the diagnosis and screening of the disease in this region due to their high specificity and speed.

Dominik Stelzle, Veronika Schmidt, Luise Keller et al.

<h4>Background</h4>Neurocysticercosis (NCC), a zoonotic disease caused by the pork tapeworm T. solium, represents one of the most common causes of secondary epilepsy but remains often undiagnosed due to lack of awareness and diagnostic facilities.<h4>Methodology</h4>We pooled data from four cross-sectional studies on epilepsy and NCC in eastern Africa. Study sites were in Uganda, Malawi and in Tanzania (Dar es Salaam and Haydom). The study in Uganda and Malawi were community-based, the two studies in Tanzania were hospital-based. The same questionnaire was used for assessment of clinical characteristics of patients with epilepsy. Computed tomography (CT) scans and serological testing were performed in order to diagnose NCC.<h4>Results</h4>Overall, 1,179 people with epilepsy were included in our analysis. Of those, 941 PWE underwent CT scanning and were pooled for NCC analysis. Seventy patients were diagnosed with NCC, but NCC prevalence differed considerably between sites ranging from 2.0% (95%CI 0.4% to 3.6%) in Dar es Salaam to 17.5% (95%CI 12.4% to 22.6%) in Haydom. NCC prevalence did not show any association with sex but increased with age and was higher in rural than urban settings. In addition, being a farmer, non-Muslim, eating pork and living with pigs close by was associated with a higher NCC prevalence. PWE with NCC experienced their first epileptic seizure around 3 years later in life compared to PWE without NCC and their epileptic seizures seemed to be better controlled (p&lt;0.001). There was no difference between focal onset seizures and focal signs on neurological examination in both groups (p = 0.49 and p = 0.92, respectively). The rT24H-EITB had a sensitivity for the detection of NCC of 70% (95% confidence interval [CI] 51 to 84%), the LLGP of 76% (95%CI 58 to 89%) and the antigen ELISA of 36% (95% CI 20 to 55%).<h4>Conclusions</h4>NCC is prevalent among PWE in eastern Africa, although it may not be as common as previously stated. Demographic characteristics of PWE with NCC differed from those without NCC, but semiological characteristics and results on neurological examination did not differ compared to PWE without NCC. Interestingly, seizures seemed to be less frequent in PWE with NCC. Being aware of those differences and similarities may help triaging PWE for neuroimaging in order to establish a diagnosis of NCC.

Priyanka Kadam, S. Ainsworth, F. Sirur et al.

1 Snakebite Healing and Education Society, Mumbai, India, 2 Centre for Snakebite Research and Interventions, Department of Tropical Disease Biology, Liverpool School of Tropical Medicine, Liverpool, United Kingdom, 3 Department of Emergency Medicine, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, India, 4 Shree Sainath Hospital, Dharampur, India, 5 Gandhiji Health and Development Centre, Barwadih, Jharkhand, India, 6 Calcutta National Medical College Hospital, Kolkatta, India

Á. Faccini-Martínez, F. Krawczak, S. V. Oliveira et al.

[1]. Asociación Colombiana de Infectología, Committee of Tropical Medicine, Zoonoses and Travel Medicine, Bogotá, Colombia. [2]. Universidade Federal de Goiás, Escola de Veterinária e Zootecnia, Setor de Medicina Veterinária Preventiva, Goiânia, Goiás, Brasil. [3]. Universidade Federal de Uberlândia, Departamento de Saúde Coletiva da Faculdade de Medicina, Uberlândia, Minas Gerais, Brasil. [4]. Universidade de São Paulo, Faculdade de Medicina Veterinária e Zootecnia, Departamento de Medicina Veterinária Preventiva e Saúde Animal, São Paulo, São Paulo, Brasil. [5]. Universidade Estadual de Campinas, Hospital de Clínicas, Seção de Epidemiologia Hospitalar, Campinas, São Paulo, Brasil.

Margaret Sarpong-Baidoo, Michael F Ofori, Elias Kwesi Asuming-Brempong et al.

<h4>Background</h4>Schistosomiasis remains a major public health issue with over 90% of the prevalence rates recorded in Sub-Saharan Africa. In this study, the relationships between different interleukin gene polymorphisms (IL-13-591A/G, IL-13-1055C/T, IL-13-1258A/G) and Schistosoma haematobium infection levels were evaluated; as well as the host plasma antibodies and cytokine profiles associated with schistosomiasis infection.<h4>Methodology</h4>A total of 469 school children aged 6 to 19 years from four schistosomiasis-endemic communities in Ghana were involved. Single urine and stool samples were obtained from each pupil, processed via sedimentation and Kato-Katz, and examined via microscopy for Schistosoma and soil-transmitted helminth (STH) eggs. Next, venous blood samples were drawn from 350 healthy pupils, and used to measure antibody and plasma cytokine levels by ELISA. Single nucleotide polymorphisms in the IL-13 gene were genotyped on 71 selected blood samples using the Mass Array technique.<h4>Principal findings and conclusion</h4>The overall prevalence of urinary schistosomiasis was 21.11%. Community-level prevalences were 17.12%, 32.11%, 20.80%, and 15.32% for Asempaneye, Barikumah, Eyan Akotoguah, and Apewosika respectively. Generally, higher S. haematobium infection prevalence and intensity were recorded for participants with genotypes bearing the IL13-1055C allele, the IL13-591A, and the IL13-1258A alleles. Also, higher S. haematobium infection prevalence was observed among participants in the 12-14-year age group with the IL13-1055C, IL13-591A, and IL13-1258A alleles. Interestingly, higher STH prevalence was also observed among participants with the IL13-1055C, IL13-591A, and IL13-1258A alleles. Furthermore, the age-associated trends of measured antibodies and cytokines of S. haematobium-infected school-children depicted a more pro-inflammatory immune profile for pupils aged up to 1l years, and an increasingly anti-inflammatory profile for pupils aged 12 years and above. This work provides insight into the influence of IL-13 gene polymorphisms on S. haematobium, and STH infections, in school-aged children (SAC).

D. Hamer, Aisha Rizwan, D. Freedman et al.

Abstract Rationale for review In response to increased concerns about emerging infectious diseases, GeoSentinel, the Global Surveillance Network of the International Society of Travel Medicine in partnership with the US Centers for Disease Control and Prevention (CDC), was established in 1995 in order to serve as a global provider-based emerging infections sentinel network, conduct surveillance for travel-related infections and communicate and assist global public health responses. This review summarizes the history, past achievements and future directions of the GeoSentinel Network. Key findings Funded by the US CDC in 1996, GeoSentinel has grown from a group of eight US-based travel and tropical medicine centers to a global network, which currently consists of 68 sites in 28 countries. GeoSentinel has provided important contributions that have enhanced the ability to use destination-specific differences to guide diagnosis and treatment of returning travelers, migrants and refugees. During the last two decades, GeoSentinel has identified a number of sentinel infectious disease events including previously unrecognized outbreaks and occurrence of diseases in locations thought not to harbor certain infectious agents. GeoSentinel has also provided useful insight into illnesses affecting different traveling populations such as migrants, business travelers and students, while characterizing in greater detail the epidemiology of infectious diseases such as typhoid fever, leishmaniasis and Zika virus disease. Conclusions Surveillance of travel- and migration-related infectious diseases has been the main focus of GeoSentinel for the last 25 years. However, GeoSentinel is now evolving into a network that will conduct both research and surveillance. The large number of participating sites and excellent geographic coverage for identification of both common and illnesses in individuals who have traversed international borders uniquely position GeoSentinel to make important contributions of travel-related infectious diseases in the years to come.

O. Ojo, A. Ojo, B. Oyinloye et al.

BackgroundOcimum gratissimum L. is a medicinal plant widely grown in tropical and subtropical regions with the leaf decoction usually taken in folk medicine to enhance erectile performance in men although the probable mechanism of actions remains undetermined. This study examined the inhibitory potentials of Ocimum gratissimum leaves on some key enzymes associated with erectile dysfunction in penile and testicular tissues of the rat.MethodsInhibitory effect of aqueous extract (1:10 w/v) of O. gratissimum leaves on the activities of phosphodiesterase-5 (PDE-5), arginase, angiotensin I –converting enzyme (ACE), and acetylcholinesterase (AChE) in penile and testicular tissues were assessed. Also, the extract was investigated for ferric reducing antioxidant property(FRAP) and 1,1-diphenyl-2-picryl-hydrazil (DPPH) radical scavenging abilities.ResultsThe extract showed higher PDE-5 (IC50 = 43.19 μg/mL), ACE (IC50 = 44.23 μg/mL), AChE (IC50 = 55.51 μg/mL) and arginase (IC50 = 46.12 μg/mL) inhibitory activity in the penile tissue than PDE-5 (IC50 = 44.67 μg/mL), ACE (IC50 = 53.99 μg/mL), AChE (IC50 = 60.03 μg/mL) and arginase (IC50 = 49.12 μg/mL) inhibitory activity in the testicular tissue homogenate. Furthermore, the extract scavenged free radicals and in a dose-dependent manner.ConclusionThe enzyme activities displayed might be associated with the bioactive compounds present in the extract which could possibly explain its use in the management of erectile dysfunction (ED).

Lwidiko E. Mhamilawa, Sven Wikström, Bruno P. Mmbando et al.

Abstract Background Extended artemisinin-based combination therapy (ACT) for treatment of uncomplicated Plasmodium falciparum malaria with already existing drug regimens, such as artemether-lumefantrine, might be effective in tackling the emerging ACT resistance. However, given the history of cardiotoxicity among anti-malarial drugs structurally similar to lumefantrine, the potential effect of extended artemether-lumefantrine treatment on the electrocardiographic (ECG) QTc interval is of high concern. Methods Male and non-pregnant females aged 1–65 years, diagnosed with uncomplicated P. falciparum malaria in Bagamoyo district, Tanzania, were randomized into two arms. The intervention arm received an extended, i.e. 6-day, course of artemether-lumefantrine and an additional single low-dose primaquine (0.25 mg/kg) administered together with the last artemether-lumefantrine dose. The control arm received the standard weight-based 3-day course. ECGs were performed at day 0 and 4–5 h after the last dose at day 5. QT intervals were read manually using the tangent method and automatically. Bazett’s (QTcB) and Fridericia’s (QTcF) formulae were used for correction for heart rate. Descriptive statistics were used to calculate baseline characteristics and the number of supra-thresholds QTc intervals (QTc prolongation > 500, change in QTc interval (ΔQTc) > 60 ms). The mean change in QTc interval in and between the two arms was compared using the paired t-test and independent samples t-test, respectively. Results A total of 195 patients were enrolled, 103 and 92 in the intervention and control arm, respectively. No patient experienced QTc intervals > 500 ms on day 5 by both formulae. Patients with ΔQTc > 60 ms, for QTcF were 6/103 (5.8%) vs 2/92 (2.2%) and for QTcB 2/103 (1.9%) vs 1/92 (1.1%) in the intervention and control arms, respectively. The mean difference in ΔQTc interval was statistically significant between the two arms with both correction formulae, 11.4 ms (95% CI 2.7–20.0, p = 0.010) and 13.4 ms (95% CI 5.3–21.5, p = 0.001), for QTcB and QTcF, respectively. Conclusion The extended 6-day course of artemether-lumefantrine did not reveal clinically relevant QTc prolonging effects. However, significant QTcF prolongation and presence of patients with supra-threshold QTc values observed in the intervention arm underscore the importance of further monitoring of QTc parameters in extended artemether-lumefantrine treatment. Trial registration ClinicalTrials.gov, NCT03241901. Registered July 27, 2017. https://clinicaltrials.gov/show/NCT03241901

B. da Silva, A. P. Hage, E. O. Silva et al.

Leishmaniasis, a neglected disease caused by Leishmania protozoans, primarily affects people in tropical and subtropical areas. Chemotherapy based on the use of pentavalent antimonials, amphotericin B, paromomycin, miltefosine and liposomal amphotericin B is currently the only effective treatment. However, adverse effects, long-term treatment and the emergence of parasite resistance have led to the search for alternative treatments. Natural products used in traditional medicine provide an unlimited source of molecules for the identification of new drugs, and the Amazon region has abundant biodiversity that includes several species of plants and animals, providing a rich source of new products and compounds. Although the literature describes numerous promising compounds and extracts for combating Leishmania protozoans, the results of such research have not been embraced by the pharmaceutical industry for the development of new drugs. Therefore, this review focused on the antileishmanial activity of extracts, isolated compounds and essential oils commonly used by the local population in the Brazilian Amazonian region to treat several illnesses and described in the literature as promising compounds for combating leishmaniasis.

Hau V Doan, S. Riyajan, Roongtip Iyara et al.

BackgroundChrysophyllum cainito L., a tropical fruit tree, has been used as an alternative medicine for the treatment of diabetic patients in many countries. However, there is very limited scientific rationale for this medical use. The present study aimed to evaluate the antidiabetic activity of the extract from C. cainito stem bark and the possible mechanisms underlying this activity.MethodsPhytochemistry and in vitro antioxidant capacity of the extract were studied. Hypoglycemic activity of the extract was examined in normal and alloxan-induced diabetic mice. The effect of C. cainito extract on glucose absorption and glucose uptake were conducted using mouse isolated jejunum and abdominal muscle, respectively. Finally, an in vitro effect of C. cainito extract on α-glucosidase activity was evaluated.ResultsC. cainito extract possessed a strong antioxidant activity comparable to the ascorbic acid and butylated hydroxytoluene. The extract at 500 mg/kg significantly reduced the area under curve of blood glucose level in oral glucose tolerance test in normal mice. In alloxan-induced diabetic model, similar to glibenclamide, a single dose of the extract significantly decreased fasting blood glucose level from 387.17 ± 29.84 mg/dl to 125.67 ± 62.09 mg/dl after 6 h of administration. From the isolated jejunum experiment, the extract at any doses used did not inhibit glucose absorption. However, the extract at 50 μg/ml significantly increased the amount of glucose uptake by abdominal muscles in the presence of insulin (P < 0.05). Lastly, it was found that the extract produced stronger inhibition of α-glucosidase activity (IC50 = 1.20 ± 0.09 μg/ml) than acarbose (IC50 = 198.17 ± 4.74 μg/ml).ConclusionDirect evidence of antidiabetic activity of C. cainito stem bark with possible modes of action, glucose uptake stimulation and α-glucosidase inhibitory effect, was reported for the first time herein. These data support the potential use of this plant for the treatment of diabetic patients.

A. Heywood, R. López-Vélez

BACKGROUND migration has reached unprecedented levels, with 3.6% of the world's population living outside their country of birth. Migrants comprise a substantial proportion of high-income country populations, are at increased risk of a range of infectious diseases, compared to native-born populations and may experience worse health outcomes due to barriers accessing timely diagnoses and treatment. Poor access to essential healthcare services can be attributed to several factors, including language and cultural barriers and lack of specific inclusive health policies. METHODS This review draws on evidence from the immigrant health and travel medicine literature, with a focus on infectious disease risks. It presents strategies to reduce barriers to healthcare access through health promotion and screening programs both at the community and clinic level and the delivery of linguistically and culturally competent care. The Methods: Salud Entre Culturas (SEC) 'Health Between Cultures' project from the Tropical Medicine Unit at the Hospital Ramon y Cajal in Madrid is described as an effective model of care. RESULTS For those providing healthcare to migrant populations, the use of community-consulted approaches are considered best practice in the development of health education, health promotion and the delivery of targeted health services. At the clinic-level, strategies optimizing care for migrants include the use of bilingual healthcare professionals or community-based healthcare workers, cultural competence training of all clinic staff, the appropriate use of trained interpreters and the use of culturally appropriate health promotion materials. CONCLUSIONS Multifaceted strategies are needed to improve access, community knowledge, community engagement and healthcare provider training to provide appropriate care to migrant populations to reduce infectious disease disparities.

F. Gobbi, E. Bottieau, O. Bouchaud et al.

Background Loa loa infection is endemic in limited areas of West-Central Africa. Loiasis has been associated with excess mortality, but clinical studies on its treatment are scant, particularly outside endemic areas, due to the rarity of cases diagnosed. Methodology/Principal findings With this retrospective TropNet (European Network for Tropical Medicine and Travel Health) study, we aimed at outlining the treatment schedules followed by different reference centers for tropical medicine across Europe. We gathered information about 238 cases of loiasis, 165 of which had follow up data. The regimens followed by the different centers were heterogeneous. The drugs most frequently administered were: diethylcarbamazine alone (74/165, 45.1%), ivermectin alone (41/165, 25%), albendazole + ivermectin (21/164, 11.6%), ivermectin + diethylcarbamazine (16/165, 9.7%). Conclusions/Significance The management of loiasis substantially differs across specialized travel clinics in Europe. These discrepancies could be due to different local protocols as well as to (un)availability of the drugs. An harmonization of clinical protocols for the treatment of loiasis would be suggested across reference centers for tropical medicine in Europe.

J. I. Randriamboavonjy, M. Rio, P. Pacaud et al.

Moringa oleifera (MOI) is a tree currently used in traditional medicine in tropical Africa, America, and Asia for therapeutic applications in several disorders including arterial hypertension. We previously described a cardiac protective role of a treatment with MOI seeds in spontaneously hypertensive rats (SHR). Here, we investigated the effects of this treatment on oxidative and nitrosative vascular stresses in SHR, with normotensive Wistar Kyoto rats used as controls. Oxidative and nitrosative stresses detected in SHR aortas using the fluorescent dye dihydroethidine and protein nitrotyrosine staining were reduced in MOI-treated SHR aortas. This was associated with a decrease of free 8-isoprostane circulating level, vascular p22phox and p47phox expressions, and SOD2 upregulation. Moreover, circulating nitrites and C-reactive protein, increased in SHR, were both reduced in SHR receiving MOI. This was associated to decrease iNOS and NF-κB protein expressions after MOI treatment. In functional studies, the endothelium-dependent carbachol-induced relaxation was improved in MOI-treated SHR resistance arteries. Oral administration of MOI seeds demonstrates vascular antioxidant, anti-inflammatory, and endothelial protective effects in SHR. Our data support the use of MOI seeds in diet against cardiovascular disorders associated with oxidative stress and inflammation such as hypertension, scientifically validating the use of these seeds in Malagasy traditional medicine.

N. Biritwum, D. D. de Souza, Benjamin Marfo et al.

1 National Neglected Tropical Diseases Programme, Ghana Health Service, Accra, Ghana, 2 Parasitology Department, Noguchi Memorial Institute for Medical Research, University of Ghana, Legon, Accra, Ghana, 3 FHI360, Ghana Office, Accra, Ghana, 4 Liverpool School of Tropical Medicine, Liverpool, United Kingdom, 5 European and Developing Countries Clinical Trials Partnership (EDCTP), Africa Office, Cape Town, South Africa, 6 University of Health and Allied Sciences, Ho, Ghana

Semvua B. Kilonzo, Daniel W. Gunda, Bonaventura C. T. Mpondo et al.

Hepatitis B is one of the most common infectious diseases in the world with high prevalence in most of sub-Saharan Africa countries. The complexity in its diagnosis and treatment poses a significant management challenge in the resource-limited settings including Tanzania, where most of the tests and drugs are either unavailable or unaffordable. This mini review aims at demonstrating the current status of the disease in the country and discussing the concomitant challenges in diagnosis, treatment, and prevention.

Yan Hu, Melanie Miller, Bo Zhang et al.

The soil-transmitted nematodes (STNs) or helminths (hookworms, whipworms, large roundworms) infect the intestines of ~1.5 billion of the poorest peoples and are leading causes of morbidity worldwide. Only one class of anthelmintic or anti-nematode drugs, the benzimidazoles, is currently used in mass drug administrations, which is a dangerous situation. New anti-nematode drugs are urgently needed. Bacillus thuringiensis crystal protein Cry5B is a powerful, promising new candidate. Drug combinations, when properly made, are ideal for treating infectious diseases. Although there are some clinical trials using drug combinations against STNs, little quantitative and systemic work has been performed to define the characteristics of these combinations in vivo.Working with the hookworm Ancylostoma ceylanicum-hamster infection system, we establish a laboratory paradigm for studying anti-nematode combinations in vivo using Cry5B and the nicotinic acetylcholine receptor (nAChR) agonists tribendimidine and pyrantel pamoate. We demonstrate that Cry5B strongly synergizes in vivo with both tribendimidine and pyrantel at specific dose ratios against hookworm infections. For example, whereas 1 mg/kg Cry5B and 1 mg/kg tribendimidine individually resulted in only a 0%-6% reduction in hookworm burdens, the combination of the two resulted in a 41% reduction (P = 0.020). Furthermore, when mixed at synergistic ratios, these combinations eradicate hookworm infections at doses where the individual doses do not. Using cyathostomin nematode parasites of horses, we find based on inhibitory concentration 50% values that a strongylid parasite population doubly resistant to nAChR agonists and benzimidazoles is more susceptible or "hypersusceptible" to Cry5B than a cyathostomin population not resistant to nAChR agonists, consistent with previous Caenhorhabditis elegans results.Our study provides a powerful means by which anthelmintic combination therapies can be examined in vivo in the laboratory. In addition, we demonstrate that Cry5B and nAChR agonists have excellent combinatorial properties-Cry5B combined with nAChR agonists gives rise to potent cures that are predicted to be recalcitrant to the development of parasite resistance. These drug combinations highlight bright spots in new anthelmintic development for human and veterinary animal intestinal nematode infections.